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 [...]
Post-Chemo Disability
When a diagnosis of cancer is followed with treatments that include chemotherapy, patients often experience lingering symptoms of fatigue, muscle weakness, brain fog (often called chemo brain), decreased ability to concentrate, and peripheral neuropathy. In some people, these symptoms can last well past the remission of cancer. This is precisely what happened to a client of Stennett & Casino who had a disability policy through her employer with United of Omaha. Omaha provided disability benefits while she was going through treatment. But those benefits were terminated by Omaha after she went into remission. Though her cancer was in [...]
Insurer Rescinds Policy for Failure to Disclose High Blood Pressure
Our client’s husband died unexpectedly at age 48 following a massive heart attack. Fortunately, he had a life insurance policy. Unfortunately, the insurance company denied her claim for benefits. The denial was based on the fact that her husband had not disclosed his history of high blood pressure to the insurance company when he first applied for the coverage. Insurers may rescind a life insurance policy within 2 years of its issuance if it discovers the applicant made a misrepresentation that the insurer reasonably relied upon in issuing the life policy. The key is whether the misrepresentation (whether innocent or [...]
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 [...]
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 [...]
Coverage Under Accidental Death Insurance Policies for Drug and Alcohol Overdoses
Accidental Death and Disability policies (AD&D) require that one’s death be caused by an “accident” to trigger coverage. The term “accident” is usually defined as an “unforeseeable, unintended, and sudden event.” These policies will also contain several exclusions including one for death due to an illness or the treatment thereof. Insurers continually deny benefits under an accidental death policy when death results from an accidental overdose of prescription drugs. When death is caused by medication that is prescribed to treat an illness insurers cite the “illness and treatment thereof” clause to deny the claim. Despite this exclusion Stennett & Casino [...]
Zurich Claims Subdural Hematoma Not Caused by Fall.
Our client’s husband died as a result of a subdural hematoma (bleeding on the brain). Subdural hematomas are typically caused by trauma to the head. Our client found her husband unconscious on the bedroom floor upon returning from church. He died several days later in the hospital. Zurich, who provided Accidental Death Coverage, claimed that the subdural hematoma was caused by a spontaneous bleed due to the use of Coumadin (a blood thinner), and not by the fall. Zurich pointed to the lack of evidence of external trauma to the head and medical literature supporting the potential for spontaneous bleeds [...]
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 [...]
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 [...]
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) [...]