ERISA Disability Lawyer
Michael A. McKuin
Long Term Disability Claim Denials
California Long Term Disability Insurance
Long Term Disability and Health
Benefit Claims, Litigation and Appeals.
Serving California from San Diego to the Bay Area
Phone: 1-760-565-7598; Email:
mike@mckuinlaw.com
© 2014 by Michael A. McKuin
(California State Bar No. 103328)
The information provided at this website is intended for educational and promotional purposes only. It is strictly general in nature and under no circumstance should it be considered legal advice. Every case is unique and a competent, qualified lawyer must be consulted for legal advice regarding any specific case.
If you won't accept that amount, how about this amount?
We've changed our mind. We don't want to pay you anymore.
Sometimes a letter and a few phone calls will do the trick.
Termination of Long Term Disability Benefits Based on False medical reviews.
Health claims denied based upon the application of undisclosed medical criteria for determining "medical necessity".
If you can't deny it, just delay it for as long as you can.
Managed care criteria are not necessarily plan criteria.
Is a notification really a notification if you never see it?
We don't believe your doctors; we don't believe our own doctor; and we don't believe you do what you do. Oh, you have a lawyer. Let us rethink that.
Denial of Long Term Disability claim based on an inapplicable "pre-existing condition" provision.
Rickey Thomas Sebo v. Metropolitan Life Insurance Company, Allstate Long Term Disability Plan, CV 99-10770 HLH; (9th Cir. Case No. 00-55765)
I h...
Oasis Treatment Center, Inc. vs. The Travelers Insurance Co. (Related Cases) Case Nos: SACV 97-799 AHS and SACV 97-800 AHS (9th Cir. Case Nos: 99-5...
If the standard of review is deferential, logic goes out the window.
Rick R. (Plan administered and insured by Massachusetts Mutual Life Insurance Co.)
Rick R. was admitted to a residential treatment center, where he und...
Benefits terminated benefits after four years, even though nothing changed.
Sally Haithman vs. Unisys Corporation, CV 98-5800 KMW
Ms. Haithman was in her early-40s, and had worked for UNISYS as a systems analyst for 9 years when she became disabled as a result of several debilitating illnesses. It was the consensus of her treating doctors that she might be able to work around any one of her physical problems. But in combination, they rendered her totally disabled from any occupation that she was qualified for.
Ms. Haithman was covered under her employer's self-funded Long Term Disability (LTD) plan, administered first by The Travelers and then later by The Hartford. The Travelers approved her LTD claim for "Own Occupation" benefits, which were paid for the first two years. After that, The Hartford continued to pay her benefits for almost another two years, while it engaged in an on-going "investigation" to determine her eligibility for "Any Occupation" ("Any Occ.") benefits.
The Hartford's "investigation" could aptly be described as somewhat less than diligent. There were enormously long gaps in time, when The Hartford did nothing, except to send some perfunctory (and clearly unnecessary) letters to Ms. Haithman's primary care doctor. This was done in a transparent effort to keep the claim investigation alive. The "investigation" included two "Independent Medical Examinations" (IME), but neither shed any new light on the facts of her claim.
Although nothing had changed for almost 4 years, The Hartford cut off her benefits, contending that there were several jobs she was qualified to do by virtue of an advanced psychology degree she had. Ms. Haithman did have a Masters degree in psychology; but the degree was more than 15 years old when she became disabled and she had never before used it professionally. She had never been licensed as a psychologist. Moreover, The Hartford had known the full extent of her educational background all along. Therefore, the abrupt cutting off of her benefits was based upon the exact same information that had been reasonably available to The Hartford from the beginning. In addition, when The Hartford did cut off her benefits, it did so without any analysis at all. It just pulled a bunch of job descriptions out of a Dictionary of Occupational Titles (DOT) job classification manual, all of which were completely unrelated to Ms. Haithman's education, training and experience. There wasn't a shred of evidence in the administrative record that she was physically capable of doing any one of those jobs.
The medical evidence that was in the administrative record clearly established the extent of her impairment. The Hartford's own IME Physicians had even recommended further testing and evaluation, which The Hartford never did. The denial of her long term disability benefits was based upon a mere contention -- rooted in a theory or hypothesis -- that there must be "some job" that she could perform effectively. But there was no substantial evidence in the record to support that contention. It was a denial based upon speculation, conjecture and bare conclusions. The denial was a textbook ERISA abuse of discretion.
Result: A lawsuit was filed. The case was resolved satisfactorily.
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