The client had been employed for 8 years as a registered nurse at a San Diego hospital. In July 1999, she was diagnosed with Stage IV metastasized breast cancer, and underwent a lumpectomy, chemotherapy, radiation and a bone marrow transplant. All of her doctors considered her to be disabled from work. She received disability benefits until 2002, when the insurance carrier abruptly denied her disability.
The client sought our help. We found that the insurance company had misinterpreted her doctors’ reports and violated its own claims manual when it denied her disability. That claims manual defined what internal rules, guidelines, protocol and criteria the insurance adjuster had to follow in evaluating a claim for disability. We found that the insurance company’s own manual listed health conditions which, if confirmed, would give the client a presumption of disability. Metastasized breast cancer was one of those health conditions. Since this case was not bound by ERISA, we pursued not only the client’s contractual rights but also damages for bad faith under California insurance law.
After a settlement conference Stennett & Casino was were able to successfully settle the matter with the insurance company. Our client received her disability payments, plus additional money based on our evidence of the insurer’s bad faith.