Some disability plans require plaintiffs to receive Social Security benefits within 24 months of initially qualifying for long-term disability benefits or no further benefits are payable. In this ruling, the court declined to dismiss the complaint due to a tardy SSDI approval, deeming such a denial to be arbitrary and capricious.
In this health insurance ruling obtained by the DeBofsky law firm, the district court allowed a lawsuit to proceed against Humana and the plaintiff’s employer over their refusal to cover proton beam radiation therapy treatment for a patient suffering from brain stem cancer.
Standard of Review
This matter involved a claim for accidental death insurance, but before addressing the merits, the court first needed to determine the applicable standard of review. The court accepted the arguments of DeBofsky shareholder William Reynolds that the more favorable de novo standard applied.
DeBofsky Sherman Casciari Reynolds won a landmark decision in Fontaine v. Metro. Life Ins. Co., 800 F.3d 883 (7th Cir. 2015), which upheld a challenge to the Illinois Insurance Regulation barring health and disability insurance companies from incorporating provisions in their policies that would trigger an “arbitrary and capricious” standard of court review – 50 Ill. Admin. Code § 2001.3.
DeBofsky Sherman Casciari Reynolds P.C. prevailed in a healthcare case, Dominic W. on behalf of Sofia W. v. N. Tr. Co. Employee Welfare Benefit Plan, 392 F. Supp. 3d 907 (N.D. Ill. 2019), involving the denial of residential psychiatric treatment.
DeBofsky Sherman Casciari Reynolds P.C., recently won a remand from the U.S. Court of Appeals for the Seventh Circuit in Hennen v. Metro. Life Ins. Co., 904 F.3d 532 (7th Cir. 2018). Susan Hennen suffered from chronic low back pain radiating into her legs, despite having undergone three back surgeries…
DeBofsky Sherman Casciari Reynolds P.C., along with Bridget O’Ryan and O’Ryan Law Offices, won a victory in the U.S. Court of Appeals for the Seventh Circuit in Kennedy v. Lilly Extended Disability Plan, 856 F.3d 1136 (7th Cir. 2017), a case involving the denial of disability benefits to a claimant with fibromyalgia.
On December 13, 2016, the U.S. Court of Appeals for the Seventh Circuit issued a ruling in the case of Prather v. Sun Life & Health Ins. Co. (U.S.), 843 F.3d 733 (7th Cir. 2016). The case, which involved a claim for accidental death insurance benefits, overturned a lower court ruling denying Lee Ann Prather’s claim and ordered Sun Life to pay the full amount…
See what the courts have to say about us:
- Notification of Docket Entry – Minute entry – Robert Sanderson vs. Sun Life Assurance Company of Canada
- Notification of Docket Entry – Tremback v. MONY Life Insurance Company
- Memorandum Opinion and Order – Lanette Holmstrom vs. Metropolitan Life Insurance, Company and Experian Information Solutions, Inc. Employee Welfare Benefit Plan
- Order Regarding Plaintiff’s Motion for Attorney’s Fees and Expenses – Jean Torgeson vs. Unum Life Insurance Company of America
“I can’t thank you enough for ending the nightmare and securing my future.”
“I knew after researching you and your law firm, talking with other attorneys about you, that not only were you the best choice but the only choice. Martina did fantastic work on the review of my claim file, please extend my gratitude to her, I was so relieved the day she called, after discussing the case with you and offering your services to take my case. It was very unnerving suddenly not knowing what my financial future was going to look like at my age. I can’t thank you enough for ending the nightmare and securing my future.”
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., 831 F.3d 426 (7th Cir. 2016), reversing an adverse judgment in the district court against DeBofsky Sherman Casciari Reynolds P.C.’ client, Eric Berg.
499 F.3d 640 (7th Cir. 2007) and 422 F.3d 635 (7th Cir. 2005). This case was heard twice by the court of appeals; and in both rulings, the court overturned a lower court’s finding in favor of Prudential. The opinions, collectively, put to rest the notion that deferential review is due merely because the insurance policy requires proof of disability satisfactory to the insurer. Also, the Seventh Circuit recognized that subjective symptoms such as pain cannot be discounted simply because they are not “medical” or “neurologic” evidence.
615 F.3d 758 (7th Cir. 2010). In Holmstrom, the plaintiff, Lanette Holmstrom, was successful in her appeal against Metropolitan Life Insurance Company and convinced the court of appeals to overturn a lower court finding in favor of the insurance company and award past-due disability benefits and order the continuation of benefit payments.
DeBofsky Sherman Casciari Reynolds P.C won a decisive ruling from the United States Court of Appeals for the Seventh Circuit in Lacko v. United of Omaha Life Ins. Co., 926 F.3d 432 (7th Cir. 2019), a case involving disability benefits and vocational issues.
“I know this would not have happened without your advocacy.”
“Mark, THANK YOU THANK YOU THANK YOU!!! I know this would not have happened without your advocacy. I thank God for you and your firm and may blessings be poured upon all of you. I needed a warrior of the most excellent and greatest kind and I found one in you.”
DeBofsky Sherman Casciari Reynolds P.C. has also secured numerous lower court rulings that have found that a regulation issued by the Illinois Department of Insurance, 50 Ill. Admin. Code § 2001.3, bars insurance companies from incorporating language in their policies that would trigger an arbitrary and capricious standard of review.
463 F.3d 880 (9th Cir. 2006). In this ruling, the court of appeals reversed a judgment for Sun Life entered by a lower court, ruling that policy language requiring that a claimant submit “satisfactory proof” of disability was insufficient to alter the ERISA standard of review from the default de novo standard.
“Thank you for believing in me.”
“It has been an absolute pleasure doing business with you. I can’t thank you enough for everything you have done for me. More than just successfully winning this appeal, but for having the confidence in me to proceed. For the moral support to help me continue to fight and for believing in my illness. I will continue to tell everyone about the excellent work. You have no idea what your support has meant to me. Thank you for believing in me.”
545 F.3d 555 (7th Cir. 2008). This case involved a chronically ill individual whose disability benefits were summarily terminated without just cause.
697 F.3d 917 (9th Cir. 2012). The U.S. Court of Appeals overturned a lower court ruling that favored Unum. Stephan was the first circuit court decision to recognize the applicability of the fiduciary exception to attorney-client privilege in the context of a fully-insured ERISA plan.