Above Full Value Settlement Secured in Long-Term Disability Insurance Claim Denial
We are thrilled to announce that once again, we have secured a settlement over and above the full value of the contract for our Monterey County-based client whose claim for long-term disability insurance benefits was improperly and unfairly denied. Moreover, Donahue & Horrow LLP was able to convince the insurance company to pay the favorable settlement shortly after filing the case without having to take a single deposition nor file a single motion.
Our client, a 58-year-old Police Records/Detention Supervisor for the City of Monterey, became disabled in June 2013 due to a variety of conditions including degenerative disc disease. This condition caused low back pain, fibromyalgia as well as severe depression and anxiety. Under the terms of the insurance policy, our client initially had to demonstrate that she was unable to perform the duties of her “own occupation,” and after two years, she had to demonstrate an inability to perform “any occupation.”
While the insurance company initially approved our client’s claim and continued to find our client disabled even after the definition of disability changed, the insurance company seemed determined to find an excuse to deny her claim.
In 2015 and 2016, the insurer conducted two thorough reviews but failed to develop evidence that she could perform the duties of any occupation given her restrictions and limitations. Yet that did not stop the insurance company from its efforts to continue to try to deny the claim.
In March 2020 – at the start of the pandemic, when no companies were hiring – the insurance company denied her claim, stating that she could suddenly return to work. The insurer’s decision relied on the opinion of a one-time medical examiner, who ignored the evidence supporting disability and a heavily flawed vocational review. The vocational review concluded that our client could return to her same physically demanding pre-disability occupation that six years earlier, the insurance company found she could not do.
After our office filed the lawsuit, the insurance company removed it to Federal Court, specifically the Northern District of California, San Jose Division.
Donahue & Horrow LLP’s Founding Partner, Michael Horrow, convinced the insurance company to reach a quick settlement with our client.
As a result, we were able to secure a large lump sum payment for our client to secure and invest in her future well-being. Additionally, the terms of the settlement included a provision whereby she would no longer have to certify her disability to the insurance company every month until she turned 65.
We Are Here to Help.</strong?
If your private disability insurance claim was unfairly denied, contact Donahue & Horrow LLP at (877) 664-5407 today, and we will conduct a free evaluation of your case. We are here to help you get the private disability insurance benefits you deserve and paid for.