I’m pleased to report that this week’s notable decision is a Kantor & Kantor victory in the matter of Sangha v. Cigna Life Ins. Co. of New York, No. 17-CV-05158-HSG, __F.Supp.3d__, 2018 WL 3023514 (N.D. Cal. June 18, 2018), involving a termination of long-term disability benefits. Sangha sought long-term disability (“LTD”) benefits relating to chronic pain secondary to cervical degenerative disc disease and C4 to C7 spinal fusion surgery. Under the governing LTD policy, Sangha was entitled to benefits if she is “unable to perform the material duties of any occupation for which he or she may reasonably become qualified based on education, training or experience,” and if “solely due to Injury or Sickness…she is unable to earn more than 60% of…her Indexed Covered Earnings.” Cigna paid Sangha for several years, though during the course of that time it denied her claim on three occasions and required her to go without benefits while she appealed those denials. On its most recent denial, however, after the Social Security Administration found Sangha disabled, and she reimbursed Cigna for overpaid LTD benefits, Cigna refused to reinstate her claim. That is, until now.
Continue Reading Firm Victory in Long-Term Disability Dispute Against Cigna Life Insurance Company of New York
Sixth Circuit Reverses Denial of Long Term Disability Benefits to Claimant with Paraplegia
I love it when I can report a righteous outcome in an ERISA disability case. I remember when I first read the district court decision in Wagner v. Am. United Life Ins. Co., 2017 WL 4099216 (S.D. Ohio Sept. 15, 2017), I said to myself “are you kidding me?!” As I previously reported, Wagner was rendered paraplegic in a motorcycle accident as a teenager and went to school and worked for much of his adult life. In his fifties, he was involved in another motorcycle accident and broke his right femur.
He stopped working and received long term disability benefits after that time but American United Life Insurance Company (“AUL”), a la its claims administrator, Disability Reinsurance Management Services (“DRMS”), terminated his claim in reliance on surveillance video showing Wagner active and not in pain as well as medical reviewers’ opinions of non-disability. This happened on month 34 of his claim, just two months before a change in the policy’s definition of disability was to take place. On de novo review, the district court found in favor of AUL. The court determined that despite Wagner’s subjective complaints, the surveillance video showed a different reality. The district court also rejected Wagner’s argument that AUL must prove that he can do the thinking required for his job.
Continue Reading Sixth Circuit Reverses Denial of Long Term Disability Benefits to Claimant with Paraplegia
In the Seventh Circuit, File Suit Immediately or Lose De Novo Review
A few weeks ago one of the notable decisions out of the Eastern District of Tennessee, Jordan v. Reliance Standard Life Insurance Company, 2018 WL 543041 (E.D. Tenn. Jan. 24, 2018), held that the claimant’s failure to file her ERISA lawsuit for benefits upon the administrator’s failure to make a decision on her appeal within 45 days, and her continued pursuit of administrative remedies thereafter, required her to “pursue the administrative pathway to its end.”
This week’s notable decision out of the Seventh Circuit, Dragus v. Reliance Standard Life Ins. Co., No. 17-1752, __F.3d__, 2018 WL 851164 (7th Cir. Feb. 14, 2018), is the same song to a different beat. In Dragus, the Seventh Circuit held that Dragus waived the argument that Reliance Standard’s failure to render a timely decision on her claim compelled de novo review simply because she pursued administrative review through an appeal rather than pursued available remedies when the issue arose (i.e. immediately file a lawsuit). On the merits of the case, the court determined that Reliance Standard’s decision was not arbitrary and capricious, where it relied on four independent physicians who did an “unbiased investigation.” [Query: Is that really possible?]. Additionally, the court held that Plaintiff was not entitled to supplement the claim record with the Social Security Administration’s decision finding that Dragus is disabled from any gainful employment.
Continue Reading In the Seventh Circuit, File Suit Immediately or Lose De Novo Review