Disability Insurance Claims

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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 [...]

How To Overcome A Disability Policy Mental Illness Limitation

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 [...]

By |2017-06-02T16:18:45+00:00June 2nd, 2017|Disability Insurance Claims|0 Comments

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 [...]

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 [...]

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 [...]

Disability Insurance Claim: County of San Diego (SDCERA)

Denial of Disability Retirement Reversed Stennett & Casino's client was employed by the County of San Diego for over 10 years in a clerical position.  She had to stop work because of an injury to her knee resulting from continued banging against a desk when she was placed in an awkward work station.  Despite the fact that she underwent 4 unsuccessful knee surgeries that left her with severe standing and walking limitations and severe pain with extended sitting, the County asserted that it could accommodate her limitations and continue to provide her a sedentary position. The County denied the client's [...]

Disability Insurance Claim: Lupus

Our client was a financial analyst for a large defense contractor.  She had to stop work due to severe symptoms related to her diagnosis of Lupus.  Lupus is an autoimmune disease in which the immune system attacks one’s own body.  Our client was treated with medication to suppress her immune system, which exposed her to other illnesses and infections which her suppressed immune system could not fight. […]

Disability Insurance Claim: (SDCERS) City of San Diego’s Claim of a Pre-existing Condition Reversed

The City of San Diego provides Disability Retirement Plans to employees that differ from private sector plans.  San Diego City employees are provided with two levels of Disability Insurance Benefits: Industrial Disability Retirement – If your disability is work related, you are entitled to greater benefits from the date of disability regardless of your age. Non-Industrial Disability Retirement – If your disability is not related to your employment, you are entitled to benefits beginning at age 55. The criteria for a member to be considered for Industrial Disability Retirement is to be permanently incapacitated by bodily injury or illness caused by their [...]

Disability Claim: Neuromuscular Disease

Our client was employed as the Clinical Director of a medical research company whose job was classified as sedentary, even though it required her to travel.  She developed a neuromuscular disorder which became progressively debilitating and eventually totally disabled her from work.  Her condition was considered to be permanent and had no treatment or cure. […]

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