While the medical community works to uncover the intricacies and unknowns of long COVID, long-term disability applicants are still struggling to receive benefits for this condition. The pre-existing condition tactic fails again Insurance providers, huge fans of pre-existing condition denials, are still tossing out this oldie, even as the medical community coalesces around the conclusion that long COVID is a legitimate, standalone condition. In Kim v. The Guardian Life Ins. Co. of Am., Guardian swung for the fences, insisting that the plaintiff’s condition—”severe physical, cognitive, and menta ..read more

Regular readers of this blog will know that we have paid close attention to the rollercoaster case involving former NFL running back Michael Cloud and his quest to attain the highest level of disability benefits from the NFL Player Retirement Plan. While we wish we could report a miraculous change in Mr. Cloud’s circumstances, alas we only have a symbolic addendum to his saga to share. The backstory This tale has many twists and turns, so we encourage you to read our previous posts (in chronological order): The NFL’s shameful history with disabled former players (Jan 12, 2023) A new report rev ..read more

Back in January of this year, we found ourselves in the awkward but not unpleasant position of praising Sun Life after they encouraged Congress to pass legislation requiring mental health and substance abuse parity among long-term disability insurance plans. Sun Life’s goal was to level the playing field among insurance providers by requiring all providers to provide the same level of long-term mental health disability benefits. Per their press release: “Any one company introducing this approach without a market-wide solution would immediately be uncompetitive. A legislative solution is theref ..read more

Never underestimate the willingness of insurance companies to “try again” to deny benefits for reasons which have already been considered and rejected by the Courts. We highlighted a case in July 2023 wherein a dental hygienist continued working through her chronic back pain while waiting for her insurance provider, Hartford Life, to process her long-term disability claim. She did this because she would lose her coverage and be deemed ineligible if she stopped working. Hartford cleverly argued that she could not be totally disabled because she was still doing her job. The Court wasted little t ..read more

Ideally, you should get through life without having to think about long-term disability and the often arduous ERISA application process. Worst case scenario, you should only have to deal with this once. So, unless you’re an avid reader of this blog, it’s understandable that you wouldn’t be aware of the veritable minefield of potential missteps and mistakes laying in wait for applicants. In the following case, which was a slam-dunk win for the plaintiff, there are nevertheless a couple tips that might have saved the plaintiff from appearing in court. If possible, apply for ERISA benefits before ..read more

Here in the muddy trenches of ERISA law, we usually find ourselves condemning insurance providers for unfair benefit denials and disingenuous tactics designed to please shareholders at the expense of their customers’ wellbeing. Today is not one of those days. Everyone in this field took notice earlier this month when Sun Life put out a press release endorsing the ERISA Advisory Council’s recommendation that Congress pass legislation requiring mental health parity in long-term disability insurance plans. We already have such parity in the area of health care insurance, but not in the disability ..read more

Insurance providers routinely deny many of ERISA LTD claims. While some denials are legitimate, a disappointing number range from dubious to absurd. Unfortunately, insurance providers know that only some applicants will appeal their denial. There are many common and understandable reasons people don’t appeal these rejections. Frequently, it’s simply a matter of not feeling up to a difficult and protracted legal battle while one is sick or injured. Others feel like they can’t afford the legal fees. There’s also an often false perception that insurance companies employ the most aggressive lawyer ..read more

A longstanding lawsuit between former NFL running back Michael Cloud, which we’ve cited in previous posts, and the NFL Player Retirement Plan came to a startling and disappointing end. The decision, which defies reality and common sense, is a massive blow to disabled, former NFL players, particularly those who are suffering the neurological effects from multiple concussions. What in the world happened? In Cloud v. The Bert Bell/Pete Rozelle NFL Player Retirement Plan, the Fifth Circuit reversed the district court’s ruling which awarded Mr. Cloud the highest level of disability benefits. By any ..read more

Barely an hour passes these days without a company giddily announcing a new AI partnership to improve its performance. But does the current state and limitations of AI belong in long-term disability benefits, a realm where crucial financial security and even people’s lives may be at risk? Prudential’s announcement Prudential’s press release is all fairies and rainbows, as one would expect. They go to great lengths to explain how AI processing insurance claims applications will improve the process for everyone involved, namely by streamlining the most manual and tedious stages of the work. Much ..read more

Buckle up because this story could easily be adapted into a three-hour dramatic film starring Reese Whitherspoon and directed by Oliver Stone. And if you think reading this story takes a long time, imagine how the plaintiff feels. The main takeaway from this case is that assuming the disabled person can summon the mental and physical energy to challenge illegitimate benefit denials, justice will eventually find its way – even if it’s the long way. It started fine In Jordan v. Reliance Standard Life Insurance Company, the plaintiff was forced to leave her job as a nurse anesthetist due to Lyme ..read more