ERISA Disability and Life Insurance Litigation

Ben Glass argues after Aetna Cuts Off Benefits After Seven Years

This is a case that Ben Glass argued in the 4th Circuit Court of Appeals in November. It involved a former Cox Enterprises employee who's benefits were terminated by Aetna, the plan administrator, after seven years of payments. Ben argued that Aetna violated ERISA claim regulations in several ways, including ignoring the social security determination that the claimant remained disabled.  Ever wondered why insurance companies can suddenly terminate benefits after years without warning? Here we argued that Aetna failed to engage in meaningful dialogue with Smith. Discover how these missteps can affect unrepresented individuals and the critical role of clear communication and adherence to regulatory standards in protecting their rights. Join us as we dissect the complexities of remanding long-term disability cases and the intricacies involved in evaluating chronic pain patients' work capacity. With cases like Harrison and Gagliano, we highlight the contentious issue of paper reviewers challenging in-person medical opinions and the importance of a thorough review of all medical evidence. The discussion sheds light on the standards insurance companies must meet and emphasizes the need for fair and unbiased determination of work capacity and benefits entitlement. We also delve into the distinct differences between Social Security and ERISA evaluations, exploring how these systems impact claimants' ability to perform gainful activity. With a focus on fiduciary responsibilities, this episode underscores the importance of objective evidence and the need for insurers to remain unbiased and curious throughout their decision-making processes. We aim to equip you with invaluable insights into the legal landscapes of disability claims, ensuring that individuals like Jeremy Smith receive the fair treatment they deserve. These public domain recordings are brought to you by Ben Glass Law [https://benglasslaw.com/], a national long term disability and life insurance firm headquartered in Fairfax, VA. By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike. If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter. [https://benglasslaw.com/free-denial-letter-review/]

How Did the Court Expose Reliance Standard’s Flaws in Terminating the Claimant’s Benefits?

In this episode, we explore a financial advisor's battle against the wrongful termination of his long-term disability benefits. He was a financial advisor at Fulton Financial Corporation, where he began working in 2009. In 2014, he started experiencing severe pain and numbness in his legs and feet, progressively losing his ability to stand, walk, and drive. By 2015, his condition had deteriorated to the point where he could no longer work. After consulting with specialists, he was diagnosed with neurogenic muscular atrophy and diabetic polyneuropathy. Following his diagnosis, the claimant filed for long-term disability benefits, which Reliance Standard initially approved, acknowledging his inability to work. However, in October 2017, despite no improvement in his condition, Reliance Standard ordered an independent medical examination (IME), which concluded that he was still capable of working. As a result, Reliance Standard terminated his benefits in December 2017. The claimant challenged this decision through the company’s internal appeals process, submitting updated medical records that confirmed his ongoing disability. Curious about the full story and its potential impact on others facing similar challenges? Listen to our podcast as we delve into the court's ruling and the broader implications for long-term disability claims. This is the oral argument in the third circuit court of appeals. These public domain recordings are brought to you by Ben Glass Law [https://benglasslaw.com/], a national long term disability and life insurance firm headquartered in Fairfax, VA. By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike. If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter. [https://benglasslaw.com/free-denial-letter-review/]

How Did Procter & Gamble Change the Claimant’s Status From Total to Partial Disability?

The episode revolves around the denial of the claimant's claim for long-term disability benefits. The claimant was an employee at Procter & Gamble for many years. His role required him to perform various duties, which he could no longer carry out due to medical issues. Specifically, in June 2012, he underwent gallbladder removal surgery for gallbladder cancer. Following his surgery, he was initially approved for total disability benefits under the company’s Disability Benefit Plan. However, in April 2013, after undergoing an Independent Medical Examination (IME) and a Functional Capacity Evaluation (FCE), it was determined that he was only partially disabled. The evaluations indicated that while the claimant could not perform the tasks required for his line operator position, he was capable of performing medium-demand-level work on a full-time basis, subject to certain limitations. Consequently, Procter & Gamble transitioned him to partial disability benefits, which ended after 52 weeks. The claimant appealed the decision on several grounds: 1. Failure to produce the correct plan documents, specifically a 2012 plan which was referenced but never provided. 2. Inconsistencies in the definition of "totally disabled" provided to treating doctors versus the plan's definition. 3. Failure to consider new evidence submitted during the appeal, including vocational assessments and additional medical records. The core of the case rests on whether the denial of benefits was handled appropriately, both procedurally and substantively. LET'S TUNE IN! This is the oral argument in the Eighth circuit court of appeals. These public domain recordings are brought to you by Ben Glass Law [https://benglasslaw.com/], a national long term disability and life insurance firm headquartered in Fairfax, VA. By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike. If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter. [https://benglasslaw.com/free-denial-letter-review/]

Can Sun Life Terminate Disability Benefits Based on One Medical Record's Opinion?

Can an insurance company really decide you're no longer disabled based on just one medical record? This episode begins with the story of Dr. Rohr, an anesthesiologist who had to stop practicing due to crippling hand and finger tremors in 2007. After a decade of receiving long-term disability benefits, a controversial 2017 reassessment by Sun Life concluded that his tremors had ceased, causing a heated debate about who must prove that the disability continues. Hear about Dr. Potts, who initially claimed the tremors were gone, and Dr. Honig, who later confirmed their persistence. We discuss how these discrepancies impacted Sun Life's decision to terminate benefits and their failure to seek further evaluations. The episode examines the internal biases within Sun Life's communications and the flawed reasoning behind their conditional offer to reconsider the decision if additional proof was provided. TUNE IN for a straightforward look at how these issues connect in the world of disability benefits. This is the oral argument in the Eighth circuit court of appeals. These public domain recordings are brought to you by Ben Glass Law [https://benglasslaw.com/], a national long term disability and life insurance firm headquartered in Fairfax, VA. By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike. If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter. [https://benglasslaw.com/free-denial-letter-review/]

What Treatments Did the Claimant Undergo to Prove Her Disability?

DISCOVER how one woman's struggle with her insurance company highlights the difficulties of getting long-term disability benefits.  Occupation: Insurance sales agent. Medical Condition: Persistent and severe pain in the neck, shoulders, upper extremities, and lower back. Despite extensive treatments like surgery, injections, medication, acupuncture, and physical therapy, the claimant's pain persisted, making it impossible for her to perform essential job tasks such as prolonged sitting and frequent typing. She filed for long-term disability benefits with Lincoln Life Assurance Company due to severe pain impacting her ability to work. However, Lincoln denied her claim, stating that the medical evidence did not support a finding of total disability and suggesting ergonomic accommodations as a solution. THE CLAIMANT APPEALED, arguing that Lincoln failed to consider substantial medical evidence and her subjective symptoms.  Join us as we break down the issues, explore the legal arguments, and discuss what this means for anyone trying to get disability benefits. This is the oral argument in the Ninth circuit court of appeals. These public domain recordings are brought to you by Ben Glass Law [https://benglasslaw.com/], a national long term disability and life insurance firm headquartered in Fairfax, VA. By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike. If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter. [https://benglasslaw.com/free-denial-letter-review/]