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A client of ours filed a lawsuit against Connecticut General Life Insurance Company, the subsidiary arm of CIGNA Group Insurance which provides group life insurance coverage, claiming that her life insurance coverage was improperly terminated. Her claim was governed by the Employee Retirement Income Security Act of 1974 (“ERISA”).
Ms. C. was a former employee of Martin Marietta (now Lockheed Martin) and was a participant in Lockheed Martin Long Term Disability Plan (LTD Plan and the Lockheed Martin Group Universal Life Plan (Life Plan). Ms. C. has been disabled since 1993 and has continuously received LTD benefits since that time. As is true with most group life insurance plans and policies, Ms. C. enjoyed the benefit of a “waiver of premium” (LWOP) provision which provides for continued life insurance coverage if the participant is disabled. Connecticut General, as the insurer of the Lockheed Martin Life Insurance Plan, found Ms. C. to be disabled as that term is defined under the waiver of premium provision and continued her life insurance coverage until that coverage was unceremoniously terminated on June 9, 2009. Ironically, the LTD benefits provided by Life Insurance Company of North America (LINA), also a subsidiary company of CIGNA, continued to be paid in an uninterrupted fashion.
With the assistance of the disability and life insurance attorneys at the Law Office of Shawn E. McDermott, LLC, Ms. C. filed suit on March 30, 2010. Because the issue seemed so clear-cut that the denial of coverage under the waiver of premium provision was wrongful, it was decided not to pursue any discovery and to proceed as quickly as possible to judgment. The disability attorneys for Ms. C. provided CIGNA with the opportunity to simply reinstate coverage under the life insurance plan and, if so, the lawsuit would be dismissed. In our opinion, this would have been a reasonable approach to the dispute since, (more…)
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Our office was recently successful in obtaining Colorado PERA* disability retirement benefits on behalf of a former teacher suffering with Marfan’s syndrome and several other medical conditions. Standard Insurance agreed our client could no longer perform her job as a teacher, and that she was fully disabled for a brief four-month period of time, during which PERA short term disability (STD) benefits were payable. However, it contended she then recovered the ability to perform other jobs, and therefore, terminated her PERA STD benefits.
This claim is one of many this office has handled that has arisen during the transition from Standard Insurance Company to Unum Life Insurance Company of America. Let me provide a quick background. (more…)
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Our office was recently successful in an ERISA disability appeal submitted to Life Insurance Company of North America (“LINA”) on behalf of a gentleman suffering with chemotherapy-related cognitive impairment, commonly referred to as “chemobrain.” In this disability claim, our client (a former high-level executive) was diagnosed with cancer; as part of his treatment, chemotherapy was administered. While the treatment was successful with respect to combating his cancer, it resulted in damage to certain cells in the brain, which ultimately resulted in decreased cognitive functioning. (more…)
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A client of ours filed a lawsuit against Connecticut General, the subsidiary arm of CIGNA Group Insurance, which provides group life insurance coverage, claiming that her life insurance coverage was improperly terminated under the Employee Retirement Income Security Act of 1974 (“ERISA”). Ms. C. was a former employee of Martin Marrietta (now Lockheed Martin) and was a participant in Lockheed’s long term disability (LTD) and life insurance employee benefit plans. Ms. C. has been disabled since 1993 and has continuously received LTD benefits since that time. As is true with most group life insurance plans and policies covering employees, Ms. C. enjoyed the benefit of a “waiver of premium” (LWOP) provision which provides for continued life insurance coverage if she is disabled. Connecticut General, as the insurer of the Lockheed Martin Life Insurance Plan, found Ms. C. to be disabled as that term is defined under the life waiver of premium provision and continued her life insurance coverage until that coverage was unceremoniously terminated on June 9, 2009, 16 years later. (more…)
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If you have income replacement protection if you become disabled due to a sickness or injury or illness, such coverage is most likely available to you through a group disability policy purchased by your employer. For the most part, these policies and claims thereunder are governed by the federal statute known as the Employees Retirement Income Security Act (“ERISA”). Most state and federal employees as well as employees of church groups are not covered by the federal ERISA laws.
If you have purchased a policy directly from an insurance company or insurance agent, then you have an individual as opposed to a group policy. Your individual policy will not be governed by ERISA, and instead be guided by the statutes and case law of your particular state. The state laws can differ. In Colorado, for example, a “bad faith” denial of your claim can lead to the recovery of extra-contractual damages. Some states do not have these bad faith laws. Colorado also has a powerful statute which provides for a recovery of double the contract benefits and attorneys’ fees if the claim is “unreasonably delayed or denied.”
What to do if your claim is denied?
The answer to this question depends greatly on whether you have an individual or group policy. If an individual policy, (more…)
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We recently received a favorable decision from Hartford overturning a termination of our client’s (let’s call her Ms. B) ERISA long-term disability benefits. Ms. B left her former job as a retail sales manager due to her lower back condition. She had previously undergone lumbar fusion, and had been diagnosed with chronic pain syndrome, lumbar degenerative disc disease, sacroiliitis, lumbosacral spondylosis and lumbar radiculopathy. Due to her constant pain, she was prescribed several narcotic medications (including morphine and valium) which affected her cognition and mood. These conditions and medications rendered her unable to work.
Hartford originally agreed Ms. B was unable to perform her prior occupation, and paid her benefits for two years. (more…)
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We were recently successful in having partial disability benefits reinstated for a client insured by the Hartford. Ms. S was diagnosed with Parkinson’s disease. She enjoyed her job and wanted to continue her work. However, her disease left her incredibly fatigued and unable to perform her occupation on a full-time basis. Her insurance policy contained a residual disability (or partial disability) provision, under which she was considered disabled if she could not perform her regularly scheduled work hours. Hartford denied the claim, based on the report of a reviewing physician who concluded she could perform sedentary work. The reviewing physician missed the mark all together—he failed to even discuss her fatigue and what effect that could have on her ability to work full-time.
Ms. S contacted the Law Office of Shawn McDermott to request our assistance in preparing her ERISA long term disability appeal. Attorney Heather Petitmermet prepared and submitted a thorough appeal to Hartford on her behalf. Under ERISA regulations, claims administrators are required to (more…)
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A client of ours will finally receive the long term disability and life insurance benefits she has been pursuing for four years! We recently received a favorable decision on her case from Judge Brooke Jackson, the newest member of the bench for the United States District Court for the District of Colorado. This claim was governed by the Employee Retirement Income Security Act (“ERISA”), and involved the denial of long term disability benefits and a life insurance benefit claim by Sun Life and Health Insurance Company. This case took more than four years to wind its way through the ERISA internal appeal and litigation process, but our client was ultimately successful. She has been awarded long term disability benefits, survivor benefits under the LTD policy and the full amount of the life insurance claim due to the death of her husband.
The court’s Order (and now Final Judgment) can be found at:
Bray v. Sun Life & Health Ins. Co., 2012 U.S. Dist. LEXIS 24131 (D. Colo. 2012)
Our client’s husband was a high-level travel executive. In 2005, his work performance began to suffer (as confirmed by numerous clients, co-workers, and others). He also started exhibiting odd behavior in his personal life. His physician incorrectly diagnosed these issues as depression. Shortly thereafter, he was terminated from his job, because his small (3 person) division was not as successful as it had been in the past and was no longer “a good fit” for the company. About six months later, he learned he had a massive brain tumor, which (more…)
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I previously blogged about the 10th Circuit’s decision in Murphy v. DeLoite & Touche and the permissible scope of discovery in claims governed by the Employee Retirement Income Security Act (“ERISA”). (Click here for prior post.) Although many of our local judges in the federal court in Colorado previously allowed at least some discovery sought on behalf of our clients, the gate has clearly been pushed further open. More recently, this office received favorable orders in Erickson v. Lincoln National and Bottoms v. Liberty Life. The decision issued by Magistrate Judge Shaffer in the Bottoms case has been published by Westlaw at 2011WL6181423.
In this case, Liberty Life argued that Plaintiff was not entitled to conduct discovery. Plaintiff’s discovery request sought information concerning the insurance company’s conflict of interest in rendering ERISA claim decisions, (more…)
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Every employer-provided long term disability policy I have reviewed in the past ten years contains some sort of limitation on conditions for which disability benefits can be granted or the duration of those benefits. The most common type of limitation seen in a long term disability policy relates to “mental disorders,” “substance abuse,” and a general provision typically referred to as “other limiting conditions.” The payment of LTD benefits is often limited to 24 months for the lifetime of a claimant’s disability if it is caused or contributed to by any of these conditions.
Over the years, the “other limiting conditions” provisions we have seen have grown ever more inclusive. We suspect that employers buying these group policies from the various insurers are quite unaware of the nature of these limiting provisions and the reality that many types of disabling illnesses are not actually covered or are seriously limited. A particularly onerous provision recently found in a policy issued by Standard Insurance includes (more…)
