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Case Summary Blog

Brown v. LINA – Can A Peer Review Doctor Outweigh My Doctor’s Opinion?

In this case, the Court found that the Plaintiff’s complaints of pain were credible there was no reason to question the Plaintiff’s credibility. As such, the Defendants’ motion for decision was denied and Plaintiff’s motions was granted.

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Abrams v. Unum – It’s the Disabling Symptoms That Matter, Not the Exact Medical Label

Today we review Abrams v. Unum Life Insurance Company of America that was decided by the United States District Court for the Western District of Washington. William Abrams was a trial and appellate lawyer for the Schwabe law firm. His disabilities were described as debilitating symptoms from an illness. Although the exact medical condition was …

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Paquin v. Prudential – Insurer Wrongfully Disregarded Opinions Of Treating Physicians

In this case, the claimant won a reinstatement of his long term disability insurance benefits in the United States District Court for the District of Colorado. The Plaintiff’s Medical History and Claim History:  Mr. Paquin worked for Transistor Devices, Inc. as a Business Development Director. In 2003, Mr. Paquin contracted encephalitis from a mosquito infected …

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Robinson v. Aetna – Claim Sent Back to Insurer to Assess Disability Under Plan’s “Any Occupation” Definition

Plaintiff Laverne Robinson brought a lawsuit against Aetna Life Insurance Company (“Aetna”) and Mondelez Global LLC Employee-Paid Group Benefits Plan (“the Plan”) for unpaid long-term disability (“LTD”) benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”). Robinson was a former utility machine operator for Mondelez. As an employee, she could receive disability benefits under the Plan. Aetna served …

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Court Finds Plaintiff Failed to Meet His Burden of Proof for Long-Term Disability

On April 7, 2023, the United States District Court for the District of Massachusetts decided an ERISA long-term disability insurance case against the Unum Insurance Company of America. The Court ruled in favor of Unum. The claimant worked with Symbiotic LLC Plan as the Director of Software Quality Assurance. He had worked in the computer software and information …

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Arenson v. Unum – Court Ruled In Favor of Unum Under Deferential Standard of Review

Today we review Arenson v. First Unum Life Insurance Company that was decided by the United States District Court for the Northern District of Illinois. Gregg Arenson was a futures and options trade broker. He sued his former employer’s benefits administrator, First Unum Life Insurance Company (hereinafter “Unum”) under ERISA. He challenged Unum’s denial of …

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Moseley v. Unum – Unum Should Have Ordered an IME to Determine if Disability Was Mental or Physical

Unum paid long term disability (LTD) insurance benefits to Susan Moseley, but stopped paying after a period of time pursuant to the mental illness limitation in her long term disability policy (a policy is also called a “plan” of benefits). Moseley appealed the case all the way to federal court, arguing that Unum abused its …

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Marselle v. Unum – Kentucky District Court Finds Unum Made a “Reasoned Determination”

Jonni Marselle was covered for long term disability (LTD) benefits under a group plan provided to Humana, Marselle’s former employer. Marselle was a consultant with Humana. The position was sedentary as it required her to constantly sit, occasionally stand, and occasionally walk. She mostly did computer work. Her disabilities included immunodeficiency, serious back pain, sinus …

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Foss v. Standard – “Own Occ” is With Any Employer, Not With Specific Employer

I’ve been away from case summaries for a bit. Going to turn that around with a recent decision in Foss v. Standard Insurance Company, Case No. 20-cv-2449, decided by the United States District Court for the District of Minnesota on August 19, 2022. Unfortunately, the Court ruled in favor of the insurance company. Plaintiff Caroline …

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Fowkes v. MetLife – Plaintiff Did Not Prove She Was Disabled

Ms. Fowkes does not contend the Plan’s written evidence requirement violates ERISA. Instead, she takes issue with MetLife’s procedures to evaluate her LTD claim. In particular, she contends MetLife required her to present “objective evidence” supporting her LTD claim. At the hearing, she argued that MetLife did not consider the cumulative effect of her conditions in determining whether she adequately established disability. MetLife contends subjective reports of pain need not be taken at face value and argued at hearing that no disability is established even when considering Ms. Fowkes’s conditions in combination.

Fowkes v. MetLife – Plaintiff Did Not Prove She Was DisabledRead More