Life Insurance Company of North America sued under ERISA in three different cases for denial to pay disability benefits
Three different lawsuits were recently filed by disability lawyers under the Employee Retirement Income Security Act (ERISA) against the Life Insurance Company of North America (LINA) in the Federal Courts of Illinois and Minnesota for improper denial of claims for disability benefits.
The First Case
In the first complaint, the plaintiff through a disability attorney filed a lawsuit in the District Court for the Northern District of Illinois. The plaintiff was employed as a general manager for SCI Funeral and Cemetery Purchasing (SCI). While working for SCI, the plaintiff participated in both a short-term and a long-term disability plan that was sponsored by SCI and underwritten and administered by LINA.
The plaintiff stopped working at his position on December 10, 2009 due to symptoms associated with a major depressive disorder, acute stress reaction, generalized anxiety disorder, personality disorder, hypertension, agoraphobia, and insomnia, along with side effects from his prescribed medications. Plaintiff claimed short-term disability (STD) benefits on December 11, 2009.
Despite multiple requests from Plaintiff, LINA failed to provide a copy of the STD disability plan, even though LINA used parts of the Plan’s language to deny benefits. Initially, LINA did pay for benefits after acknowledging Plaintiff’s disabilities in a May 14, 2010 letter, but only through April 10, 2010.
STD benefits were stopped on May 27, 2010; LINA claimed that Plaintiff no longer met the Plan’s definition of disability. Plaintiff appealed the denial letter and submitted extensive medical evidence to prove his disability, but LINA again denied Plaintiff LTD benefits on October 27, 2010. As all administrative appeals have been exhausted, Plaintiff filed this lawsuit.
The Second Case
This lawsuit was filed at the District Court for the District of Minnesota Fourth Division by a disability attorney. The plaintiff was an employee for Aldi. She was provided with a LTD coverage plan that was fully insured and administered by LINA. Due to her salary, Plaintiff was a Class 1 employee under the Plan.
During her time working as a full time store manager for Aldi, in or about October 2005, Plaintiff unloaded a grocery truck at Aldi and sustained an injury that caused pain in her back and lower-right extremity. This same incident occurred again in or about May 2006 and on or around July 12, 2006. After the July incident, Plaintiff was no longer able to work as a Store Manager.
Despite several treatment methods, including facet joint blocks, right transforaminal epidural steroid injection, a three-level lumbar discography, and a spinal rehabilitation program, from November 2, 2006 to May 30, 2007, little to no improvement was made in her condition. On or around April 22, 2007, Plaintiff filed a claim for LTD benefits with LINA. LINA granted LTD benefits on September 5, 2007, with the period beginning January 11, 2007 after a benefit waiting period of 180 days.
Plaintiff underwent recommended intradiscal injection on October 4, 2007. On or around November 21, 2007, LINA informed the Plaintiff that LTD benefits would be terminated and that her claim would be denied beyond October 19, 2007. LINA’s claim was that there was no longer continuing documentation to support Plaintiff’s inability to perform her own occupation.
Plaintiff appealed denial. On or around February 6, 2008, LINA reversed its denial and reinstated Plaintiff’s LTD benefits. Plaintiff underwent more procedures to reduce her lower back pain between April 2008 and August 2009. LINA again informed Plaintiff that it was terminating her LTD benefits in October 2009 because the medical information on file no longer supported that she could not do her occupation.
On or around November 10, 2009, LINA stopped paying Plaintiff’s LTD benefits. Plaintiff immediately appealed this denial, supplying medical evidence and undergoing tests to prove she was so disabled that she could not continue her occupation. On or around December 18, 2009, LINA again denied the Plaintiff of LTD benefits. Plaintiff again appealed on June 16, 2010 after undergoing more procedures and supplying more evidence to LINA. After continuous dialogue and submittal of evidence from the Plaintiff to LINA, LINA again denied Plaintiff LTD benefits on November 23, 2010, stating that the Plaintiff can do sedentary work based on observance of videos provided to LINA. Since all administrative levels of appeal were exhausted, Plaintiff filed this lawsuit.
The Third Case
The third case was filed by a disability attorney at the District Court for the District of Minnesota Fourth Division. The suit alleged that LINA denied LTD benefits beyond Dec. 16, 2009 despite the Plaintiff undergoing numerous operations and procedures for a fall that occurred in her cabin on August 10, 2009. It was very difficult for the Plaintiff to comply with LINA’s requests for updated medical records since both LINA and Lakeview Clinic, where Plaintiff received continuous treatment for her injuries, would not cooperate on providing updated medical records in a timely fashion.
LINA claims that the records did not indicate a continuation of benefits was needed beyond December 16, 2009, despite numerous submissions by the Plaintiff toward her injuries and treatments. On August 20, 2010, LINA again denied the Plaintiff’s continuation of LTD benefits. Plaintiff appealed this denial on November 2, 2010, including additional medical evidence to support her disability claim. LINA again denied her claim on January 18, 2011, citing no “consistent functional impairment.”
Relief Sought in the Lawsuits
In the three mentioned cases, the relief sought by the plaintiffs from LINA in their lawsuits comprises of:
- A judgment that the plaintiffs are entitled to LTD benefits under their respective plans
- Benefits that have not been paid to be paid with interest
- An award of attorney’s fees and costs
- Any other relief that the court deems just and appropriate
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Answered Questions by Our Lawyers
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Q: I filed an appeal and lost. Is it worth pursuing?
A: Kim, in my opinion, yes. If you are still within your timeframe to file a lawsuit you have little to lose in t... Read More >
Q: Do I have a case for STD? I was denied twice because a) I hadn't been a fulltime employee for 6 months and b) I had ben on FMLA since Febury.
A: Frank, we would need to see a copy of the denial letter and the policy. Please feel free to contact our office... Read More >
Q: How can I appeal Cigna's decision if there are no written communications explanation the reasons for claim termination?
A: Tret, Cigna will be required by law to provide you with a written denial letter setting forth its reason for t... Read More >
Q: Is there a process for appeals not being responded to in the time given? Also, how do I access my records?
A: SB, ERISA provides 45 days to render a decision on appeal with the possibility of a 45 day extension- basicall... Read More >
Q: Is it worth is to go to court over $2500?
A: Mark, If you have no additional appeals your only option would be to find representation to file a federal law... Read More >
Q: How long will it take Cigna to get back to me? Will my military retiree pay be held against my policy 60%? Will Cigna exploit the disparity in the medical community over my illness?
A: Craig, Unfortunately it can sometime take up to 45 days to receive a decision from Cigna as to your entitlemen... Read More >
Q: Do I have any options to void an agreement I signed? Can Signa offset my SSDI benefits?
A: Donna, I do not know if you would have any avenues to void the agreement you signed. Regardless of agreeing th... Read More >
Q: Can I sue Cigna even if they do end up paying me?
A: Linda, If your policy is governed by ERISA you will need to go through the administrative appeal process prior... Read More >
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Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
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We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
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Who are Dell Disability Lawyers?
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
Do you work in my state?
Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
What are your fees?
Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
Do I have to come to your office to work with your law firm?
No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
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When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.