Texas Disability Insurance Attorney Regularly Fight ERISA Disability Denials
In Texas, a claimant’s ability to challenge a denial of disability benefits depends on many factors, not the least of which is whether the disability insurance policy is governed by ERISA. Another critical factor is having a good lawyer: a Texas disability attorney must have considerable experience in handling ERISA disability denials to have any chance of either winning an Appeal or convincing a judge to reverse a disability claim denial. While not every disability policy is governed by ERISA, the majority are and being prepared is critical.
Texas Passes Law Banning Discretionary Clauses in Disability Policies
Every ERISA disability denial lawsuit begins with consideration of whether the disability insurance policy contains a “discretionary clause,” which is nothing more than insurance company language written to give them the right to interpret certain terms of the disability policy and make a final claim decision. Many insurance companies try to build this kind of language into policies to limit claims and to restrict a court’s ability to overturn insurance company decisions. With a discretionary clause, the court must defer to the insurance company and can only reverse the denial if it is “arbitrary and capricious.” However, if a disability policy does not contain a discretionary clause, then a court is not restricted in their review of a disability claim denial.
“As of January 1, 2012, the State of Texas passed a law which prohibits any insurance company from issuing or selling a disability policy which contains a discretionary clause. The Texas law banning discretionary clauses only applies to disability policies issued or renewed after Janaury 1, 2012″.
A Texas Court’s Review of a Claim Denial
The Fifth Circuit Court of Appeals – Texas’ highest federal court – explained the “arbitrary and capricious” standard of review in the case of Firman v. Life Insurance Company of North America. That case involved a dispute over insurance benefits. The plaintiff’s husband died in single-vehicle accident. The police report indicated that his truck veered off the street when entering a curve and then he overcorrected, causing the truck to rollover. Without a seatbelt, he was partially ejected out of the passenger window and crushed by the truck. He died instantly. Toxicology tests showed he had alcohol in his system at the time of the crash.
The widow filed a claim for insurance benefits under two Group Accident Policies. Although both policies were accidental death policies, neither defined the term “accident.” While the policies excluded coverage for injuries from certain activities, they didn’t contain any exclusion for deaths resulting from intoxication or the use of controlled substances. But both policies gave LINA (also known as CIGNA) “full discretionary authority to administer and interpret” the policies.
LINA denied the claim on the ground that the incident was not an accident. In its view, the deceased would have been aware of the risks involved in operating a vehicle under the influence and, for this reason, his death was a foreseeable result of his actions and not an accident. In fact, LINA announced a rule that driving while intoxicated automatically precludes a finding of an accident under any circumstance.
The Texas Court’s Basis for Overruling Cigna’s Denial of an Accidental Death Benefit Claim
The Fifth Circuit Court of Appeals found that LINA / CIGNA had improperly denied coverage. Even though the policy gave LINA the right to make some decisions, the Fifth Circuit Court of Appeals determined that the decision to deny coverage could not stand. The court said that LINA could not assume that all alcohol-related deaths are automatically foreseeable and therefore non-accidental. Some alcohol-related incidents may be foreseeable, while others may not. LINA’s categorical approach was fundamentally unreasonable. The court’s decision was bolstered by the way LINA handled the claim including:
- LINA had a conflict of interest, as the insurance company was both the claims administrator and the source of funds for paying claims;
- LINA offered no evidence, other than the blood-alcohol content, to contradict the argument that the incident was an accident; and
- LINA misrepresented the severity of the intoxication by comparing the deceased’s urine-alcohol content to the legal limit for blood-alcohol content.
Ultimately, the court characterized LINA’s actions as arbitrary and capricious, which resulted in an order requiring LINA to pay the insurance benefits to the widow.
Firman v. Life Insurance Company of North America, No. 11-20451, 2012 WL 2161135 (5th Cir. June 15, 2012)
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong Cigna Appeal Package
We work with you, your doctors, and other experts to submit a very strong Cigna appeal.
Sue Cigna
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Cigna.
Protect Your Benefits
Get Your Cigna Disability Application Approved
We help claimants throughout the entire application process.
Prevent a Cigna Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a Cigna Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Cigna Reviews
(660)
Policy Holder Rating
5
0%
4
0%
3
0%
2
0%
1
0%
Timely Payments
0.0out of 5
Handling Claim
0.0out of 5
Customer Service
0.0out of 5
Dependable
0.0out of 5
Value
0.0out of 5
Showing 8 of 660 Reviews
Lincoln Financial
Uses every dirty trick in the book
It’s next to impossible to get $ out of them without a lawyer. They use plenty of intimidation and unfair tactics. They don’t want to pay. And yet, their CEO made 13 m... read more >
Unum
Unum is evil
On 11/3/2021 I got shot by my boyfriend and my spinalcord got hit, paralyzing me from the neck down and accepting Unum benefits was the worst decision I ever made. I sued ... read more >
Lincoln Financial
Every month I get paid on a different date
I will start by saying that my experience is not as horrible as others, like the folks who have valid claims but get nothing from Lincoln. I feel for you and hope to god y... read more >
MetLife
They will do anything to not approve your claim
MetLife’s handling of my short-term disability claim has been incredibly frustrating and stressful. I followed all the necessary steps prior to my surgery, providing the... read more >
Reply
Sedgwick
Don't trust them, they like to play games
They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >
New York Life
Lyme Disease Disability Claim Denial
I have had repeat claims for genuine medical leave and they have repeatedly been denied by NY Life. I have even been diagnosed with Lyme and going through treatments and t... read more >
New York Life
Disappointed with NY Life Disability Excuses
I am beyond disappointed with NY Life Disability Insurance’s handling of my father’s claim. My father, a 66-year-old man who has suffered two strokes and continues to ... read more >
New York Life
New York Life is a joke!
This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >
Answered Questions by Our Lawyers
(48)
Showing 8 of 48 Answered Questions
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 >
Helpful Videos
(910)
Showing 12 of 910 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
Is Cigna Seeking To Offset Disability Benefit by Social Security Survivor Benefit?
I recently spoke with a gentleman who called into our office who has been receiving long term disability benefits from Cigna for several years and is also receiving Social Security disability benefits. Employer provided disability policies contain what is known as an “Other Income” provision that identifies all the sources of income that will offset your monthly benefit- the most common of which is Social ... Read More >
Is Cigna's Denial of Your Appeal Really a Denial?
Following the submission of your appeal has Cigna sent you a letter stating that after review of the information provided on appeal their decision to deny your claim was correct but also providing you a copy of their medical reviews?Recent changes by the Department of Labor to ERISA regulations now require that a disability insurance company provide you an opportunity to respond to adverse information crea... Read More >
What Should a Claimant Expect When Suing Cigna or any Other Disability Company for Long Term Disability Benefits?
ERISA disability lawsuits are complicated due to the pro-insurance company laws. Our disability attorneys have handled thousands of ERISA disability lawsuits and Cigna is one of the companies that we sue on a routine basis. In this video, attorneys Cesar Gavidia and Gregory Dell discuss the fundamentals of a disability lawsuit against Cigna. If you have a potent... Read More >
Are Cigna Short Term Disability Denials on the Rise?
When it comes to claims for short term disability benefits under ERISA governed group policies, more often than not the short term disability policy is not underwritten by an insurance company, but rather it is administered by an insurance company. What this means is when a policy is underwritten by an insurance company the insurance company financially funds the disability benefit to be paid from its own asse... Read More >
Cigna's latest strategies for handling and denying disability benefit claims
Watch Gregory Dell and Stephen Jessup discuss Cigna's latest strategy for handling disability benefit claims. This video has some tips which may help you to secure disability benefits. Any of our lawyers are available for a free initial phone consultation to discuss your claim.... Read More >
Is a Claimant's Complaints of Pain Enough to Qualify for Short or Long Term Disability Insurance Benefits?
The answer to this question applies to the vast majority of long term disability insurance claims that we handle on a daily basis. Pain is subjective. This means that there is no medical device or verifiable method for confirming pain. A claimant's ability to collect disability benefits based upon pain will depend upon the level of documentation and treatment received from treating physicians. In a recent case... Read More >
Is My Insurance Company Allowed to Take An Offset of My Monthly LTD Benefit for Social Security Benefits My Kids Receive As A Result of My Disability?
It is common practice for insurance companies to find ways to limit the amount of money they have to pay to claimants. If you are receiving long-term disability benefits from a policy governed by ERISA, you have most likely been required to also file for Social Security Disability Income benefits. Insurance companies write this requirement into their policies so they can reap the benefits of any past money awa... Read More >
Is My "No-Fault" Auto Insurance Settlement an Offset Under My Long Term Disability Insurance Policy?
If your policy is an employer provided group disability policy governed by ERISA, then any proceeds you receive from a settlement based on "No fault" auto insurance may very well be subject to repayment as "Other Income Benefits." This situation came to light in a recent federal court case in Michigan against Life Insurance Company of America (LINA-more commonly known as Cigna) and serves as a warning to any c... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
Dell Disability Lawyers successfully appeal denial of benefits to claimant with CRPS/RSD
Ms. S contacted our firm after receiving a letter from her disability carrier, Cigna, denying her claim for short term disability benefits under her employer sponsored disability plan. Ms. S was suffering from multiple ailments including a rare, often misunderstood condition called Complex Regional Pain syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD). At the start of the claim, Cigna accepted... Read More >
LINA overturned its previous LTD denial for Medical Technologist
Our client, Ms. H, formerly worked as a Medical Technologist for a National Clinical Laboratory. In July 2017 a number of medical issues, including psoriatic arthritis and osteoarthritis forced Ms. H to stop working and submit her claim for disability benefits under her employer’s long-term disability (LTD) policy, which was funded and administered by LINA. Under her employer’s disability policy she would ... Read More >
Dell Disability Lawyers Successfully Appeals Denial of Benefits to Former Clinical Therapist
Mr. S contacted our firm for help fighting CIGNA after receiving a letter cutting off his benefits. He had received less than a year of benefits when CIGNA scheduled an Independent Medical Examination (IME) due to a lack of response from Mr. S’s treating physicians.Some carriers, like CIGNA, will immediately exercise their right to schedule an IME if they request claim forms from doctors and do not recei... Read More >
CIGNA overturned previous denial of both long term disability benefits for Massachusetts IT Procurement Specialist
Our client, Ms. K, formerly worked as an IT Procurement Specialist for a large international technology company, which required “sedentary” work functional capabilities. In April 2015 a number of psychiatric issues, including the debilitating co-morbid effects of anxiety, depression, alcohol dependence and PTSD forced Ms. K to stop working and submit her claim for disability benefits first under his employ... Read More >
CIGNA overturned its previous denial of both short term and long term disability benefits for Michigan Senior Personal Banker
Our client, Ms. C, formerly worked as a Senior Personal Banker for a large national bank, which required “light” work functional capabilities. In July 2016 a number of medical issues, including the debilitating co-morbid effects of Sternal Osteomyelitis, Arthritis, Depression and PTSD forced Ms. C to stop working and submit her claim for disability benefits first under her employer’s short-term disabilit... Read More >
Respiratory Therapist whose claim was denied without a proper review gets LTD claim approved after Appeal to CIGNA
A Respiratory Therapist was forced to stop working due to bilateral degenerative knee conditions which required a total knee replacement. Over time, the knee problems resulted in worsening lumbar spine problems, which required surgical intervention as well as numerous steroid injections and physical therapy treatments. The severe lumbar spine pain, as well as degenerative conditions in her knees, prevented her... Read More >
Cigna reinstates disability benefits to Project Manager on Appeal
Prior to filing for disability insurance benefits our client worked as an executive level Project Manager. She initially went out of work following the removal of a brain tumor, which resulted in complications of bilateral diploma (severe double vision), hearing loss and migraines. Initially, Cigna approved her claim for benefits and issued long term disability benefits for approximately a year before determin... Read More >
Trinity Health Care Registered Nurse wins Cigna long term disability Appeal
After receiving Long Term Disability (LTD) benefits for two years due to severe back conditions, a Nurse who formerly worked at Albany Memorial Hospital (which is part of the Trinity Health System) was denied continued LTD benefits after Cigna made a determination that she no longer satisfied the definition of disability under the policy.The timing of such a denial is very common in the disability insuranc... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
5 Ways We Help Get Your Benefits Paid
Get Your Disability Application Approved
Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
Submit A Strong Appeal Package
If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
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.
Sue Your Disability Company
98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the little guy against the multi-billion dollar insurance company giants.
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.
Prevent A Disability Benefit Denial
Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
Negotiate a Lump-Sum Settlement
Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
Questions About Hiring Us
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.
How can I contact you?
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.