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Death from Drug Overdose Was an Accident – Not Suicide

Client’s husband died from an overdose of a combination of prescribed drugs, including [drug* and drug*] Decedent had suffered from a very painful condition that required long-term use of the prescribed narcotics. Over the last year before his death, he had been unable to work but had hidden that from his wife by pretending to go to work each day.  He had been depressed and was in severe financial debt at the time of his death. In order to avoid liability under an accidental death policy, MetLife claimed that the death was not “accidental”, but rather the result of suicide.  [...]

By |2022-10-11T18:35:09+00:00October 11th, 2022|Legal Updates, Success Stories|0 Comments

Side Effect of Medication Causes Disability

The Federal District Court in San Diego issued an opinion granting disability benefits to a client of Stennett & Casino that contains several quotable statements relevant to ERISA disability claims. Stennett & Casino’s client’s claim was that side effects from medication taken to control seizures (fatigue and cognitive slowing) prevented him from returning to work. The disability insurer, Lincoln National, initially paid disability benefits while our client was actively having seizures. But once the medication successfully controlled his seizures Lincoln National, terminated his benefits based on the opinions of two physicians retained by Lincoln National who neither examined nor talked [...]

By |2022-09-08T20:31:15+00:00September 8th, 2022|Legal Updates, Uncategorized|0 Comments

Post-Covid Syndrome Can Support a Claim for Disability Benefits.

Most people with Covid-19 recover completely within a few weeks. However, some people, even those with mild versions of the disease, continue to experience symptoms after their initial recovery. Even people without Covid-19 symptoms in the days or weeks after they were infected can have post-Covid conditions. These conditions can present as different types and combinations of health problems for different lengths of time.   These post-Covid conditions may also be known as long-Covid, long-haul Covid, post or chronic Covid. The Center for Disease Control (CDC) and experts around the world are working to learn more about short and long-term [...]

By |2022-06-02T20:44:44+00:00June 2nd, 2022|Legal Updates|0 Comments

Who Has The Burden of Proof In An Insurance Claim

Whether you make a claim for benefits under an Accidental Death Policy or a Disability Policy the same burden of proof rules apply. The claimant has the burden of proving that they qualify for policy benefits (that they are disabled in a disability policy claim or that the death was accidental in an accidental death policy claim). However, the insurer has the burden of proving that any claimed exclusion in the policy applies to defeat coverage. As an example, in an accidental death claim the claimant must prove that the death resulted from an “accident” but the insurer who denies [...]

By |2022-05-03T18:00:12+00:00May 3rd, 2022|Legal Updates|0 Comments

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 [...]

The Danger of Replacing Your Old Life Insurance Policies

The Agent’s Commission is Their Motivation The replacement of existing life insurance policies with new policies (referred to as twisting) is a practice that has been abused by insurance agents for decades.  Because the agent’s commission is heavily weighted toward the first year’s premiums (commissions equaling as much as 120% of first year’s premiums) their financial incentive is to convince clients to buy policies, not to service old policies. The agent makes larger commissions when their client rolls over the cash value of their existing policy into a new policy because the cash value (often tens of thousands of dollars) [...]

By |2014-11-20T10:33:27+00:00November 20th, 2014|Legal Updates|0 Comments

DISABLING SYMPTOMS OF PARKINSON DISEASE

Most people associate Parkinson Disease as a disorder characterized by resting tremor.  Often the resting tremor is not noticeable because it is controlled by medication.  However, a major aspect of the disease effects cognition which cannot be controlled by medication and which may be the most disabling symptom of Parkinson. The cognitive impairments associated with Parkinson include visuospatial ability, memory, and executive functions.   If the requirements of a job include quick decision making, supervision of employees, working with the general public, writing detailed reports, and other types of executive functions, the cognitive impairments resulting from a Parkinson diagnosis would disable [...]

By |2014-05-29T11:48:20+00:00May 29th, 2014|Legal Updates|0 Comments

MLS Website Supports Fibromyalgia Disability Claims

Typically insurance companies hire Medical Services Companies to have one of their physicians review a disability claimant’s medical records to confirm that the claimant can work.  MLS, MES, PDA, PRN, UDC, BMI, PsyBar are some of the Medical Service Companies frequently used by insurance companies to perform a “record review” to bolster a denial of benefits.  These third party vendors claim to be independent but in truth are anything but.  In fact, many of these vendors have been formed by prior employees of insurance companies.  To try to support their claim of independence they produce Websites that claim their impartiality [...]

By |2014-05-20T11:07:52+00:00May 20th, 2014|Legal Updates|0 Comments

Court Declares That Unum Has A History of Biased Claims Handling

The 9th Circuit Federal Court of Appeals, in the case of Stephan v. Unum Life Insurance Company, 697 F.3d 917 (9th Cir. 2012) overturned a trial court’s finding that the public record did not demonstrate that UNUM had a history of “biased claims administration.”  The Stephen Court specifically stated “Numerous courts, including ours, have commented on Unum’s history “’of erroneous and arbitrary benefits denials, bad faith contract misinterpretations, and other unscrupulous tactics.’”  Indeed, in Saffon, we attributed the trend of state prohibitions on discretionary provisions in insurance contracts to ‘the cupidity of one particular insurer, Unum-Provident Corp., which boosted its [...]

By |2013-10-09T10:10:10+00:00October 9th, 2013|Insurance Companies, Legal Updates|0 Comments

Lyme Disease Disability Claims Targeted by Insurance Companies

Lyme Disease is difficult to diagnose.  Although there are some laboratory tests that can confirm the diagnosis, the condition is mainly diagnosed clinically.  As a result, insurance companies often sieze upon the opportunity to argue that there is not objective proof of disability. Lyme Disease is a bacterial infection transmitted by the bite of an infected tick. A person may be aware of the bite; however, he may not be aware that the tick was infected. In its early stages, Lyme Disease may be a mild illness with flu like symptoms such as fever, chills, swollen lymph nodes, headache, fatigue, [...]

By |2013-01-17T11:26:35+00:00January 17th, 2013|Legal Updates|0 Comments
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