Disability Benefits Lawyer & Attorney : Dell & Schaefer : Disability Insurance Claims Law Blog

Donald Holman, a maintenance technician for Tyson Foods Inc., was insured under Tyson’s group disability plan with Hartford Life and Accident Insurance Co. In April, 2001, Mr. Holman began experiencing headaches and blurred vision. After a cranial MRI, Mr. Holman’s neurologist diagnosed him with a Chiari malformation. Mr. Holman’s neurologist stated he was disabled and Mr. Holman stopped working and filed a claim for long-term benefits. Hartford consulted their doctor who further confirmed Mr. Holman’s disability stating activities such as lifting, pushing, and pulling could cause further complications in Mr. Holman’s condition. Hartford initially approved Mr. Holman’s claim for benefits but later found he was not totally disabled and terminated benefits. Mr. Holman filed suit in the U.S. District Court for the Western District of Arkansas, seeking reinstatement of benefits under the Employee Retirement Income Security Act.

Judge Jimm Larry Hendren ruled that terminating benefits to a claimant suffering from a rare neurological condition was an abuse of discretion. Judge Hendren said Hartford had objective medical evidence of Mr. Holman’s condition and disregarded the opinion of his treating physicians. “Hartford’s failure was based on an almost total failure to investigate Holman’s claims” stated Judge Hendren and found Mr. Holman entitled to long-term disability benefits.

Donald Holman v. Hartford Life and Accident Insurance Co., No. 04-5305, W.D. Ark.; 2006 U.S. Dist.

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James Linnen, a powerhouse operator for Goodyear, Tire and Rubber Company, was insured under his company’s group disability plan issued by Continental Casualty Company. Mr. Linnen began collecting long-term disability benefits for narcolepsy and cataplexy in 2001. In 2004, Hartford Life and Accident Insurance Company purchased Continental and reviewed Mr. Linnen’s disability status. After the treating physician admitted Mr. Linnen was capable of sedentary work, Hartford terminated Mr. Linnen’s benefits in April 2005. Hartford found alternate occupations Mr. Linnen could perform such as cage boss and order parts clerk. Hartford upheld its decision in appeal and Mr. Linnen sued, seeking benefits under the Employee Retirement Income Security Act. (ERISA)

Judge David S. Dowd Jr. of the Northern District of Ohio reviewed Hartford’s decision to terminate benefits and ruled that Hartford used the wrong standard in assessing if Mr. Linnen was entitled to long-term benefits. The policy states the claimant must be unable to “engage in any substantially gainful occupation for which you are, or may reasonably become, qualified by your education, training or experience”. Judge Dowd ruled the term “substantially” alters the definition and Hartford should have assessed whether Mr. Linnen was able to obtain “substantial gainful employment” before terminating benefits. However, if employment is available that pays nearly the same wages and benefits, benefits could possibly be terminated.

James Linnen v. Hartford Life and Accident Insurance Co., No. 05:06CV0141, N.D. Ohio; 2006 U.S. Dist.

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