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San Francisco Long-Term Disability Insurance Blog

Court opinions create permanent records of LTD insurer behavior

On June 28, 2018, a federal court in Mississippi issued a scathing decision ordering payment of past and future long-term disability benefits as well as attorney’s fees to LTD claimant, Juanita Nichols. One interesting aspect of this opinion is that the court described its own research into previous lawsuits against Reliance Standard Life Insurance Co., Nichols’ LTD insurer. 

Here at Roboostoff & Kalkin, Reliance is one of the large national insurers we have opposed on behalf of our clients.

Doctors’ understanding of the science of pain slowly sharpens

One common challenge in the quest for short- or long-term disability benefits is getting the insurance company to take the disabling nature of pain seriously. There is friction between insurers asserting that claimants have not objectively proven that they are disabled by pain and claimants who struggle to “prove” the pain that contributes to their disabilities. 

Pain is a subjective experience unique to each patient and there is no simple lab test or scan to objectively confirm its existence or intensity.

Another day, another court, another LTD insurer gets CFS wrong

We recently discussed the devastating disease chronic fatigue syndrome or CFS and its impact on the ability to work. Many long-term disability insurers have denied CFS-based claims, at least in part, because of the subjective nature of CFS symptoms and the difficulty of proving CFS disability when an insurer insists on “objective” proof. 

We also blogged about the medical community’s increasing understanding of CFS, an incurable condition that may be linked to immune-system disruption from stress or an infectious agent (especially Epstein Barr Virus or EBV, Ross River virus or Coxiella burnetii).

Reliance on SSDI safety net in lieu of LTD short sighted

If you are offered long-term disability insurance as part of your benefits package at work, you might be tempted to turn it down. Why pay for something (even if your financial contribution toward the premium is small) that you think you are unlikely to need? You may be young and healthy, and maybe you figure you can use Social Security Disability Insurance instead if you cannot work because of illness or an injury. 

This logic is not necessary sound. You should seriously consider options at work for LTD coverage (and if you are self-employed, you should investigate private policies). After all, if the two programs were the same, there would be a much smaller market for LTD policies.

Federal court sends disability claim back to administrator

A short- or long-term disability insurance policy is governed by applicable law and by its terms, as it is at its core a contract. Many a dispute comes down to an interpretation of the explicit terms of a disability insurance contract

On May 9, a judge released an opinion in the U.S. District Court in Kansas that looked at the definition of the phrase “totally disabled” within a policy. In Derichs v. AT&T Services, Inc., the court sent the case back to the claims administrator to reconsider the claim according to the court’s interpretation of this phrase.

Judge frowns on LTD insurer cherry-picking medical evidence

On May 8, a federal court in Washington state held that Aetna must pay back and future long-term disability benefits that had been denied to a claimant with multiple sclerosis, depression and other impairments. The judge was especially troubled by the insurer’s practice of “cherry-picking” through the medical evidence in the record. 

This LTD insurer practice is, unfortunately, an all-too-common basis for denying disability benefits. In cherry-picking, the insurer sifts through the medical record, emphasizing evidence that is less serious, while ignoring test results, symptoms and doctors’ opinions that support a finding of severe disability.

Disability claimant alleges disturbing claim processing practices

A disability-insurance claimant filed a lawsuit last week that contains alarming allegations of insurance company claims processing practices based on profit motives, rather than on good-faith efforts to determine whether claimants are disabled under the terms of their policies.

Court: LTD insurer improperly used video surveillance evidence

A federal appeals court said on May 3 that an injured claimant’s long-term disability benefits had been wrongfully terminated. An important issue in this case is the use by an insurance company of video surveillance of a claimant going about his daily life. 

Richard Wagner, a man with paraplegia from a motorcycle accident that happened decades ago in his youth, began receiving long-term disability benefits after a leg injury kept him from continuing his employment as a service analyst for a crane company. After 34 months, the disability insurer terminated his benefits, saying he could go back to his job full time.

Federal judge finds LTD claimant’s CFS, fibromyalgia disabling

In our last post, we talked about the increasing understanding of chronic fatigue syndrome, a disease that presents unique challenges in a long-term disability claim. As we wrote, while the symptoms of CFS are subjective, rather than being objectively provable via medical testing or observation, research is beginning to uncover subtle physical changes associated with CFS patients. 

Perhaps as research improves, reliable objective medical traits of CFS will be discovered, but for now, there are no reliable scans or lab tests to objectively prove the disease is present.

Medical understanding of chronic fatigue syndrome improving

Here at Roboostoff & Kalkin, we have represented many people who are disabled because of medical conditions that can be hard to prove, giving disability insurance companies an excuse to deny their claims. Chronic fatigue syndrome, known as CFS, is a classic example of this type of illness with its myriad of subjective symptoms. 

While symptoms like pain, fatigue and weakness may not be objectively measurable, they are still very real and can prevent people from being able to work.


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