Verdicts and Settlements

Michael Horrow and his team at Donahue & Horrow LLP recently reached an early settlement in a lawsuit involving a teacher whose claim for disability insurance benefits under an ERISA-governed insurance plan was unfairly denied.

Our client was an Adapted Physical Education Specialist who provided adapted physical education sessions to students with disabilities. She loved her job and cherished the positive impact she had on the lives of her students. Unfortunately, she was diagnosed with multiple sclerosis, as well as anxiety, stress, and insomnia. The combined symptoms of these conditions prevented her from continuing to work.

After she filed a claim for disability insurance benefits, the insurance company initially agreed that our client was disabled and entitled to monthly benefits. Over the next year, she provided the insurance company with copies of her medical records. As would be expected given her diagnoses of stress, anxiety, and multiple sclerosis, those records did not reflect any substantial improvement in her condition. Instead, her treating physicians continued to report that she suffered from excessive worry, depression, forgetfulness, and panic attacks, and that she remained unable to return to work. Accordingly, she continued to receive monthly benefit payments from the insurance company.

Shockingly, after about a year, the disability insurer suddenly reversed course and determined that she was able to return to work. That conclusion was not based on any statements from her treating physicians, but instead relied entirely on a “paper review” report prepared by a physician paid by the insurance company who never examined or even spoke with our client. To add insult to injury, the multi-billion-dollar insurance company claimed that it had overpaid benefits and insisted that she owed the company several thousand dollars. She was instructed to immediately repay the alleged overpayment.

Our client timely appealed the claim denial, but the insurance company refused to reverse its decision. She then contacted our office, and we promptly filed a lawsuit in federal court in Los Angeles, California.

After receiving the lawsuit, counsel for the insurance company quickly reached out to discuss a possible settlement. The parties ultimately reached a confidential settlement without engaging a mediator. This resolution allowed our client to keep her costs down and avoid lengthy, drawn-out litigation.

If you need help fighting an insurance company, call Donahue & Horrow LLP at (877) 664-5407 for a free consultation. Donahue & Horrow are ready to fight for the benefits you deserve.