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District Court Finds That A Formal Functional Capacity Evaluation is Compelling Evidence of Disability

Stennett & Casino filed a complaint in San Diego Federal District Court against United of Omaha Life Ins. Co. for terminating its client's long-term disability (LTD) benefits. United of Omaha initially paid LTD benefits due to disability related to the client's low back pain following two surgeries. Omaha, however terminated benefits after one year concluding that the surgeries had resolved client's low back problems. Stennett & Casino had their client undergo functional capacity testing and submitted the findings of that testing to Omaha during the administrative appeal process. The Functional Capacity Evaluation (FCE) found that the client had a maximum sitting [...]

MetLife Denies Accidental Death Benefits Under Exclusion For Death Caused Or Contributed To By Illness Or Sickness.

We are seeing more and more claims for Accidental Death benefits denied under an exclusion for “loss” caused by “illness or the treatment thereof.” Whenever an insured involved in an accident is taking prescription medication, the insurer argues that the accident was, in part, caused by the medication side effects. Likewise, when an insured has an illness that weakens his/her ability to recover from a physical trauma, the insurer argues that the illness contributes to the death and thus is excluded under the policy.   These arguments taken to their extreme would result in almost all Accidental Death Claims being [...]

Neuropsychological Testing Supports Traumatic Brain Injury

Our client was a 64 year old second grade bi-lingual teacher who fell hitting her forehead into a concrete wall. She immediately lost consciousness but believed she was okay.  Over the next several days her family noticed that she was incoherent so she did not return to work but had a substitute teacher cover her classes. She filed a claim for disability benefits with Standard Insurance Company. They paid her benefits for a year and a half when her benefirs were terminated.  She hired Stennett & Casino to handle her appeal. It was obvious to us that our client suffered a [...]

Death Due to Toxic Drug Interaction and Medical Malpractice

Our client’s daughter died while she was an inpatient at a drug rehabilitation center due to the toxic effect of combining prescriptions for an anti-depressant with methadone which were both administered by the facility. The treating physicians should never have combined these 2 medications since they have a known toxic reaction. The father’s claim for benefits under his accidental death policy with Life Insurance Company of North America (LINA) however was denied under an exclusion for death resulting from an illness or the treatment thereof. The father lived in Palmdale California and found the Law Offices of Stennett & Casino [...]

Death Due to Accidental Overdose of Pain Medication

Our client’s wife had been prescribed narcotic pain medication for several years due to extreme back pain. Tragically her pain became so severe that she accidentally overdosed on her medication. Our client made a claim with Prudential Ins. Co. under his Accidental Death & Disability policy. Prudential denied his claim under an exclusions for death caused by illness or the treatment thereof. Our client lived in San Bernardino County and found the Law Offices of Stennett & Casino through our webpage and noticed that we had handled many similar cases.  After retaining Stennett & Casino Prudential continued to deny the [...]

A Tale of Two Life Insurance Companies – One (LINCOLN NATIONAL) Pays Accidental Death Benefits And One (CIGNA) Denies Benefits

Our Client’s Husband, who had a history of alcohol issues, died following an evening of binge drinking.  The coroner’s office classified the manner of death as “accidental” and the cause of death as “acute alcohol intoxication.”  The Husband had two insurance policies that promised benefits to his wife if he died as a result of an accident. Our client submitted a claim to each of the insurance companies and both denied coverage under an exclusion for loss caused by “sickness or disease.”  Both insurance companies claimed that a contributing factor to decedent’s death was his alcoholism which they asserted excluded [...]

CIGNA Reprimanded For Denying Benefits to Claimant With Chronic Fatigue Syndrome

The Ninth Circuit Court of Appeals in Salomaa v. Honda LTD Plan 637 F.3d 958 found that CIGNA’s Insurance Company’s decision to deny disability benefits to a claimant with chronic fatigue syndrome was illogical, implausible and without support because: Every doctor who personally examined the insured concluded that he was disabled; The Plan Administrator demanded objective tests to establish the existence of a condition for which there are no objective tests; The Administrator failed to consider the Social Security Disability Award; The reasons for denial shifted as they were refuted, were largely unsupported by the medical file, and only the [...]

By | 2014-11-20T10:54:07+00:00 November 20th, 2014|Disability Insurance Claims, Success Stories|0 Comments

UNUM Denies Accidental Death Benefits Due to Poor Health of Insured

Our client's husband died after falling and hitting his head on their back patio.  The trauma caused a subdural hematoma which became mortal in less than four hours.  The death certificate classified the death as "accidental."  The "immediate cause" of death was listed as "subdural hemorrhaging from blunt force injury to head" and a "contributing condition" was listed as "thrombocytopenia." Client submitted a claim to UNUM Insurance Company for benefits under an accidental death policy.  UNUM denied the claim based on a limitation in the policy that excludes coverage for accidental losses "caused by, contributed to by,  or resulting from diseases [...]

Disability Claim – Surveillance Video – Back Injury

Our client was in a serious auto accident at the age of 22, which confined him to a wheelchair due to serious back injuries.  Despite his serious disability, he returned to school to learn computer programming.  He successfully returned to the workforce and became a program manager for Oracle Corp.  Due to a combination of his serious back injuries and the wear and tear after 17 years of working as a computer programmer and manager, his back finally gave out, precluding him from working full time.  He applied for and received long term disability benefits. Four years later, on December [...]

Disability Claim – Degenerative Back

Our client was a pharmacist for 32 years.  His back began to bother him the last 6-7 years before he was unable to continue work.  Pharmacists must be on their feet almost all day and his back condition precluded him from standing more than 20 minutes at a time.  The disability insurer denied benefits after doing a job survey to determine that other employers (not our client's) would allow him to use a stool to accommodate his back problem. Stennett & Casino retained a vocational expert who performed a more thorough job market survey and found that although employers by [...]

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