Most people assume that if they become unable to perform their usual work on account of sickness or injury, that they would qualify to receive benefits under their work-sponsored long-term disability insurance coverage. That may not be the case, though. In Nichols v. Reliance Standard Life Ins. Co., 2019 WL 2223614 (5th Cir. May 23, 2019), the court permitted a disability insurer to classify the work of an inspector in a poultry processing plant as that of a "sanitarian," a quite different occupation. Although the district court delivered a blistering indictment of Reliance Standard's review of Juanita Nichols's claim for disability benefits (2018 WL 3213618 (S.D. Miss. June 29, 2018)), the Court of Appeals reversed and awarded judgment to the insurance company. The lower court was so incensed by the insurer's behavior, it cited over 100 examples of Reliance Standard's arbitrary and capricious conduct in other litigation and found similar misconduct in its treatment of Nichols. The Fifth Circuit had a different view, though.
In a recent Ohio federal court ruling, Linda Hines successfully challenged Unum's invocation of its pre-existing condition exclusion when she became disabled due to anisometropia, a neurologic condition where the brain is unable to coordinate the separate images generated by each eye. Unum maintained that the cataract surgery Hines underwent during the 3-month lookback period prior to the effective date of her coverage related to the anisometropia. In Hines v. Unum Life Ins. Co. of Am., 2018 WL 6599404 (N.D. Ohio December 17, 2018), the court overruled Unum's determination.
A recent article published by Bloomberg Law offers a stark warning to disability insurance claimants who use social media.The article by Jacklyn Wille entitled "Facebook Has a New Friend: Disability Insurers" (https://www.bna.com/facebook-new-friend-n73014475033/) discusses insurers' use of social media to investigate disability insurance claimants.And it is becoming more common that social media posts are cited as the basis for denying disability insurance payments.
On July 27, 2016, the U.S. Court of Appeals for the Seventh Circuit handed down a decision in the case of Berg v. New York Life Ins. Co. reversing an adverse judgment in the district court against DeBofsky, Sherman & Casciari' client, Eric Berg. The court of appeals found in Berg's favor on two significant issues: First, the court ruled that a claimant for disability benefits did not have to be under a doctor's care for the claimed disabling condition as of the date the claim arose. The court found the policy lacked such a temporal requirement and that its terminology was ambiguous on the issue. Second, the court found that if the insured is unemployed when he submits a claim, his "regular job" is the occupation that was last performed, not the so-called occupation of "unemployed person."
Short-term and long-term disability plans are supposed to provide workers and professionals with coverage to make ends meet when a serious medical impairment or injury takes the person away from work. Not everybody participates in these insurance plans. In fact, the Bureau of Labor Statistics says the roughly 39 percent of people working in private industry 2014 had short-term disability (STD) coverage and 33 percent carries long-term disability (LTD) coverage. Of those in management and professional positions the participation rate was significantly higher.
DeBofsky, Sherman & Casciari attorneys Mark DeBofsky and Martina Sherman recently won the case of Wonsowski v. United of Omaha Life Ins. Co., 2016 WL 3088141 (N.D. Ill. June 2, 2016) following a bench trial before Magistrate Judge Geraldine Soat Brown in the federal court in Chicago.The case involved Shellie Wonsowski, who had worked as a mechanical engineer before becoming disabled on account of symptoms of idiopathic gastroparesis.Although Wonsowski initially qualified for benefits, United terminated her benefit payments after concluding she was capable of returning to her regular occupation, which was classified as requiring sedentary exertion.
Many disability insurance policies require a showing of an inability to perform each and every regular job duty.Does that mean you can't be considered disabled if you are unable to perform some but not all of the required job duties? In most jurisdictions, the answer is yes - you need not prove an inability to perform every single job duty in order to receive benefits.
A recent ruling won by DeBofsky, Sherman & Casciari, Curtis v. Hartford Life & Acc.Ins.Co., 2014 WL 485233 (N.D.Ill. August 20, 2014) illustrates the importance of considering the combined impact of more than one medical condition in determining disability. Cindy Curtis, a former operating room nurse at Lurie Children's Memorial Hospital in Chicago, became disabled in 2007 due to musculoskeletal impairments of the back, knees and shoulders suffered in car accidents, along with fibromyalgia and myofascial pain throughout her body. She filed a claim for long-term disability insurance with Hartford, which provided group disability coverage through her employer. Hartford approved the claim and paid benefits under the own occupation definition of disability that covered the first 24 months of payments. However, two years later Hartford discontinued Curtis's benefits, finding that she did not meet the "any occupation" definition of disability that became effective on that date. In the key portion of the ruling, the court emphasized that "even if none of her impairments in isolation necessarily compel a finding in [Curtis's] favor," the co-morbidity of her impairments had to be considered in combination in assessing disability.
A recent DeBofsky, Sherman & Casciari victory, Cheney v. Standard Ins.Co., 2014 WL 4259861 (N.D.Ill. August 28, 2014) illustrates the concept of being disabled while still working and thus qualifying for disability insurance benefits. The plaintiff, Carole Cheney, was a non-equity partner at the law firm of Kirkland & Ellis, LLP who specialized in appellate and commercial litigation. After struggling with neck and back pain for years and receiving workplace ergonomic accommodations that ultimately failed to enable her to keep working in the office, Cheney began working from home most days beginning in 2003. Ultimately, though, she had to stop working after December 19, 2011; and she took an approved leave of absence from her law firm beginning January 3, 2012 to pursue treatment for her back pain, ultimately undergoing major spine surgery a few months later. Although Cheney's disability insurer, Standard Insurance Company, maintained that Cheney's coverage ended when she ceased working, the court ruled otherwise based on the policy language, which continues coverage after the cessation of active work during a leave of absence. Thus, Cheney qualified for benefits even though her date of disability did not commence until shortly before she underwent surgery.