MS Insurance Lawyers
- If you or a loved one have MS and need help getting health related insurance
claims paid, please contact us. Whether you are dealing with an ERISA
or non-ERISA governed claim for Disability Health, or Life Insurance,
or a claim for Long Term Care benefits, we can help.
- For over 20 years we have been successfully representing individuals with
MS, both in the appeals of denied claims, and in Federal Court litigation.
There is no charge for an initial consultation.
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throughout the United States who can help us help you.
Click on the link below for a PowerPoint presentation:
Multiple Sclerosis Cases
Letvinuck v. Aetna Life Ins.Co., 319 Fed.Appx. 661 (9th Cir. June 22, 2011)(unpublished)
In approximately 2003, Letvinuck was diagnosed with Multiple Sclerosis,
but continued to work despite symptoms of fatigue and cognitive decline.
After attempting to work from home, Letvinuck submitted a claim for disability
to her employer's claim administrator, Aetna. Aetna also funds the
benefits to be paid under the Plan. Aetna initially approved Letvinuck's
claim under the employer funded short term disability phase of the Plan.
As Aetna's own liability approached, under the long term phase of
the Plan, Aetna terminated Letvinuck's disability benefits. Suit was
filed in Federal Court. After a prior remand because the district court
failed to apply the appropriate standard of review, the Ninth Circuit
again heard plaintiff's appeal because the district court again ruled
for Aetna. This time, the court reversed outright based on
Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 962 (9th Cir. 2006) (en banc),
Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 108 (2008), and
Montour v. Hartford Life & Acc. Ins. Co., 588 F.3d 623, 630-31 (9th Cir. 2009). The court found several errors
in Aetna's determination: First, Aetna gave no consideration to a
Social Security award. Although the court did not deem that award binding
on Aetna, "not distinguishing the SSA's contrary conclusion may
indicate a failure to consider relevant evidence." Montour, 588 F.3d
at 635. The award was not mentioned at all when benefits were denied and
only acknowledged, but never distinguished, when the denial was upheld.
Although Aetna told the plaintiff after the appeal was denied that Social
Security uses different standards, the court ruled that failure to address
it offers support that the plan administrator's denial was arbitrary,
an abuse of discretion."
Salomaa v. Honda Long Term Disability Plan, F.3d , 2011 WL 2040934, at *11 (9th Cir. 2011).
Second, Aetna failed to adequately communicate to Letvinuck what additional
material or information was necessary to perfect her claim as required
by ERISA according to
Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863, 870 (9th Cir. 2008). Aetna never told the plaintiff what
was missing at a time when she could have obtained and submitted such
documentation. Although Aetna left a voice mail with her treating doctor
seeking "clinically objective findings," that was not enough
according to Saffon, 522 F.3d at 873 (communicating with a doctor rather
than the Plan participant is not meaningful dialogue). Aetna also denied
benefits without examining her. As Montour held, a "pure paper"
review of a Plan participant's claim "raises questions about
the thoroughness and accuracy of the benefits determination." Because
Aetna failed to engage in "a meaningful dialogue" with the claimant,
its decision was deficient.
For those reasons, Aetna's decision was viewed "with a high level
of skepticism" which caused the court to conclude that Aetna abused
its discretion in denying benefits. The court thus held:
Aetna based its denial of benefits on the absence of specific medical evidence
- evidence that Aetna did not tell Letvinuck she should obtain and send
to Aetna to perfect her claim. Aetna did not meaningfully explain why
it disagreed with the SSA's award of disability benefits, and only
attempted to do so when Letvinuck called Aetna after it had already denied
her appeal. Therefore, we reverse the district court's judgment in
favor of Aetna and remand to the district court with instructions to direct
an award of benefits.
Discussion: Although this ruling is unpublished and therefore non-precedential,
it is still extremely instructive. The two key issues raised by the court
(failure to distinguish Social Security and failure to inform the claimant
what evidence is needed), along with the sub-issue – the skepticism
raised by a pure paper review and lack of examination – are major
points to keep in mind as a checklist in future litigation.
KREEGER v. LIFE INSURANCE COMPANY OF NORTH AMERICA
(C.D. Cal. 2011) 766 F.Supp.2d 991
Margaret Kreeger, a 57–year–old woman who formerly held a high
level position as in-house counsel at BP Corporation North America, Inc.
(“BP”), suffers from multiple sclerosis (“MS”).
The condition was first diagnosed in 1988, but Ms. Kreeger managed to
continue working without accommodation for ten years. In 1998, due to
the progress of the disease, Ms. Kreeger's work schedule was modified
to permit her to work three days at the office and to tele-commute two
days each week. However, in December 2005, due to further deterioration
in her condition, including distress due to memory dysfunction, chronic
depression, anxiety and pathological fatigue, she was no longer able to
work. In May 2006, Ms. Kreeger applied for long term disability benefits
pursuant to her employee benefits plan and began receiving her requested
benefits a month later. Life Insurance Company of North America (“LINA”),
which funded and administered the disability benefits plan, approved the
application. However, on May 8, 2008, LINA notified Ms. Kreeger it was
terminating her benefits effective April 30, 2008. While Ms. Kreeger sought
to reverse this decision on appeal, LINA affirmed its denial of benefits
on October 29, 2008. Ms. Kreeger retained Kantor & Kantor, LLP to
commence legal action against LINA. A complaint was filed in U.S. District
Court on November 12, 2009, alleging a cause of action under the Employee
Retirement Income Security Act of 1974 (“ERISA”). In that
action, Ms. Kreeger contended that Defendants LINA and BP Welfare Plan
Trust–III's Insurance Plan wrongfully terminated her benefit
payments. She sought reinstatement of those benefits, payment of back
benefits, and interest to the date of Judgment. On February 28, 2011,
the Court found for Ms. Kreeger and ordered Defendants to pay benefits.
The Court’s order was based primarily on the fact tht LINA failed
to act fairly and reasonably in administering Ms. Kreeger’s claim
because it failed to 1) conduct a medical exam of Ms. Kreeger; 2) Provide
all relevant medical evidence to the doctors it hired to review her records;
3) give reasonable consideration that the Social Security Administration’s
award of disability benefits; 4) appeared to be motivated by protecting
its own financial interests and failed to show that any measures had been
taken to minimize the effects of that financial bias.
Gullige v. Hartford
Ms. Gullidge was a former Title Examiner for First American Title and participated
in her employer’s long term disability plan. Ms. Gullidge was diagnosed
with Multiple Sclerosis in the early 1980's, but continued to work
until 2002. She submitted a claim for disability benefits due to her progressive
weakness and fatigue. Hartford Insurance Company approved of plaintiff’s
claim and Ms. Gullidge was also awarded Social Security disability benefits.
Hartford then sent a confusing letter to Ms. Gullidge’s physician,
asking him if Ms. Gullidge could perform “sedentary work,”
even if she could only sit for less than 3 hours a day. The physician
misunderstood the letter and then later corrected his statement and advised
Hartford that Ms. Gullidge was absolutely disabled. Hartford refused to
accept the correction and terminated plaintiff’s benefits.
After litigating the case for several months, Hartford unilaterally decided
to reverse its claim decision and reinstated Ms. Gullidge to her benefits.