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For those of us handling long term disability claims for people suffering from chronic back conditions, a clause in the MetLife LTD policies has caused us much tsuris (Yiddish word, “worry”). Their policies contain a limitation for “neuromuscular disorders” providing coverage for only two years for disorders of the spine unless one of six exceptions…

Reliance Standards’ unreasonable and bad faith claims handling , was carefully scrutinized by Judge Reeves, sitting in the Southern District of Mississippi. Reliance and its competitors in the industry, as the Judge notes, “have conflicting missions of deciding who qualifies for benefits and ensuring those decisions do not undermine their own bottom line.” Nichols v.…

Our clients often ask how to retain employee benefits while on disability leave. A source of this information should be an employee handbook or summary of benefits available from the employer. Often all benefits such as medical coverage or life insurance continues while the employee is on short term disability. Then if the employee does…

We often suggest to our clients that they carefully limit their exposure on social media. It is simple for insurance companies to track a claimant’s whereabouts if they are regularly posting on Facebook, and not making it private, uploading pictures on Instagram, or other people are tagging them in photos or discussing their whereabouts. An…

We have been following the Courts’ treatment of mental or nervous disorders limitations in group long term disability policies. (See blog, Disability Caused by Physical Impairment, July 2015) Recently, the 6th Circuit Court of Appeals joined other courts holding that a claimant is disabled by physical conditions alone, then the mere presence of a psychiatric…

Disability insurers love to deny claims based on their medical consultant’s conclusion that the claimant has “sedentary capacity.” The insurer’s vocational counselor swiftly identifies various jobs that the claimant can allegedly perform without performing a full or fair investigation of the transferable skills. Does the inquiry end at the point it is established that the…

Insurance coverage is based on the provisions of the contract and the proofs submitted by the claimant. In medical claims, a full and fair investigation of the facts concerning the particular claim requires the insurer to consult with medical professionals who are supposed to independently apply their expertise to the case facts and determine if…

Multiple sclerosis is a serious and unpredictable medical condition which effects the central nervous system (brain and spinal cord). Most people are diagnosed between the ages of 20 and 50. Worldwide, more than 2.3 million people are affected by MS and every week approximately 200 people are diagnosed. Over 400,000 Americans live with MS. The…

Rochow v. LINA 2013 FED APP. 0338P(6th Cir 2013). In a groundbreaking decision, the 6th Circuit awarded the Rochow’s estate both disability benefits due plus equitable relief under 502(a)(3). Rochow had been due the benefits since 2002, but had been tied up in legal battles with LINA (a subsidiary of CIGNA) ever since. The disability…

The Supreme Court of the United States recently granted certification in the matter of Heimeshoff v. Hartford Life & Accident Ins. Co., 496 Fed. Appx. 129 (2d. Cir. 2012), in which the Second Circuit determined that Heimeshoff, who had been denied disability benefits in 2005, had no remedy against Hartford because she was in violation…