Software Engineer Denied ERISA Long-Term Disability, Wins In $125k in Mediation Settlement Agreement

Regardless of how informed and prepared you are, it can be difficult to achieve a desirable outcome should you find yourself going against one of the nation’s largest insurance companies. Our client, a software engineer forced to stop working due to orthopedic issues, recently discovered this firsthand when she was suddenly denied her ongoing long-term disability plan. This is where Donahue & Horrow LLP stepped in to assist the client in winning a settlement through mediation, allowing the client the resources to focus on her health. 

Our client, a hardworking software engineer,was forced to stop working after orthopedic issues and related pain prevented her from sitting at a desk and typing on a keyboard. Initially, the insurance company approved her claim under an “own occupation” definition of disability, and paid benefits. Two years later, the definition of disability changed, and our client was again required to provide evidence that she was unable to perform the “material and substantial duties of any occupation” to continue receiving long-term disability benefits. Despite providing this evidence, our client was suddenly denied her ongoing claim only a year later.  

Because our client’s insurance policy was provided by her employer, her claim was governed by ERISA. Under ERISA, when a claim is denied, a claimant cannot immediately sue. Instead, they must file an appeal with the very same company that denied the insurance claim. Only after a second denial can the claimant initiate litigation.  

Typically, Donahue & Horrow LLP advises insureds to seek the assistance of attorneys with ERISA experience when proceeding with an appeal due to the nuances and complexities of ERISA laws. However, our client initially handled the appeal herself, providing the insurance company with records and statements from two of her doctors to support her disability claim. She also submitted documents from a pain management clinic who reported that, despite everyone’s best efforts, her pain persistently worsened, radiating throughout her body. Unfortunately, without the assistance of counsel, she was unable to convince the insurance company to overturn its claim decision. 

This is where Donahue & Horrow LLP stepped in, joining our client in the legal battle against her insurance company. Once joining the case, our team quickly worked to file an ERISA lawsuit in the Orange County branch of the Central District Court of California. Even before the parties were given a trial date by the court, the insurance company agreed to conduct a mediation before an experienced ERISA mediator. At the mediation, a settlement was reached that will allow our client to focus on her health, without the mental, emotional, and physical undertaking of  reporting to the insurance company every month. Reaching this settlement allowed our client the necessary resources to recuperate without the overhanging fear of financial burden. 

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.