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

Carolyn Kinser, an employee of Associates First Capital Corporation filed a lawsuit against Met Life for wrongful denial of disability benefits. Ms. Kinser was disabled from her occupation due to bipolar disorder and major depressive order. Ms. Kinser had been under continued care and treatment with the same psychiatrist for more than ten years.

Met Life hired an allegedly independent doctor to review Ms. Kinser’s medical records. After review of Ms. Kinser’s records, the independent doctor advised Met Life that Ms. Kinser’s medical condition was not supported by objective evidence and there was “no documented functional impairment that would preclude plaintiff’s ability to return to work”.

The Federal Judge held that “Met Life was wrong to essentially ignore Dr. Patel’s (Ms. Kinser’s psychiatrist) clearly stated and supported opinion that plaintiff was unable to work in any type of position.” The judge also stated “psychiatric conditions are not easily identifiable by objective measures.” The court also noted that Met Life’s doctor neither examined Ms. Kinser nor spoke with her treating psychiatrist.

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Daniel J. Rochow, the former president of Arthur J. Gallagher & Co., was insured under Life Insurance Co. of North America’s disability plan. The Sixth Circuit affirmed that a disability insurer’s denial of benefits to a former employee who was terminated because his symptoms prevented him from performing his duties was arbitrary and capricious, even though the employee’s diagnosis was not made until after he stopped working.

Daniel Rochow began to experience short term memory loss and was demoted from President to a sales executive. Rochow was diagnosed with a rare form of herpes which causes brain trauma. Rochow sought long-term disability benefits through Gallagher’s Group Insurance Plan, which was administered by Life Insurance Company of North America (LINA). LINA contended that Rochow’s inability to function did not occur until his hospitalization after he stopped working. 

Rochow challenged LINA’s denial of benefits under the Employee Retirement Income Security Act and the District court ruled that LINA’s denial was arbitrary and capricious. The Sixth Circuit affirmed, concluding that Rochow presented sufficient evidence to establish that he was disabled before he stopped working within the meaning of the plan.

Daniel J. Rochow v. Life Insurance Co. of North America, No. 05-2100, 6^th Cir.; 2007 U.S. App. LEXIS 7599.

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Pamela A. Ray, an attorney, was insured under a UNUM disability policy. A Denver trial court ruled recently ruled in her favor that working in a large office building was a material duty of a disability claimant’s occupation as an attorney specializing in major real estate, oil and gas and mining transactions. The court determined that UNUM Life insurance Company of America’s denial of benefits was arbitrary and capricious.

On appeal the 10^th Circuit reversed and remanded with instructions for the District Court to apply the de novo standard of review and to consider new evidence. In affirming the Circuit court ruled that the District court did not err in finding that working in a large office building environment was material duty of the plaintiff’s occupation. The majority noted that working from home was not an effective alternative and that her practice was not easily transferable to another firm. Even if the plaintiff could find equivalent work it would most likely be located in a large office building environment, therefore she is totally disabled.

Pamela A. Ray v. UNUM Life Insurance Company of America, Nos. 05-1284, 05-1420, 10^th Cir,; 2007 U.S. App. LEXIS 7234)

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Carol Shepherd, a fork-lift operator for Daramic, was insured under the company’s group disability plan with Reliance Standard Life Insurance Company. In 2004, Ms. Shepherd had an anxiety attack at work and Daramic suspended her and required that she participate in anger management before returning to work. During her suspension, Ms. Shepherd was receiving treatment at Owensboro Medical Health System Outpatient Counseling Center where she was diagnosed with major depression and anxiety disorder.

Prior to her suspension, Ms. Shepherd worked the swing shift but when it was time to return to work she requested the day shift because her treating physician believed the sleep disturbances would aggravate her psychological conditions. When Daramic refused to give Ms. Shepherd the day shift her doctor said she could not return to work and Ms. Shepherd applied for long-term disability benefits.

Reliance denied Ms. Shepherd’s claim stating that she is not totally disabled and had their own reviewing psychiatrist evaluate her medical records. Reliance upheld its denial of benefits on appeal and Ms. Shepherd sued, seeking benefits under the Employee Retirement Income Security Act (ERISA).

After reviewing the case, U.S. Judge Joseph H. McKinley Jr. of the Western District of Kentucky found that Reliance’s decision to deny benefits was reasonably supported by Ms. Shepherd’s medical record. The judge rejected Ms. Shepherd’s claim that Reliance failed to conduct a personal psychological evaluation since the company’s psychiatrist “thoroughly reviewed Ms. Shepherd’s medical record and relied on the evidence therein to form his opinion.” Judge McKinley found that there was no competent medical proof in the record to support a disability claim.

Carol Shepherd v. Reliance Standard Life Insurance Co., No. 4:06CV-83, W.D. Ky.; 2007 U.S. Dist.

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Jenny Eberle, an employee of Purdue University, was initially approved for long-term disability benefits by the Prudential Insurance Company of America. Shortly after her claim was approved, a new claims examiner and registered nurse reviewed Ms. Eberle’s medical records and decided to terminate her long term benefits in November 2004.

In May 2005, Ms. Eberle sued Prudential alleging breach of contract and breach of the covenant of good faith and fair dealing. Prudential filed a summary judgment motion claiming Ms. Eberle failed to provide objective proof of her disability. Ms. Eberle had four treating physicians that stated she was disabled and could not work. Prudential hired two Registered Nurses and one doctor, which opined that Ms. Eberle’s disease did not prevent her from performing her pre-disability occupational duties. Judge Rudy Lorenzo found that Ms. Eberle satisfied her burden under the policy of providing Prudential with objective medical evidence of her disability but there was a discrepancy as to whether Ms. Eberle’s diabetic complications render her totally disabled from her occupation. The policy defined total disability as ‘unable to perform all of the material and substantial duties of his or her occupation on an Active Employment basis because of an Injury or Sickness”. Judge Lorenzo found that a “genuine issue of material fact as to whether Ms. Eberle was ‘disabled’ as defined by the policy.” Prudential’s motion for summery judgment was denied.

Jenny Eberle v. The Prudential Ins. Co. of America, No. 4:05-cv-0030, N.D. Ind., Lafayette Div.; 2007 U.S. Dist.

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Insured Denied Benefits by Unum Due to Failure to Receive “Appropriate Care”

Larry Mack claimed that he is totally disabled from his occupation as a marriage and family therapist due to diabetes. He sued his disability insurer, Unum Life Insurance Company, after being denied his claim for long-term disability benefits. Unum argued that Mr. Mack is not entitled to long-term benefits because he did not receive “appropriate care” as required by his policy. Mr. Mack admitted to not seeking help from his internal medicine doctor for long periods of time but argued that during these months he was “self-treating” his diabetes by taking Glucophage daily and by monitoring his diet.

The court said such “self-treatment” does not meet the policy requirement that the claimant be under medical treatment in order to receive benefits. The court reasoned that Mr. Mack failed to abide by the standard of care his internal medicine doctor prescribed for diabetic patients, U.S. Judge Linnea R. Johnson granted partial summary judgment to Unum.

Larry B. Mack v. Unum Life Insurance Company of America, No. 06-80308, S.D. Fla.; 2007 U.S. Dist.

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