Disability Case Studies

Case Studies

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Sampling of court decisions in which Rosen Moss Snyder LLP was lead plaintiff’s counsel:


Benefits Plan Description is a ‘Contract’

An insurance company’s short-term disability benefits program for its employees created an enforceable contract under Pennsylvania law.
The Pennsylvania Superior Court ruled that the “summary plan description that Capital Blue Cross gave to BE laid out the terms and conditions under which the company would pay short-term disability benefits, so she could sue the company for breach of contact when she claimed it unfairly terminated those benefits.  The Superior Court reversed the trial court’s summary judgement ruling that BE had not express or implied contract for short-term disability and that as an at-will employee, she had not guarantee of employment for a definite term let alone specific benefits.

Insurer Engaged in a Bad Faith Review in Terminating Claimant’s Disability Benefits

CL was placed on disability benefits for major depression by both her treating psychologist and psychiatrist. Thereafter, CL underwent a comprehensive psychological evaluation which further supported her total disability status. The insurer, Cigna, terminated CL’s disability benefits and in doing so disregarded the assessments of CL’s treating providers. Instead, Cigna relied on an internal medical assessment. After commencing ERISA litigation, and filing cross motions for summary judgment, the Court ruled that Cigna “relied on unreasonable inference made from isolated and out-of-context notations in the medical record, an incomplete paper review by a psychiatrist who never examined Plaintiff, and a lack of information about Plaintiff’s job demands.” In granting CL’s motion for summary judgment and granting an award for attorneys’ fees, the Court held that “the medical record was unambiguous as to Plaintiff’s inability to perform her previous occupation, and Defendant’s strenuous efforts to conclude otherwise evidence a bad faith review.”
Levine v. Life Insurance Company of North America 14-7050-E.D.Pa 2016-1

Claimant not Bound by Policy’s Two Year Mental Health Limitation

JB was diagnosed as suffering from Schizoaffective Disorder. He was deemed to be disabled by Aetna Life Insurance Company, and approved for long term disability benefits. Aetna thereafter terminated JB’s LTD benefits based upon its interpretation of the policy’s two year mental health limitation. JB appealed, arguing the policy’s mental health limitation provided an exception for conditions demonstrating “structural brain damage.” Aetna denied JB’s appeal for ongoing disability benefits in contravention of his treating psychiatrist’s report, and based upon its own medical record review reports. After commencing litigation pursuant to ERISA and filing cross-motions for summary judgment, the Court ruled that Aetna’s decision to deny JB’s claim was “arbitrary and capricious” and JB’s claim was remanded back to Aetna for proper handling in accordance with the Court’s decision.
Berkoben v. Aetna Life Insurance Co., 12-1677, (W.D.Pa 2014).
Berkoben v.Aetna Life Insurance Co – Report and Recommendation

Deteriorating Low Back Condition

CH suffered from a progressively deteriorating low back condition. After several months of failed conservative treatment, she underwent a lumbar fusion surgery which only afforded limited pain relief. CH was placed on disability by both her primary care physician and neurosurgeon. Aetna Insurance Company denied both her claim and appeal for disability benefits based upon medical record review reports. After commencing litigation pursuant to ERISA and filing cross-motions for summary judgment, the court ruled that Aetna’s decision was “arbitrary and capricious” and CH was awarded her disability benefits.
Harper v. Aetna Life Insurance Co., 10-1459, (E.D.Pa 2011).

Cardiac Artery Disease

FM was diagnosed by his treating cardiologist as suffering from severe cardiac artery disease, which could be fatal if exposed to workplace stress if he continued working as a warehouse manager. Unum’s consulting physician denied there was any nexus between workplace stress and an increased risk of a cardiac incident. Unum denied FM’s disability claim on this basis. After filing cross-motions for summary judgment, the court awarded FM disability benefits pursuant to ERISA, upon finding that Unum’s denial was not reasonable.
McGuigan v. UNUM, 02-cv-7691 (E.D.Pa.)

Degenerative Hip Condition

AB was a pharmacist who suffered from a degenerative hip condition. The insurer, Unum denied her claim for long term disability benefits based upon an alleged pre-existing condition. After commencing litigation and filing cross-motions for summary judgment, the court found in accordance with ERISA, that Unum’s decision to deny AB’s claim was without merit and an abuse of discretion. The court awarded AB disability benefits.
Bryant v. UNUM, 04-cv-3819 (E.D.Pa.)

Visual Disorder

EP was employed as a nurse. She suffered from a rare visual disorder which caused loss of vision, excessive blinking, and extreme light sensitivity. Both her treating eye specialist and neurologist said she was unable to work. The insurer denied EP’s claim and appeal for disability benefits. Following the commencement of litigation and the filing of cross-motions for summary judgment, in accordance with ERISA, the court ruled that the insurer, CNA, wrongfully denied EP’s claim for benefits. She was awarded both short term and long term disability benefits.
Patton v. Continental Casualty Co., 04-cv-00220 (E.D.Pa.)

Lumbar Fusion

CH was injured in an automobile accident, and had a lumbar fusion in 1991. She continued working for 14 years during which time her back continued to deteriorate. In 2005, she had a second fusion which afforded very little pain relief. All of her treating physicians opined she was completely disabled from employment. The insurer, Prudential, terminated CH’s claim based upon two medical record reviews. Upon the commencement of litigation, the parties filed cross-motions for summary judgment. Though the trial judge ruled in favor of Prudential, the Third Circuit reversed finding that Prudential’s denial was an abuse of discretion. CH was awarded long term disability benefits.
Hession v. Prudential 06-cv-01641 (E.D.Pa).

Degenerative Lumbar and Cervical Disc Disease

For more than 25 years, AK was employed as a senior project manager for a large corporation. For several years, AK suffered from progressively severe degenerative lumbar and cervical disc disease. She treated with several prominent orthopedic and neurosurgical specialists; all of whom categorically opined that she was medically and physically unable to continue working. The insurer, MetLife terminated AK’s long term disability claim based upon two medical reviews even though there was no evidence to suggest AK’s physical condition had improved. After filing a lawsuit and the submission of cross-motions for summary judgment, the court ruled that MetLife had no reasonable basis for terminating the claim. AK’s long term disability benefits were thus reinstated.

Kaufmann v. MetLife, 08-2587 (E.D. Pa).

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