Client Receives 65k Settlement in ERISA Long Term Disability Insurance Dispute

Having provided long-term disability payments for over seven years, one of the nation’s top insurers unexpectedly denied our client’s ERISA-regulated, employer-sponsored disability claim. Ignoring the ample proof backing his inability to work, they chose to rely entirely on the opinion of a nurse employed by the company.

If your insurance claim is denied, we typically recommend you contact an attorney

immediately. ERISA regulations are highly specific and failing to abide by them precisely can result in losing your rights. Having an attorney by your side will likely encourage insurers to take your claims more seriously.  Rather than hiring the help of a lawyer, our client filed a timely appeal, along with a sizable amount of medical evidence demonstrating his ongoing chronic conditions, as well as new medical issues. Despite this evidence, the company upheld its previous claims decision based entirely on an unqualified in-house medical reviewer, unreasonably but predictably.

 Fortunately, our client was eventually led to the capable hands Of Donahue & Horrow, LLP We promptly took action, quickly filing a lawsuit in the United States District Court for Central District of California, which covers disputes arising in seven counties: Los Angeles, Orange, Riverside, San Bernardino, Ventura, San Luis Obispo and Santa Barbara. In the ERISA Complaint, we requested that the Court award our client all past-due benefits, as well as attorneys’ fees and costs associated with the filing of the lawsuit. Under ERISA, a claimant cannot ask for all future benefits to be awarded, as is permitted in standard breach of contract and bad faith lawsuits.

Shortly after the lawsuit was filed, both parties agreed to conduct a mediation to resolve the dispute without the risk of trial. Michael Horrow presented a comprehensive summary of the medical evidence supporting our client’s claim. This included a synopsis of multiple surgeries our client underwent to treat and cure his various conditions, evidence that our client’s treating physicians repeatedly and consistently certified his disability and a finding by the Social Security Administration that our client’s medical condition prevented him from engaging in “any gainful employment.” Additionally, Donahue & Horrow, LLP. detailed how the company’s in-house nurse and physician reviewer ignored certain medical evidence for the sake of supporting the insurance company’s denial of the claim.

A favorable settlement was reached at mediation for our client, allowing him to move on with his life   without having to

answer to a hostile insurance company every month. 

If you believe your ERISA long-term disability insurance, short-term disability insurance life insurance or AD&D claim was improperly denied by your insurance company, call Donahue & Horrow, LLP at (877) 664-5407 for a free consultation.