ERISA Disability and Life Insurance Litigation

This is the oral argument in a case involving MetLife’s two year limitation of benefits for neuromuscular, musculoskeletal, or soft tissue disorders.

In his disability claim, Penland cited several conditions. He contracted E. Coli during a business trip, leading to colon resection surgery, where part of his colon and a small intestinal cyst were removed. He also reported suffering from idiopathic gastroparesis, depression, cervical and lumbar degenerative disc disease, degenerative joint disease with osteoarthritis in both hips, IBS, cervical kyphosis, diverticulitis, restless leg syndrome, sleep apnea, psoriasis, vagus nerve damage, and altered bowel habits. Additionally, Penland underwent left hip replacement surgery.

Penland's last position was as a Regional Procurement Specialist at Continental Automotive, Inc. His role involved managing indirect procurement for plant spending under $5,000, supporting operational and tactical activities for assigned plants. He was responsible for leading efforts in payment-related issues, receiving confirmations, and handling expedites. Penland reported becoming "completely and totally disabled" on August 14, 2015, ending his tenure in this role.

The insurance company determined that the claim was subject to a two-year limitation of benefits due to the nature of the disability being categorized as a neuromuscular, musculoskeletal, or soft tissue disorder. These conditions are specifically limited under the plan. As a result, the maximum duration of benefits for this limited condition was set to expire on February 16, 2018.

The claimant asserted he had radiculopathy, but the insurance company's doctor, Dr. Pietruszka, disagreed. Dr. Pietruszka's examination found no measurable evidence of radiculopathy in the claimant's cervical and lumbar spine around December 12, 2020. Despite cervical cord compression and lumbar disc disorder, there were no motor or sensory impairments or abnormal cord signals noted. The claimant also showed improvement in mobility and responsiveness to opioid therapy. Consequently, Dr. Pietruszka concluded the claimant was not functionally impaired to an extent that would necessitate restrictions or limitations.

These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.
By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.
If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

In this episode, we explore a financial advisor's battle against the wrongful termination of his long-term disability benefits. He was a financial advisor at Fulton Financial Corporation, where he began working in 2009. In 2014, he started experiencing severe pain and numbness in his legs and feet, progressively losing his ability to stand, walk, and drive. By 2015, his condition had deteriorated to the point where he could no longer work. After consulting with specialists, he was diagnosed with neurogenic muscular atrophy and diabetic polyneuropathy.

Following his diagnosis, the claimant filed for long-term disability benefits, which Reliance Standard initially approved, acknowledging his inability to work. However, in October 2017, despite no improvement in his condition, Reliance Standard ordered an independent medical examination (IME), which concluded that he was still capable of working. As a result, Reliance Standard terminated his benefits in December 2017.

The claimant challenged this decision through the company’s internal appeals process, submitting updated medical records that confirmed his ongoing disability.

Curious about the full story and its potential impact on others facing similar challenges? Listen to our podcast as we delve into the court's ruling and the broader implications for long-term disability claims.
This is the oral argument in the third circuit court of appeals.

These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.
By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.
If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

Here, the claimant sued her insurance company, Reliance Standard, for not paying her long-term disability benefits after a car accident. She claimed to be not able to work due to a number of medical conditions, including post-concussion syndrome, severe hyperacusis, vestibulopathy (dizziness), migraines, and cognitive problems.
The District Court decided in Tekmen's favor. Reliance Standard didn't agree with this decision and appealed.
Most of the argument centers on just what the roles of the District Court and Appellate court are when you have a closed administrative record and a de novo standard of review.

The Fourth Circuit Court was asked by Reliance Standard to use a special kind of quick decision-making process in the Tekmen case, a lawsuit about denied insurance benefits. This process would have made it easier to decide the case based on existing records without giving the usual benefits to the party that didn't request the quick decision.

However, the court rejected this idea. They explained that this approach wasn't suitable for these types of cases, especially when there's disagreement over important facts, like in Tekmen's case. In situations where facts are disputed, courts need to closely examine everything and make their own decisions about what's true.

The court decided to stick to the usual way of handling such cases, as outlined in the Federal Rules of Civil Procedure. This involves a detailed review of all the information and making decisions based on that, not just a quick judgment.

The court also clarified that their decision-making process was in line with past legal principles, especially when it comes to reviewing the facts of a case. They emphasized that they follow a standard approach for reviewing facts and that this approach fits well with the established legal framework for insurance benefit cases like Tekmen's.

These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.
By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.
If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

The oral argument focuses on the case of a claimant who has lived with Charcot Marie Tooth Syndrome (CMT), a degenerative neurological condition. She worked as a nurse at the Mayo Clinic Health System from 2003 to 2011. Her condition, particularly noted in her legs, led to muscle atrophy. Her treating doctor has observed the progression of her CMT for over four years. By 2011, her condition worsened and then stabilized, meaning it ceased to worsen but did not improve. As of March 14, 2016, the claimant struggled with tasks for more than half an hour due to severe pain and fatigue.
In response to the claimant's appeal for long-term disability benefits, a Rehabilitation Consultant, Kate Schrot, was hired to assess her employment prospects. Schrot's evaluation acknowledged that the claimant could perform certain tasks, as evidenced by surveillance, but only sporadically, not consistently enough for full-time employment. Surveillance confirmed the claimant's limitations, showing her limited activity and consistency with her reported disability. The treating doctor's medical opinion, noting the medication-induced drowsiness and chronic pain, further supported her claim, suggesting that the evidence for terminating her benefits is insufficient.
The trial court's opinion highlighted the shortcomings in the defense expert's analysis regarding the claimant's capacity to work full-time. Despite acknowledging the severe pain and concentration issues due to Charcot-Marie-Tooth syndrome, the defense doctor failed to consider how her pain would impact her ability to perform sedentary work. This oversight was deemed unreasonable for determining her benefit eligibility. The opinion also noted contradictions in the defense doctor's assessment, particularly against Dr. Tseng's view that McIntyre couldn't work for more than half an hour on any task. The court reasoned that frequent breaks would reduce McIntyre's working hours significantly, qualifying her for benefits.

These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.
By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.
If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

In this episode, the claimant was employed as a Security Director at Manhattanville College, where he experienced several health conditions, including:

• Aortic valve replacement in August 2010
• Paroxysmal atrial fibrillation
• Fatigue and dizziness
• Chest pain and shortness of breath
• Anxiety and sleepless nights

These conditions collectively contributed to his disability and inability to perform his duties as a Security Director.
However, UNUM Life Insurance denied his long-term disability benefits, citing multiple medical reviews indicating improvement, an occupational analysis showing that his national economy role did not require the specific tasks he performed, and independent reviews that disagreed with his physicians.
Appeal Process
The claimant filed an appeal to the 2nd Circuit Court of Appeals, arguing that substantial evidence showed he was completely disabled and accusing UNUM of ignoring critical medical evidence. His attorney emphasized the claimant's inability to perform essential job tasks and submitted comprehensive medical records from Dr. Joseph Tartaglia and Dr. Fusco, which included detailed descriptions of the claimant's conditions and limitations. They also criticized UNUM for not conducting an independent medical examination. The appeal aimed to overturn UNUM's decision and prove his continued disability.
This is the oral argument in the 2nd circuit court of appeals.

These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.
By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.
If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.