by Cody AllisonSixth Circuit Decision Affirms 3,800,000.00 “Disgorgement Award”
We are asked if the insurance company can be “punished” for failure to pay off a rightful claim. Below is an example of that happening. One of the things that a court must consider in these cases is the fact that, if an insurance company doesn’t pay a substantial claim for a long period of time, that company is getting the benefit of holding on to the claimant’s money, including using it operating capital and earning interest from it. Here, there is a disgorgement award ordered — the insurance company not only has to pay out the money that it wrongfully denied a claimant, but it has to pay out profits it received from holding on to that money. In effect, the court is punishing the company for its wrongful act.
If you feel that you have a claim that is being wrongfully denied, contact us right way. We are here to help!
In an ERISA long-term disability (LTD) case, disgorgement refers to the Court ordering the insurance company to pay, not only the claimant’s benefits under their policy, but also profits the insurance company made while denying the claim (and holding onto the money).
On December 6, 2013, the Sixth Circuit Court of Appeals decision in Rochow v. Life Insurance Company of North America (LINA) sent a message that, not only did the Court have the authority to make such an award, but it would use that authority to right what it perceived as a wrong. The basis of the large monetary calculation was ROE, or return on equity. The Court used this method to determine the level of unjust enrichment to the LTD insurance company and then returned the determined amount to the claimant. The Court also appeared to be sending a message to the LTD insurance industry to act in good faith when evaluating a claim, or the Court might make a disgorgement award.
Many ERISA and non-ERISA long term disability claims are wrongfully denied each year. Wrongful denials enable the big insurance companies to hold your money while they seek to make profits the longer they hold your money. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states. We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonLong Term Disability Benefits Wrongfully Denied — Cigna to Pay Over $77 Million
Sometimes, people feel like they are having to fight against a faceless corporation that really doesn’t have their best interests at heart, just to recover benefits that they are entitled to under an insurance policy that they have paid years of premiums to have. These corporations have excessive amounts of money and attorneys at their disposal and can continue to deny claims for years. This is why is it is so important to get someone on your side to fight these folks. In this case, the Court found that Cigna had spent years wrongfully denying claims, and ordered them to go back through these denied claims and re-evaluate them, which could result in Cigna paying many millions of dollars to claimants.
Here at Cody Allison and Associates, we stand ready to assist you. If you feel that your claim has been wrongfully denied, call us. We can help.
Cigna Insurance Company is one of the top five largest group disability insurance companies in the Country. Following a very lengthy investigation which began in September, 2009 and was concluded on May 13, 2013 by the Department of Insurance Investigators from the States of California, Maine, Connecticut, Pennsylvania and Massachusetts. The investigation regarding the long-term disability claims handling practices of Cigna Insurance resulted with the signing of a Regulatory Settlement Agreement (“Cigna Agreement”) on May 13, 2013. The Agreement which Cigna Insurance has entered into requires Cigna Insurance Company to re-evaluate thousands of long term disability claims that were previously denied which could result in Cigna paying out $77 Million for potential claims that were wrongfully denied.
At Cody Allison & Associates, we handle ERISA long-term disability claims and are based in Nashville, Tennessee, however we handle claims all throughout the state of Tennessee as well as other states. If you have a long-term disability claim that has previously been denied by Cigna Group Insurance, please call Cody Allison & Associates at (615) 234-6000 for a free case analysis. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonI’m Getting Paid Under “Reservation of Rights” — What does this mean?
When you review your policy prior to filing a claim, you are probably going to run into terms in the policy that you don’t understand. One of the terms that we get asked about most is the “reservation of rights” clause in a policy, although this is not the only “legalspeak” term you are going to run across. Below is an explanation of what this term means. This illustrates the point that it is important to get a competent professional to review your policy and give you advice about your rights under the policy, and also to explain the meanings of these terms. At Cody Allison and Associates, we stand ready to help you.
If you are receiving long-term disability benefits and have been told it’s under “Reservation of Rights”, this means that while the insurance company is still reviewing your claim to approve benefits or deny benefits, they will pay you under Reservation of Rights. After the insurance company reviews your claim and makes a decision, they will either start paying your claim normally and no longer under Reservation of Rights or they can deny your claim and you will receive no more benefits.
If you are getting paid under Reservation of Rights, please call Cody Allison & Associates at (615) 234-6000 and we will be happy to go over your claim with you free of charge. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonWill my long-term disability claim be denied if I do not have surgery?
Occasionally, we get clients or callers who are worried because their Dr. has recommended surgery and they just don’t want to have surgery. This can be for various reasons. They are worried that if they don’t follow the course of treatment recommended by the Dr. by not having the surgery, their coverage will be denied. Below is the answer to the question of what happens if an insured chooses not to have surgery. Remember, here at Cody Allison and Associates, we are available to help you and answer any question you may have. If you have questions or concerns about your disability claim, give us a call today.
Our office gets asked this question often. My doctor has recommended surgery and indicates that other than surgery, there is nothing more he can do for me. Will my long-term disability claim be denied if I do not have surgery?
The disability carrier cannot force you to undergo surgery. For example, if you have back problems and have seen an orthopedic and a neurosurgeon, and the neurosurgeon is recommending surgery, and you do not want to undergo surgery for several reasons, the carrier cannot deny your claim for not going through with the surgery that your neurosurgeon has recommended. You can continue to treat with other conservative treatments.
If you have any other concerns or questions regarding this matter, please call Cody Allison & Associates at (615) 234-6000 and we will be happy to answer any other questions you may have. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.
by Cody AllisonIf your doctor has not released you to go back to work, your disability claim can still be denied.
There are certain rules that every claimant must know when making a disability claim under a policy. These rules are usually outlined in your policy. It is important to know them and abide by them to not give the insurer an excuse to deny the claim. However, there are some things that you may not really have any control over. In this instance, a disability claim may be denied even though your treating physician has not released you to return to work. Below is an explanation of how this can be done. If you need help with your case or feel that your claim has been wrongfully denied, please contact us to discuss the matter.
If your doctor has not released you to go back to work, your long-term disability claim may still be and can be denied. After the insurance company receives your claim, they will review your medical records and will start their own investigation of your claim. In this process, the insurance company may send your medical records to their own independent doctors to do a peer review. If any of these doctors conclude they don’t find any restrictions or limitations that prevent this individual from working, the insurance company can and most likely will deny the claim. They can deny your claim based on their independent peer review doctor’s opinion, regardless of what the treating physician or physicians who treat you regularly state.
If your treating physician states that you cannot work, or hasn’t released you to go back to work yet, and you received a denial from your long-term disability carrier, please call Cody Allison & Associates at (615) 234-6000 and we will provide you with a free case analysis.
by Cody AllisonDutkewych v. Std. Ins. Co.
In this 2015 ERISA case, there was substantial evidence that plaintiff’s mental illness, whether or not related to chronic Lyme disease, contributed to his disability as of June 2011 where reports from plaintiff’s own treating physicians established that he had ongoing mental disabilities, in addition to his physical symptoms, as of the period around June, 2011. The plan administrator’s interpretation of the Mental Disability Limitation and the Rules governing its application was by no means unreasonable and so must prevail. The plan administrator’s limitation of the plaintiff’s benefits to 24 months was not arbitrary or capricious given the substantial evidence in the record that mental disorders, regardless of their cause, contributed to his disability as of June 1, 2011.
Judgment affirmed.
If you need assistance navigating your claim for short term or long-term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com. We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee. We offer a free consultation and would love to speak with you.
by Cody AllisonDoe v. Std. Ins. Co.
In this 2017 ERISA case, an ERISA claims administrator acted arbitrarily and capriciously by determining an attorney’s disability onset date based on when she was disabled from performing the duties of a generic “lawyer,” rather than the specialized duties of an environmental lawyer. The administrator charged an enhanced premium for specialty coverage and unreasonably undercut that coverage by failing to consider the specific requirements of the attorney’s specialty. The appropriate remedy was an award of retroactive benefits rather than a remand to the administrator.
Judgment reversed.
If you need assistance navigating your claim for short term or long-term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com. We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee. We offer a free consultation and would love to speak with you.
by Cody AllisonGross v. Sun Life Assur. Co. of Can.
In this 2013 ERISA case, the longer-term disability benefits provided by an employer were subject to ERISA where the documents associated with the employee benefits program established all five constituent elements of an ERISA plan. ERISA’s safe harbor provision did not apply as the employer did not provide multiple, independent plans. The plan administrator’s rejection of the employee’s claim for benefits was subject to de novo review as the “satisfactory to us” language in the policy did not state with sufficient clarity that the administrator was to make a judgment largely insulated from judicial review by reason of being discretionary. Applying the de novo standard, the court could not determine whether the employee’s disability claim was justifiably rejected on the basis of the surveillance video and the likelihood of symptom embellishment, particularly relating to her right arm.
Judgment vacated; case remanded with directions.
If you need assistance navigating your claim for short term or long-term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com. We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee. We offer a free consultation and would love to speak with you.
by Cody AllisonColby v. Union Sec. Ins. Co.
In this 2013 ERISA case, the plaintiff claimant exhausted her administrative appeals and brought suit against defendant long term disability plan administrator. The parties cross-moved for judgment on the record and the United States District Court for the District of Massachusetts deemed the administrator’s termination of benefits unreasonable. The administrator appealed.
The central question was whether, in addiction context, a risk of relapse could be so significant as to constitute a current disability. Although its decision created a circuit split, the instant court answered the question affirmatively. A risk of relapse into substance dependence – like a risk of relapse into cardiac distress or a risk of relapse into orthopedic complications – could swell to so significant a level as to constitute a current disability. The holding was narrow. It pivoted on a fusion of the plain language of the plan and the administrator’s all-or-nothing approach to its benefits determination. The administrator could have written into the plan an exclusion for the risk of relapse, but it did not choose to do so. Without such a written exclusion in place, the administrator acted arbitrarily and capriciously in refusing to consider whether the claimant’s risk of relapse swelled to the level of a disabililty. A benefits determination could not be reasoned when the plan administrator sidestepped the central inquiry. Further, the district court did not abuse its discretion in awarding retroactive benefits. It already had remanded the case once, to no avail.
The district court’s decision was affirmed.
If you need assistance navigating your claim for short term or long-term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com. We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee. We offer a free consultation and would love to speak with you.
by Cody AllisonSloan v. Hartford Life and Accident Ins. Co.
In this 2006 ERISA case, the appellant insurer challenged the U.S. District Court’s determination that the appellee injured party qualified for long-term disability benefits under a plan governed by ERISA. The court first addressed the insurer’s argument that the district court abused its discretion in admitting evidence outside the administrative record. As to the duplicative medical evidence, it held that the district court did not abuse its discretion. As for the nonduplicative new evidence considered, two reasons given by the district court were sufficient to support its decision, i.e., the social security definition of disability was very similar to the definition in the plan, and the district court considered the administrative law judge’s credibility determinations regarding the subjective complaints of pain to be highly probative of the ultimate question of disability. The court turned next to the finding that the injured party qualified for LTD benefits. Under the clear error standard, there was enough evidence to support the findings. Finally, because there was simply no legitimate basis for the insurer’s contention regarding a potential offset of social security benefits at a point in time earlier than January 2001, the district court committed no error when it failed to remand the case to allow the insurer the first opportunity to calculate the offset administratively.
The district court’s decision was affirmed.
If you need assistance navigating your claim for short term or long-term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com. We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee. We offer a free consultation and would love to speak with you.