Shook & Johnson has years of experience helping disability claimants against Hartford, Prudential, MetLife, CIGNA, Life Insurance Company of North America, UNUM, Standard Insurance, Aetna, Principal Financial, Union Central Life, Jefferson Pilot, and Lincoln National to name a few. Like any law firm, we’ve won some, lost some, and settled some. Because settlements are almost always confidential, the details of those cannot be described here. However, some of the firm’s recent administrative reversals and court cases are as follows:
- In 2012, represented a 62 year-old school employee following MetLife Disability’s decision to terminate LTD benefits, and on administrative appeal, the decision was reversed where the evidence confirmed the insured’s continuing treatment for heart disease, diabetes (with related lower extremity impairment) with symptoms of pain, fatigue, malaise, dizziness, blurred vision, and lower extremity numbness and weakness.
- Represented claimant on administrative appeal to Aetna Life Insurance Company where LTD benefits were terminated in 2012 after several years of payment, and on appeal, Aetna reinstated benefits upon being presented with substantial evidence of claimant’s continuing diagnoses of lumbar disc disease, chronic pain syndrome, radicular pain, and related severe limitation in physical capabilities.
- Represented insured on administrative appeal to Aetna Life Insurance Company in 2010 following its decision to terminate benefits under the any-occupation provision of the policy, and Aetna reversed its adverse decision where the evidence presented confirmed the insured had no ability to work because of his lumbar spine/cervical spine impairments and chronic pain.
- Represented insured in Galutza v. Hartford Life and Accident Ins. Co., 2010 WL 1329985 (N.D. Okla., March 30, 2010) in claim for LTD benefits and obtained judgment in client’s favor that Hartford’s decision to terminate client’s LTD benefits was arbitrary and capricious, and its notice of denial was inadequate and deprived him of a full and fair review as required by ERISA.
- Represented insured with congestive heart failure in administrative appeal to CIGNA in 2009, and insurer reversed termination of LTD benefits where its original decision was based on a file review by an unqualified staff physician and it disregarded the SSA’s approval of client’s disability claim.
- Represented insured with right shoulder impairment in administrative appeal to CIGNA in 2009, and insurer reversed termination of LTD benefits under “own occupation” plan provision where objective medical evidence showed client could not perform the tasks of overhead lifting, reaching, or pushing/pulling away from his body as would be required while traveling (which was an occupational requirement).
- In Tinkler v. Level 3 Communications, LLC, 2008 WL 199901 (N.D. Okla. Jan. 22, 2008) represented employee in claim for severance benefits and obtained Court-ordered remand of Plan’s claim denial because decision to deny the claim was not supported by substantial evidence.
- Represented client in Fielder v. UNUM Life Ins. Co. of America and obtained court order dated March, 31, 2008, reversing and remanding UNUM’s decision to discontinue payment of LTD benefits because its conclusion that client could perform the essential job functions of a respiratory therapist was not supported by substantial evidence.
- In 2008, represented LTD claimant with Lyme’s disease and associated neurological decline with increasing problems with balance, gait, cognitive function, memory and emotional stability in administrative appeal to Lincoln National Life Insurance Company and insurer reinstated benefits where the substantial evidence showed client unable to perform the duties of her job as an assistant school superintendent.
- Represented insured in Painter v. Black & Decker Disability Plan and obtained court order and judgment in client’s favor in 2008 that the Plan’s termination of LTD benefits was arbitrary and capricious, and employee awarded past-due benefits and reinstated into the Plan.
- Represented insured with mental impairments in administrative appeal to Prudential Insurance Company of America in 2007 and insurer reinstated LTD benefits for 24 months where the substantial evidence showed the client was unable to perform the duties of his job as an aircraft mechanic.
- Represented insured with significant vision impairment in STD claim against Metropolitan Life Insurance Company in the United States District Court for the Eastern District of Oklahoma in 2006 and obtained judgment in client’s favor overturning the denial of client’s claim because of serial procedural irregularities in the administrative record such that MetLife’s decision was arbitrary and capricious.
- Represented client in Ford v. AEP LTD Plan and Kemper National Services, Inc. and obtained court order dated November 14, 2004, holding that Kemper breached its fiduciary duty to client by failing to provide her an adequate denial notice and therefore deprived client of her right to a full and fair review.
- In Hughes v. UNUM Life Ins. Company of America, the federal court for the Northern District of Oklahoma found that client was totally disabled pursuant to severe coronary artery disease and dystonia and entered an order dated March 16, 2003, finding UNUM’s decision to terminate LTD benefits was arbitrary and capricious.
- Represented client in Horn v. Cendant Operations, Inc., 2003 WL 21513210 (10th Cir. 2003) and obtained reversal of district court’s entry of summary judgment in favor of employer on claim of breach of fiduciary and duty; and obtained judgment in client’s favor that Cendant breached its fiduciary duty under ERISA by failing to inform her of the “actively at work” provision defining eligibility for LTD benefits.
- Represented LTD claimant with Lyme’s disease in Schwob v. Standard Insurance Co., 37 Fed. Appx. 465 (10th Cir. 2002) and obtained reversal of district court’s entry of summary judgment in favor of insurer.
Of course, past successes do not guarantee a similar outcome in any future cases or claims as each ERISA-related matter turns on its own particular set of facts.