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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]