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Long-Term Disability Benefits Archives

Who's That Guy Behind My Shrubs?

If you're receiving long-term disability benefits but still engaging in physical activities, you should expect to be placed under electronic surveillance at some point by your disability insurance carrier. Your carrier may then use the video footage as a basis to terminate your disability benefits. If an administrative appeal of the benefit termination is not successful and suit is brought under the Employee Retirement Income Security Act of 1974 (ERISA), the surveillance video is a piece of evidence the judge would look at to determine benefit eligibility under the policy.

Ninth Circuit Finds MetLife Abused its Discretion in Terminating Long-Term Disability Benefits

Last week, long-term disability benefits claimant "Kelly" won her case after a trial against MetLife. Kelly's claim was supported by her physician, Dr. Michael Flaningam, who diagnosed Kelly as having fibromyalgia, with a secondary diagnosis of fatigue.

How are attorney fees and expenses paid in a long-term disability benefit claim?

Long-term disability ("LTD") claimants who are forced to bring suit against their insurer after negotiations fail are understandably concerned about the attorney fees and expenses they would incur. The good news is that a claimant's attorney fees and expenses are paid by the in-surance company if and when the claimant prevails. In determining whether to award attorney fees under the Employee Retirement Income Security Act of 1974 (ERISA), a court considers the following:

MetLife Denied Claimant Full and Fair Review

In another victory for a disabled individual today, the Seventh Circuit Court of Appeals vacated a lower court's decision. In this case, the claimant, "Kirsten", sued MetLife in federal court, challenging the denial of her disability benefits under the Employee Retirement Income security Act of 1974 (ERISA). The Appeals Court refused to "rubber-stamp" MetLife's denial of Kristen's long term disability benefits. The Court found it troubling that Dr. Marion's report-the sole basis for MetLife's determination-concluded, erroneously, that Kirsten did not submit objective evidence of functional limitations.

Insurer's Recovery From Claimant of Benefit Overpayments May be Barred

Most long-term disability benefit policies provide that the insurance carrier may recover overpayments made to the claimant for disability benefits. Overpayments occur most frequently when the claimant receives SSDI back benefits that cover the time period during which the LTD carrier paid long-term disability benefits in full rather than reducing for the SSDI amount. As a result, the LTD carrier may seek to recover an offset for the amount of SSDI benefits.

XMRV Virus linked to Chronic Fatigue Syndrome May Help LTD Benefit Recovery

Our clients suffering from chronic fatigue syndrome and/or fibromyalgia will be interested to know that retro-virology researchers have found a virus that might be at the root of chronic fatigue syndrome. More than a million Americans suffer from the disease, which can leave them exhausted even after a good night's sleep, cause debilitating pain in muscles and joints, and make concentrating difficult. On NPR today, Dr. Daniel Peterson, one of the first to recognize chronic fatigue syndrome, explained the connection between CFS and the XMRV Virus. His interview is at the following link: http://www.npr.org/templates/player/mediaPlayer.html?action=1&t=1&islist=false&id=113650222&m=113650172

Cigna's Structural Conflict Will Now Be Scrutinized

An appeals court held this month that even though Cigna's plan administrator had discre-tion to decide questions of eligibility for long-term disability benefits, remand was appropriate to allow the district court to determine how heavily the administrator's structural conflict weighed in the abuse-of-discretion balance.In this case the claimant, "Edward," suffers from a number of degenerative conditions in his right foot, and especially in his great right toe. In 2003 he stopped working because of the severe pain that these conditions cause. Edward initially received long-term disability benefits under his employer's group benefit plan, which is insured by Cigna Life Insurance Company of New York. However, two years later Cigna determined that he no longer qualified for benefits because he could not meet the plan's requirement of showing that his disability prevented him from performing any job. Edward brought suit under the Employee Retirement Income security Act of 1974 ("ERISA"). The district court concluded that Cigna did not abuse its discretion in discontinuing Edward's benefits and granted Cigna summary judgment. The Court of Appeals however applied the Supreme Court's recent pronouncement in Metropolitan Life Insurance Company v. Glenn, advising courts to take cognizance of structural conflicts in ERISA cases.

District Court Shares The "Love" With Our Disabled Client

Our client, "Jim" received good news yesterday when the Court ordered Unum to fix its decision that had denied his long-term disability benefits. Our firm sued Unum when it refused to pay Jim's long term disability benefits under the policy it issued to Jim's employer, Trek Bicycle Corporation.

Liberty Mutual unlawfully failed to consider and discuss evidence of claimant's long-term disability

Last week the Court of Appeals found that Liberty Mutual failed to consider and discuss evidence of the claimant's ("Nancy") evidence of her long-term disability. Nancy worked for one employer for more than twenty years in a variety of positions including bank teller, teller supervisor, and technical-support analyst, before leaving due to health problems. After her physician diagnosed her with multiple sclerosis, Nancy applied for and received disability benefits through her employer's group Plan ("the Plan"). Three years after Nancy began receiving disability benefits, the Plan administrator terminated her benefits, stating that she no longer fit the Plan's definition of "disabled."

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