February 15th, 2018

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 tolerance of approximately twenty-seven (27) minutes and a standing tolerance of between two (2) and ten (10) minutes. Omaha had its physician, Dr. Neuren, review medical records including the FCE. Dr. Neuren dismissed the FCE as merely a restatement of subjective complaints and concluded that there was a “lack of support” for ongoing impairment.

United also sent a letter to the client’s treating surgeon asking him to agree with its assessment that although the client had some ongoing limitations due to his back condition, he was able to return to his prior occupation. The surgeon signed the document and returned it to United indicating his agreement.

Prior to the trial, Stennett & Casino contacted the surgeon and provided him with a copy of the FCE and a description of the client’s job duties, which he had never previously seen. After reviewing the FCE he provided a statement in which he deferred to the FCE findings of disability describing it as “thorough in its testing and evaluation of functionality.”

The District Court found that Stennett & Casino had met their burden of proving that their client was disabled under the plan commenting that Omaha’s physician and nurse’s paper reviews, which included no examination, observation or discussion with the client were less persuasive than the information provided by Stennett & Casino from the treating physicians and FCE. The court ordered payment of all LTD benefits to the client. The court’s opinion can be found at Fritch v. United of Omaha Life Ins. Co., 2017 U.S. Dist. Lexis 201141.

June 2nd, 2017

Most disability policies have a two-year limitation on benefits for disabilities caused by a mental illness or disorder. Thus if the cause of your disability is depression, you will be limited to 24 months of disability benefits. We are now seeing more policies that expands the mental illness limitation to those disability caused or contributed to by a mental illness or disorder. This type of limitation, applied in the extreme, could result in limiting to 2 years the benefits payable on virtually all disabilities. The following case is an example of Reliance Standard Insurance Company’s attempt to expand the application of this limitation.

Our client came to us after having been paid disability benefits for 5 years by Reliance Standard due to a back injury. The doctors were unsuccessful in treating her condition which left her in constant pain. As a result she developed what was diagnosed as a Chronic Pain Syndrome with symptoms of depression and anxiety. This resulted in Reliance Standard terminating her disability benefits claiming that her disability was contributed to by a mental disorder – depression and anxiety.

Stennett & Casino had to file suit and go to trial on behalf of our client on this issue. We were successful in convincing the court that 1) the client’s back pain was the cause of her depression; 2) the disability policy was ambiguous, and; 3) that the mental illness limitation did not apply to mental conditions arising from a physical disability.  Our client received a judgement for the payment of all back benefits owed and entitlement to future disability benefits. The court’s opinion can be found at Jarillo v. Reliance Standard Life Insurance Co., 2017 U.S. Dist. Lexis 59928.

May 6th, 2016

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 traumatic brain injury. In order to prove her disability we had her undergo neuropsychological testing. The testing supported her injury.

Stennett & Casino submitted the testing as part of her appeal.  As a result Standard Insurance reopened her claim and paid the benefits owed her under her disability policy.

November 20th, 2014

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 denial stayed constant;
  • The Plan Administrator failed to engage in the required “meaningful dialogue.”

The Court found that in a disability claim that turned upon subjective evidence, such as the amount of a claimant’s pain and fatigue, it was an abuse of discretion for the insurer to rely solely upon doctors who merely reviewed the records without examining the patient when there was a uniformity of agreement by treating physicians what the individual was disabled.

Another important feature of the case was the Ninth Circuit confirming that CIGNA’s physician report is one of the documents that the Plan is required to provide the claimant as part of its duty to provide a full and fair review.  Most importantly, the Court held that these physicians’ reports must be provided prior to a final determination.  This allows the claimant or his/her physician to comment on or rebut the insurer’s physician report prior to a final determination on appeal.

July 25th, 2012

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 23rd, the insurance carrier placed our client under video surveillance.  The video showed him Christmas shopping with his wife for several hours.  Client was driving with his specially equipped vehicle, getting in and out of his car into his wheelchair and going to various stores.  Based on the video and client’s refusal to take constant pain medication, his benefits were terminated.  Stennett & Casino had our client tested through a Functional Capacity Evaluation and had his doctor prepare additional reports; however, the insurance company refused to pay additional benefits.   We filed a lawsuit in Federal Court and the court found in our client’s favor.  In referencing the surveillance video the court noted that “the plan does not require a claimant to be utterly helpless in order to be eligible for disability benefits…and plaintiff would hardly be the only person overtaxing his abilities when shopping on December 23rd.” The court’s opinion can be found at Robertson v. Hartford Life and Accident Ins. Co. 

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