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Tash v. MetLife – Court Holds That MetLife Undermined the ERISA Process

Case Name: Raymond M. Tash, DDS v. Metropolitan Life Insurance Company; Pacific Dental Services, Inc., Employee Benefit Plan Court: United States District Court Central District of California Type of Claim: Long Term Disability Insurance Company: Metropolitan Life “MetLife” Claimant’s Employer: Pacific Dental Services, Inc. Claimant’s Occupation / Job Position: Dentist/Doctor of Dentistry Disabilities: No mention of his specific disabilities/conditions- just said he …

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New Department Of Labor Rule Strengthens Protections For Long Term Disability Claimants

On December 16, 2016, the Department of Labor announced the release of a Final Rule to strengthen consumer protections for private-sector workers making disability insurance benefit claims for benefits from their workplace disability insurance plans. This action ensures that disability claimants will receive a full and fair review of their claims, as required by ERISA …

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Seeman v. MetLife – Vice President Wins Long Term Disability Claim

In this case, Teresa A. Seeman (“Seeman”) was an employee of Bank of America and served as a Vice President, Unit Manager from May of 1990 to December of 2007. Through her employment, she was part of a long term disability plan that was administered by Metropolitan Life Insurance Company (“MetLife”). The plan defined “disability” as follows: “‘Disabled’ or …

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Important Changes for Long Term Disability in 2019 and 2020

You Have a Right to Know Why Your Claim Was Denied The new regulations require the insurance company to provide a complete explanation of denial in your denial letter and what internal protocols, rules, and guidelines were used to deny your claim upon request. Naturally, insurance companies do not want to share this information with …

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Randall v. MetLife – Doctor’s Conclusion Outweighs Subjective Complaints

Case Name: Randall v. Metropolitan Life Insurance Company Court: United Stats District Court for the Northern District of California Date of Decision: February 6, 2017 Type of Claims: Short term disability, long term disability, and related health, dental, vision, and life insurance benefits. Insurance Company: Metropolitan Life Insurance Company, aka MetLife. Claimant’s Employer: Verizon Wireless Claimant’s Occupation / Job Position: Facilities Network …

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Court Rules Insurer Cannot Ignore A Claimant’s Job Duties During Own Occupation Period

In Kavanay v. Liberty Life Assurance Company of Boston, the plaintiff sought long term disability benefits from Liberty Life, the insurer of his ERISA governed disability plan. The court held that Liberty abused its discretion, granted plaintiff summary judgment, and awarded disability benefits. The plaintiff worked as an insurance adjuster for Allstate; he was an “outside …

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Puccio v. Standard – Plaintiff is Entitled to a Description of Additional Material Necessary to Perfect the Claim

Case Name: Annina Puccio v. Standard Insurance Company Court: U.S. District Court for the Northern District of California Date of Decision: February 20, 2015 Type of Claim: Long Term Disability under the Employee Retirement Income Security Act (“ERISA”) Insurance Company: Standard Insurance Company Claimant’s Employer: NetApp Inc. Claimant’s Occupation / Job Position: Senior Manager of Assessments and Certification Disabilities: An unsuccessful gastric bypass …

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Patterson v. Aetna – Court Rules “Own Occupation” and “Regular Occupation” Are Interchangeable

The present case involves an appeal by Aetna Life Insurance Company (“Aetna”) from a successful motion for summary judgment granted in Christopher Patterson’s (“Patterson”) favor. Regarding the same case, the court had also denied a motion for summary judgment filed by Aetna. Patterson was covered under a long term disability policy by Aetna through his employer Fire Consulting …

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Parr v. Reliance – Modest Activity Captured on Surveillance Doesn’t Equal an Ability to Work

Case Name: Cheri Parr v. First Reliance Standard Life Insurance Company Court: U.S. District Court for the Northern District of California Date of Decision: March 31, 2017 Type of Claim: Recovery of Long Term Disability benefits under the civil enforcement provision of the Employee Retirement Income Security Act of 1974 (“ERISA”). See 29 U.S.C. § 1132(a)(1)(B) (2012) Insurance Company: First …

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