ERISA Disability and Life Insurance Litigation

Hosted by Ben Glass

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Nov 2024

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About the show

Oral arguments from various courts of appeal across the federal circuits involving long term disability or life insurance claims governed by ERISA. The podcast is a production of Ben Glass Law, a national long term disability and life insurance law firm headquartered in Fairfax, VA. If you have been denied life insurance or long term disability benefits, we will review your insurance claim denial letter for free.

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46 recent

November 6, 202442 min

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, 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.

August 22, 2024Episode 451 hr 5 min

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, 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.

August 8, 2024Episode 4430 min

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:Failure to produce the correct plan documents, specifically a 2012 plan which was referenced but never provided.Inconsistencies in the definition of "totally disabled" provided to treating doctors versus the plan's definition.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, 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.

August 1, 2024Episode 4332 min

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, 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.

July 25, 2024Episode 4236 min

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, 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.

July 18, 2024Episode 4122 min

Can Insurance Companies Ignore Treating Physicians' Opinions?

LISTEN TO THIS EPISODE to find out how a founder and innovator fought against his insurance company for his long-term disability claim. The primary issue was whether Aetna's denial was random and unfair, particularly when their own hired consultants acknowledged Daniel's severe limitations. The CLAIMANT suffered from neuromyelitis optica (NMO), a severe neurological condition also known as Devic's Disease. Despite extensive treatments, including chemotherapy and various medications, his condition progressively worsened, leading to significant impairments that he claimed prevented him from working.He applied for a long-term disability claim, but Aetna denied his application on the basis that the medical evidence did not support a finding of total disability as defined by their policy. This decision was made despite the opinions of the claimant's treating physicians, who provided consistent evidence of his inability to work. The claimant's team filed an appeal against Aetna, arguing that the insurance company ignored substantial medical evidence and failed to consider his subjective symptoms, which were well-documented by multiple physicians. JOIN US as we unravel the complexities of this case and discuss the broader implications for those seeking disability benefits. This is the oral argument in the 2nd circuit court of appeals.These public domain recordings are brought to you by Ben Glass Law, 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.

July 11, 2024Episode 4029 min

What Could Have Been Done Differently to Protect the Claimant's Rights to Disability Benefits?

IN THIS EPISODE, we take a closer look at the story of a former employee at a dental supply company who suffered a traumatic brain injury from a fall down a flight of stairs. Despite thorough treatment, she continued to suffer symptoms that ended her career.The claimant applied for long-term disability benefits but was denied on October 17, 2019. However, she didn't give up and appealed the decision, but unfortunately, her appeal was also turned down on August 31, 2020.Subsequently, she took her case to court, arguing that the insurance company wrongly refused her benefits. Claiming that Sun Life Assurance wrongly denied her benefits from her job's benefit plan, she took legal action under the Employee Retirement Income Security Act (ERISA) in December 2020. Her case exemplifies how complicated and tough it can be to deal with insurance companies.JOIN US as we break down her case, explore why her claims were denied, and discuss what this means for others trying to get disability benefits. Hear about her journey and the challenges she faced in getting the support she needed.This is the oral argument in the 2nd circuit court of appeals.These public domain recordings are brought to you by Ben Glass Law, 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.

July 4, 2024Episode 3932 min

What Specific Requirement Did Hartford Fail to Meet in The Claimant's Disability Claim?

THE CLAIMANT was a former employee at Wright Medical Technology. He was suffering from the side effects of prostate cancer treatment when he applied for long-term disability benefits. But, his insurance company, Hartford Life and Accident Insurance Company DENIED HIS CLAIM because they stated they did not have enough proof of loss to evaluate his disability, specifically citing missing medical records necessary to make a decision.On April 11, 2020, the claimant filed an administrative appeal with Hartford, providing additional evidence to support his claim. Despite being required to issue a final decision within 45 days, Hartford failed to do so. HE ARGUED that this failure meant his administrative remedies should be deemed exhausted, allowing him to bring his case to federal court. Substantial evidence included additional medical records supporting his disability claim.LISTEN NOW to learn how to handle similar situations and protect your rights with long-term disability claims. Don't miss the INSIGHTS from our LEGAL EXPERTS. This is the oral argument in the 2nd circuit court of appeals.These public domain recordings are brought to you by Ben Glass Law, 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.

June 27, 2024Episode 3817 min

Did Hartford Rightly Terminate the Claimant's Benefits Based on a 24-Month Cap Policy?

TUNE IN to find out why the DSM (Diagnostic and Statistical Manual of Mental Disorders), often seen as the ultimate guide, might not be as reliable as we think. Discover why re-evaluating these standards could be key to making insurance claims fairer. The claimant, employed by the School of Visual Arts, began receiving long-term disability benefits from Hartford Life Insurance Company in May 2010 due to her bipolar disorder. Bipolar Disorder: This condition led to her becoming disabled in 2009, and she subsequently began to collect long-term disability benefits in May 2010. Bipolar disorder, classified as a mental disorder under the DSM-IV, was the primary reason for her disability.In May 2012, Hartford terminated her benefits based on the Plan's 24-month cap for disabilities resulting from mental illnesses. The Plan, which incorporates the long-term disability insurance policy issued by Hartford, has a provision that limits benefits for disabilities resulting from mental illness to 24 months. Since bipolar disorder is listed as a mental disorder in the DSM-IV, Hartford applied this 24-month cap and terminated her benefits accordingly.The claimant filed an internal appeal, arguing that bipolar disorder is a biologically based illness and should be considered a physical condition, not subject to the mental illness cap.This is the oral argument in the 2nd circuit court of appealsThese public domain recordings are brought to you by Ben Glass Law, 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.

June 13, 2024Episode 3726 min

How Did the Claimant's Attorney Argue Against UNUM's Decision in the Appeal Process?

In this episode, the claimant was employed as a Security Director at Manhattanville College, where he experienced several health conditions, including:Aortic valve replacement in August 2010Paroxysmal atrial fibrillationFatigue and dizzinessChest pain and shortness of breathAnxiety and sleepless nightsThese conditions collectively contributed to his disability and inability to perform his duties as a Security Director.However, UNUM Life Insurance denied his long-term disability benefits, citing multiple medical reviews indicating improvement, an occupational analysis showing that his national economy role did not require the specific tasks he performed, and independent reviews that disagreed with his physicians. Appeal ProcessThe claimant filed an appeal to the 2nd Circuit Court of Appeals, arguing that substantial evidence showed he was completely disabled and accusing UNUM of ignoring critical medical evidence. His attorney emphasized the claimant's inability to perform essential job tasks and submitted comprehensive medical records from Dr. Joseph Tartaglia and Dr. Fusco, which included detailed descriptions of the claimant's conditions and limitations. They also criticized UNUM for not conducting an independent medical examination. The appeal aimed to overturn UNUM's decision and prove his continued disability.This is the oral argument in the 2nd circuit court of appeals.These public domain recordings are brought to you by Ben Glass Law, 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.