Gloria Archuleta worked as a Customer Service Representative, for Hub Industries.
Her job required constant sitting. Ms. Archuleta began to experience severe
pain and sudden attacks on her right side, which rendered it impossible
for her to sit for more than brief periods. Ms. Archuleta underwent surgery
and was subsequently prescribed strong pain medication to alleviate her
continuing pain. Ms. Archuleta’s doctors consistently supported
her disability and advised the insurer that plaintiff’s ability
to perform her job was impaired by not only her pain, but her strong pain
medication. The trial court held, in a published opinion, that Reliance
Standard acted in an arbitrary and capricious manner when it terminated
the benefits. The insurer ignored Ms. Archuleta’s reports of pain
and failed to investigate or consider the side effects of her pain medication.
Archuleta v. Reliance Standard Life Ins. Co
., 504 F.Supp2d 876 (C.D., Cal, 2007).
Dr. Abdel Malek is a physician at Kaiser, where he had to discontinue his
full time practice due to a cardiac condition. He had been advised to
work only part time because the stress of his full time job increased
the possibility of a serious heart attack. Kaiser’s disability insurer,
CIGNA, refused to pay Dr. Abdel Malek his disability benefits, stating
that if Dr. Abdel Malek was “capable” of working part time,
he was “capable” of working full time.
The case was tried and the trial court issued an opinion which was published.
The trial court found for Dr. Abdel Malek and stated that the severe risk
associated with a full time practice was sufficient grounds for disability
status. The Court stated: “...it would be unreasonable to interpret
“capable” to mean “capable until your condition kills
Abdel Malek v. Life Ins. Co. of N. America
, 359 F.Supp2d 912 (C.D., Cal, 2005).
Chronic Fatigue Syndrome
Kantor & Kantor, LLP represented cameraman suffered from chronic fatigue
syndrome and was unable to perform the duties of his occupation. His claim
was denied by his disability insurer, who failed to conduct any meaningful
investigation of the claim.
Kantor & Kantor, LLP filed suit and after a brief period of discovery
filed a motion for summary judgment, requesting the Court to enter judgment
in plaintiff's favor without a trial, and as a matter of law. The
Court granted our motion for summary judgment. As a result, our client
received all benefits under his policy up to age 65, a significant amount
of damages for emotional distress and payment for his attorneys' fees,
for a total of over $900,000.
Degenerative Disc Disease
Sonya Schvartsman managed the Quality Control Department of a large chemical
company for 22 years. After 22 years of employment, Ms. Schvartsman could
no longer perform the duties of her job, which required light lifting
and extensive walking, due to degenerative disease in her back, pulmonary
difficulties and depression. The insurer for the employer, Prudential
Insurance Company, initially approved her claim. However, 10 months later,
Prudential terminated her benefits, without obtaining updated relevant
records. Ms. Schvartsman appealed and during the appeal, Prudential sent
her claim file to a physician to obtain a second opinion. The physician
supported Prudential’s termination.
At trial, the Judge remanded the case back to Prudential to permit Ms.
Schvartsman to submit evidence rebutting the opinion of Prudential’s
reviewing physician. Kantor & Kantor, LLP discovered that the physician
was not experienced in the field and that his “expertise”
appeared to be limited to cosmetic procedures, such as Botox injections.
After receiving this evidence, Prudential reversed its claim decision
and Ms. Schvartsman was awarded her back benefits. Schvartsman v. Prudential
Ins. Co. of America, Civil Action No. CV05-1950 PA (Ex)
Depression - Addiction
Kantor & Kantor, LLP represented a doctor seeking benefits due under
three policies of disability income insurance. Our client was rendered
totally and permanently disabled from his former occupation as an anesthesiologist
due to severe depression and narcotic addiction, as defined under the
disability insurance policies. Defendants unreasonably denied our client's
claims without justification, and terminated his claims in reckless disregard
of his rights as an insured. The insurers' bad faith was evident from
their conduct. They failed to properly investigate our client's claim,
they ignored the opinion of our client's treating physician, they
misrepresented facts to our client, and they failed to obtain an independent
We settled the case favorably for our client.
Our client came to Kantor & Kantor, LLP after unsucessfully seeking
treatment from Kaiser for a severe eating disorder (bulimia). For four
months, she tried to obtain appropriate treatment, but Kaiser offered
only inconsistent appointments with unqualified personnel. Without appropriate
treatment, her condition worsened and she became suicidal. Even at that
point, Kaiser advised our client that there was no appropriate treatment
program available within the Kaiser system. Our client’s family
researched the question and found a program that was designed specifically
to treat the condition. Pursuant to the terms of her Plan, our client
requested Kaiser to authorize a referral to that program, and that Kaiser
pay for her treatment. Kaiser refused.
Fearful for her daughter's life, our client's mother arranged
to admit her to the program at the family’s expense. Our client
remained in a special facility as an in-patient for about a month. On
appeal, Kaiser upheld its denial of the claim, and never even responded
to our client's request for a list of available providers within the Plan.
Based on our lawsuit, the court held that Kaiser's behavior was wrongful,
unreasonable, irrational, and contrary to the evidence, the terms of the
Plan and applicable law. Kaiser was further ordered to pay all fees and
costs of our client's treatment, and attorney’s fees and costs
related to the litigation. You can read the court order by clicking here.
Kantor & Kantor, LLP represented a Customer Care Advocate who suffered
from fibromyalgia. Plaintiff's job was largely sedentary, requiring
that she sit at her desk for nearly all the work-day. After several short-term
disability leaves, plaintiff filed for long-term benefits. Despite reports
from her doctor indicating that she was unable to perform her job duties,
plaintiff's claim was denied. Plaintiff appealed this decision, included
additional doctor's reports and statements from family and friends
describing her deteriorating physical condition, but was repeatedly denied benefits.
The Court, after a de novo review of defendant's denial, overruled
defendant's administrative decision, entering judgment for the plaintiff.
Plaintiff's long-term disability benefits were resumed and defendant
was ordered to pay plaintiff's attorney fees.
Fibromyalgia & Chronic Fatigue
Kantor & Kantor, LLP represented an accountant who suffered from chronic
fatigue and fibromyalgia. Her claim was denied by her disability insurer
who failed to adequately consider plaintiff's attending physician's
diagnosis of total disability.
Kantor & Kantor, LLP filed suit and the Court granted summary judgment
for plaintiff, finding a conflict of interest existed which showed defendant's
denial of benefits was unreasonable. Defendant was ordered to pay disability
benefits to plaintiff.
Fibromyalgia & Chronic Fatigue
Defendant Paul Revere approved plaintiff's long-term disability benefits
claim under the "Other Limitations" policy provision which covers
psychiatric conditions, and was therefore subject to the 24-month policy
limitation for disorders caused or contributed by a psychiatric disorder.
Plaintiff, who suffered from fibromyalgia and chronic fatigue, initiated
an administrative appeal of Defendant's decision which was denied.
Kantor & Kantor, LLP filed suit and after a bench trial, judgment was
entered in favor of the plaintiff. Defendant was ordered to resume payment
of long term disability benefits in accordance with the policy.
Fibromyalgia & Chronic Fatigue Syndrome
Kantor & Kantor, LLP represented an attorney who, after years of successful
practice, became totally disabled due to Fibromyalgia, Chronic Fatigue
Syndrome, and a sleep disorder. Before coming to us for help, she had
filed her own disability claim, and after it was denied, she filed an
appeal. Despite our client's repeated requests to her insurer for
an independent medical examination, and despite medical opinions from
various treating doctors supporting our client's disability, her claims
were denied. The insurer justified its continued denials based upon a
review by one of its own in-house nurses and the opinions of another doctor
who never examined her.
We filed a lawsuit and argued that the insurance company failed to adequately
investigate our client's claims, ignored pertinent evidence establishing
her disability, and refused to entertain reasonable requests from our
client. We settled the case to the satisfaction of our client.
Hartford Insurance Company offered a supplemental life insurance program
to the employees and their families of Sargent Fletcher. Our client, Donald
Gaines signed up for the Supplemental Life Insurance, purchasing coverage
for his wife. The life insurance premiums were deducted from his paycheck
for five months and transmitted to Hartford. After five months, Mrs. Gaines
passed away unexpectedly and Mr. Gaines filed a claim for the benefits.
Hartford denied Mr. Gaines’ claim, stating that the employer failed
to submit the proper paperwork when it enrolled its employees in the life
We brought suit against both the employer and Hartford and we were successful
inobtaining a verdict in our client’s favor. The trial court held
that the Policy was ambiguous as to what type of paperwork was required
to be submitted to properly enroll in coverage and that after accepting
premiums, the insurer could not deny the claim. Gaines v. The Sargent
Fletcher, Inc. Group Life Ins. Plan, 329 F.Supp2d 1198 (C.D., Cal., 2004).
Through his employer, our client obtained accidental death life insurance
for his wife. Mrs. McKean underwent minor surgery for an injury she sustained
in a trip and fall accident. After the surgery, Mrs. McKean went home,
went to bed and died unexpectedly that evening in her sleep. Mr. McKean
submitted a claim for the life insurance benefits, on the basis that his
wife’s trip and fall was an accident; entitling him to benefits.
Aetna Life Insurance denied the claim, relying on a provision in the Policy
that losses due to a “bodily or mental infirmity” were excluded
under the Policy. However, in denying the benefits, Aetna ignored another
provision in the Policy which provided benefits for losses “due
to surgery when needed for an injury.” The Trial Court interpreted
the Policy in plaintiff’s favor and awarded benefits. McKean v.
Aetna Life Ins. Co., Civil Action No. EDCV 04-01104 (Central District
of California, Eastern Division).
Kantor & Kantor, LLP represented Plaintiff who sought payment of a
life insurance policy after his wife died. Defendant's refused to
pay more than $20,000 of the $150,000 policy despite Plaintiff's timely
payment of premiums on disclosure of all information solicited by Defendant.
Kantor & Kantor, LLP filed a motion for summary judgment, requesting
the Court to enter judgment in plaintiff's favor without a trial,
and as a matter of law. The court granted our motion for summary judgment.
As a result, our client received all benefits under his policy and payment
for his attorneys' fees, for a total of over $150,000.
Our client's husband died in a tragic bicycle accident. When she made
a claim for benefits under his employer provided life insurance policy,
the insurance company refused to pay. Its reason was that the husband
had failed to properly complete the insurance enrollment forms. While
it was true some of the forms were not filled out, the fact of the matter
is that no one ever provided him with the forms or oterwise asked him
to fill them out. We filed suit against the employer and the insurance
company, and after about 5 months were able to enter into a favorable
Malignant brain cancer took the life of the husband of another of our clients.
He too had life insurance through his employer. It was a $1,000,000 policy.
When his wife made a claim, the insurance company denied it in part saying
that her husband was only entitled to $500,000 in benefits because he
did not complete an "evidence of insurability" form. No one
ever provided him with, or told him to complete an evidence of insurability
form. Moreover, the employer had been deducting premiums from his paycheck
representing payment for the full $1 Mil in insurance. We filed suit against
the employer and the insurance company to force them to pay the remaining
$500,000 in benefits. After about 3 months, we were able to settle this
case to the satisfaction of our client.
Long Term Care Benefits
Our client, Mr. Frank, purchased a Long Term Care policy many years ago
for both himself and his wife. The insurance company eventually became
Conseco Senior Health Insurance Company and then, due to some interesting
financial difficulties, morphed again into Senior Health Insurance Company
of Pennsylvania also known as S.H.I.P. When Mr. Frank's wife became
ill and needed home health care, he submitted the bills and paperwork
related to that home health care to S.H.I.P. for payment. S.H.I.P. refused
to pay benefits on the grounds that the home health care agency Mr. Frank
had hired was not appropriately licensed or federally certified to provide
Home Health Care. The fact is, however, that California does not require
any specific license related to providing home health care services.
After we filed a lawsuit in Federal Court for Mr. & Mrs. Frank, S.H.I.P.
immediately agreed to pay benefits, and acknowledged that they had made
a mistake in the original denial.
If you have a Long Term Care policy that provides benefits for "Home
Health Care Services," or services from a "Home Health Care
Agency," "Personal Care Services" or "Instrumental
Activities of Daily Living," and benefits have been denied, we may
be able to help.
Long Term Care Benefits
Kantor & Kantor, LLP represented an 88-year old woman in her pursuit
of benefits under a Long Term Care Policy. Our client submitted a claim
because she could no longer attend to her basic daily activities and needed
a home health aide to assist her. The Long Term Care policy expressly
provided for these types of benefits. Our client complied with all of
her obligations under the Policy and submitted proof of her need for a
care-giver from her doctor, her daughter, and the care-giver herself.
Her insurance company denied the claim. We argued that the denial was
made in bad faith due to failure to properly investigate the claim, a
failure to notify the client of the reasons for denial, and failure to
comply with California law regarding obligations of insurers in handling
claims. We settled the case favorably.
LUPUS - Disability
Our client, Mrs. Wible, was an employee of The Boeing Company. She came
to Kantor & Kantor, LLP for help in obtaining Long Term Disability
(LTD) benefits from Aetna. While employed, Mrs. Wible became totally disabled
due to Lupus, and was thus entitled to benefits under the LTD Plan of
the Boeing Company.
Her claim was initially paid by Aetna, but was then later denied. Mrs.
Wible appealed the denial. Tragically, while the appeal was pending, Mrs.
Wible died from complications of her Lupus.
Incredibly, even though Mrs. Wible died as a result of Lupus within just
six months of the date that Aetna determined she was no longer disabled,
Aetna denied her appeal post-mortem. We succeeded in getting a Court order
stating that Aetna ignored, or at best, discounted the credible evidence
of her disability. That evidence included the opinions of Mrs. Wible's
long-time treating physician, Aetna's own physician who reviewed Mrs.
Wible's file, Aetna surveillance evidence and the Social Security
Administration findings of Mrs. Wible's disability. The Court found
that Aetna was "bent on denying" Mrs. Wible's claim and
oblivious to its fiduciary obligations as an LTD Plan administrator.
You can read the court order by clicking here.
Aetna paid 100% of all benefits and attorneys fees.
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.
Our client was an Office Manager for Edward Jones and required back surgery.
When her recovery from surgery did not progress as anticipated, she underwent
Neurological testing, which revealed that she suffered from Parkinson’s
Disease. When she advised Continental Casualty that she would not be able
to return to work as previously anticipated, the insurer refused to pay
further benefits. Hartford Insurance Company then assumed the obligations
under the Policy and had our client’s records reviewed by a medical
reviewing service that it routinely uses. Kantor & Kantor, LLP successfully
tried this action and the trial court found that Hartford erroneously
evaluated plaintiff’s disability, using a “sedentary occupation”
standard when the insurance policy only required that one be disabled
from their own occupation.
Rorabaugh v. Continental Cas. Co
., 2006 WL 4384712 (C.D., Cal, 2006).
Hartford then appealed the trial court’s verdict and the Ninth Circuit
upheld the decision in favor of our client. Our client was awarded benefits
from August, 2005 to the present.
Rorabaugh v. Continental Casualty Company
, 321 Fed. Appx. 708, 2009 WL 979885 (9th Cir., 2009).
The plaintiff worked as a Support Assistant for Safeco Insurance Company.
In 2000, Ms. Broderick began to experience problems with her shoulders,
elbows and hands. She was eventually diagnosed with “frozen shoulder”
and carpal tunnel syndrome. Although Prudential paid her benefits for
two years, it terminated her benefits after 2 years, claiming that Ms.
Broderick could perform another occupation for which she was suited by
virtue of her “education, training and experience.” However,
Prudential failed to realize that Ms. Broderick’s medical conditions
made it impossible for her to reach and type, which were activities required
for any suitable alternative occupation. The trial court agreed and rendered
judgment for plaintiff. Broderick v. Prudential Ins. Co. of America, Civil
Action No. CV04-0719 GAF (Central District of California)
Our client, Carl Barteau was a former College Professor, who had always
experienced vision problems. However, in 2002, his vision worsened and
the treatment which he received caused extreme pain and migraines. In
addition, Mr. Barteau suffered from multi disc degeneration in his back.
The insurer for his employer, Prudential Insurance Company, paid Mr. Barteau’s
benefits for several years and then terminated his benefits without any
signs of improvement in Mr. Barteau’s condition. Rather, to support
its claim termination, Prudential had Mr. Barteau’s claim file reviewed
by a physician it routinely uses in its claims administration, Dr. Steven
Gerson. The case was brought to trial and the Court held that Prudential
erroneously terminated the benefits without any signs of improvement.
In addition, the trial court found that Dr. Steven Gerson did not provide
a full and fair assessment of Mr. Barteau’s disability, but rather,
had acted as an advocate for Prudential. Mr. Barteau was awarded his back
benefits and was reinstated to the Plan. Barteau v. Prudential Ins. Co.
of America, 2009 WL 1505193 (C.D., Cal, 2009).
After working for his employer for over 35 years, Samuel Toven submitted
a disability claim due to an eye injury, diabetes and depression. Although
Social Security recognized that Mr. Toven was disabled from “any
occupation,” his employer’s insurer, Metropolitan Life Insurance
Company, refused to grant him disability benefits. Kantor & Kantor,
LLP successfully fought to take the depositions of MetLife’s claim
representatives and used that testimony at trial to obtain a victory for
Mr. Toven. Mr. Toven’s back benefits were paid and he was reinstated
to the Plan. Toven v. Metropolitan Life Ins. Co., 2008 WL 5101727 (C.D.,