03 May

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Vertebral Compression Fracture and Wedging Claim Denial by UNUM Overturned by Federal Judge

Vertebral Compression Fracture Disability Claim

One of the most painful back injuries is a compression fracture of the spine that results in wedging and a loss of height of the vertebral body. The bone of the spine can collapse and, as it heals, wedge. The spinal bone can also fracture and fragment. That is known as a Retropulsed fragments. The fracture fragment is displaced into the spinal canal, potentially causing a spinal cord injury. Common Causes and Symptoms of Vertebral Compression Fracture The common causes are due to trauma, like ejection from a car or ejection seat, or something as “simple” as osteoporosis, lytic lesions, tumors, or infection. Symptoms...

02 May

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UNUM’s Claim that Policy Holder’s Back Pain was Out of Proportion to the Evidence of Radiculopathy on Exam Reversed by Federal Judge

Posted by Nancy Cavey

in UNUM Insurance Company

Radiculopathy ERISA UNUM Disability Attorney

One of the common reasons disability carriers like UNUM deny or terminate benefits is the argument that the policy holder’s pain is out of proportion to examination findings and, therefore, the policy holder isn’t disabled by the terms of the disability plan or policy. Many times, disability carriers can get away with this argument because the disability plan or policy has “get out jail free” language that grants the plan or policy the discretion to determine whether the policy holder is disabled. It can be extremely hard to legally prove that a disability carrier has abused its discretion in denying a...

09 September

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What You Need To Know About Aetna’s Application Of The “Any Occupation” Definition In Its Disability Policies

Posted by Nancy Cavey

in Aetna

Own Occupation Aetna Disability Policy Claims

Many disability carriers, such as Aetna, have a two-tiered definition of disability. For example, Aetna's policy provides that for the first 24 months, you're entitled to your benefits if you can't perform the material duties of your own occupation. However, after 24 months of disability, the monthly benefits are payable if you "are unable to work in any reasonable occupation solely because of an illness, injury or any pregnancy-related condition." The policy also defines "reasonable occupation" as "any gainful activity for which you are or may reasonably become fitted by education, training or experience and which results in or can be...

18 July

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UNUM’s Current Tricks To Reduce Policy Holder’s Disability Benefits In Settlement Negotiations

Posted by Nancy Cavey

in UNUM Insurance Company

Disability Benefits In Settlement Negotiations UNUM Policy

UNUM disability policies, like most disability policies, have an "other income" provision that allows the disability carrier to reduce the gross LTD benefits by the receipt of the policyholders Social Security Disability benefits and that of the policyholder's dependents. Unum has started offsetting dependent Social Security benefits to 19 years and 2 months. There is a Social Security Administration provision that allows children still in high school to receive benefits to age 19 and 2 months if they are continuing as a full-time student at a secondary or elementary school. Normally the benefits would stop at age 18 unless the child...

27 August

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How Disability Carriers Like United of Omaha Use Pre-Existing Condition Clauses To Wrongfully Deny Disability Applicants Their Benefits

Posted by Nancy Cavey

in Insurance Carriers, United of Omaha

United of Omaha Use Pre-Existing Condition Clauses Disability Claims

Christian Hornland hurt his back in a slip and fall accident that fractured his thoracic spine. He had pain management treatment and rehabilitation that allowed him to work. He subsequently became employed as a real estate manager for Thortons and was offered and accepted a long term disability policy through United of Omaha. A few months after he became a real estate agent, Hornland began experiencing back pain and spasms because his job required him to stand 15-20 hours per week. Several months later, he experienced an onset of sharp stabbing pain in his mid-back. He returned to his doctor and got...

19 March

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Why Do Insurance Companies Deny Short Term Disability Benefits or Cut Off Benefits During The Short Term Disability Period?

Posted by Nancy Cavey

in Insurance Carriers

Short Term Disability Period Denial Insurance Company

Unfortunately, it's not uncommon for disability insurance carriers to deny a short term disability claim, or cut off a policy holder during a short term disability period. Why? Most of these policy holders also have long term disability insurance and that creates a significant exposure to the long term disability insurance carrier. The disability carrier is hoping that you get discouraged and don't file an appeal and/or fail to even apply for your long term disability benefits. Why Do Disability Insurance Carriers Deny Short Term Disability Claims I believe that disability insurance companies set up short term disability denials to make it...

30 January

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Substance Abuse Limitations and United of Omaha Disability Insurance

Posted by Nancy Cavey

in United of Omaha

Substance Abuse United of Omaha Disability Insurance

Many disability policies will have a 24-month payment limitations for disabilities due to “substance abuse” and it is not uncommon for disability carriers to argue that, notwithstanding physical problems, a policyholder is really disabled because of drug use. In the case of Blount v. United of Omaha Life Ins. Co., No. 16-3672,-F.App’x, 2007 W.L. 2829102 (6th Circuit, June 30, 2017), Ms. Blount, a former hospital controller began receiving long term disability benefits after leaving work in March of 2008. She was paid benefits for seven years as a result of undifferentiated connective tissue disorder. She also suffered from depression and anxiety...

09 January

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Reliance’s Structural Conflict of Interest Results In Reversal of District Court Order

Posted by Nancy Cavey

in Reliance Insurance Company, Short Term Disability

It’s not uncommon for disability insurance companies, like Reliance, to be responsible for both paying benefits and administrator during the claims process. That’s a conflict! Disability carriers routinely have provisions in the policy that provides them with the discretion to interpret the terms of the policy and make a determination of entitlement to benefits. To overcome that denial, the policy holder has to show an abuse of discretion. The Abuse of Discretion Standard While the fact that disability insurance companies, like Reliance, are responsible for paying benefits and administering the claims process, it won’t alter the standard of review. However, depending on what...

28 February

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What Reliance Standard Should Have Done When A Policyholder Couldn’t Attend An In-Person Medical Examination

Posted by Nancy Cavey

in Insurance Carriers

It’s not uncommon for the disability insurance companies like Reliance Standard, to schedule an independent medical evaluation. In the case of Mason v. Reliance Standard Life Insurance Company, 14-CV-01415-MSK-NYW, 2015 WL 5719648 (D. Colo. Sept. 30, 2015), the Colorado court found that Reliance’s denial of benefits was arbitrary and capricious. Reliance had scheduled an independent medical evaluation of Mr. Mason and he was unable to attend as he was in the hospital on the scheduled date. Instead of rescheduling, Reliance Standard hired a peer review doctor to conduct a medical review of Mr. Mason’s medical records. Of course, the peer review physician rendered an...