I was able to obtain a victory in the Ninth Circuit in this Salyers v. Metropolitan Life Insurance Company. The Court held that Met Life had waived its right to require evidence of insurability when it had never asked for such a form to be completed and had deducted premiums for the life insurance coverage requested. The Court also adopted the common law rules of agency into ERISA, holding that when an employer accepts premiums and applications for coverage from the employees, the employer is acting as an agent of the insurance company.
I recently argued a life insurance case before the Ninth Circuit Court of Appeals. Here is a video of the oral argument. We are awaiting the Court's decision.
We received a favorable decision in an Aetna disability case today, where the Court found that Aetna's denial was unreasonable and that it ignored the evidence in its own files: "It is puzzling that Aetna’s explanation for its denial in the letter sent to Plaintiff states that neither Dr. Wang nor Dr. Mehta provided “submitted any clinical rationale or any resent [sic] test results,” when both doctors included test results, including the recent MRI results, and all of Plaintiff’s medical records in faxes submitted to Aetna in support of their clinical assessments finding Plaintiff permanently disabled."
Here is an article that I wrote some time ago about when an insurance company must defend its insured when the insured is facing a lawsuit.
WestLaw has published another recent case of mine, Carrier v. Aetna Life Insurance Co., 116 F. Supp. 3d 1067 (C.D. Cal. 2015). Judge O'Connell ruled that the insured was disabled under the terms of her group disability insurance plan. In the denial letter, Aetna told Ms. Carrier that her file had been reviewed by a psychiatrist who stated that she was not disabled when in fact Aetna never hired a psychiatrist prior to the denial.
WestLaw has published a recent case of mine, Williby v. Aetna Life Insurance Company, 2015 WL 5145499 (C.D. Cal. Aug. 31, 2015). Judge Consuelo Marshall ruled that the insured was disabled under the terms of her group disability insurance plan and that even though the benefits were self-funded, California Insurance Code § 10110.6 voided the plan's effort to make the abuse of discretion standard apply.
Here's an article published this month that I wrote regarding things to watch out for in group life, health, and disability cases. They are subject to the Employee Retirement and Income Security Act "ERISA."
Accident policies provide coverage in the event of accidental death, dismemberment, and other specified injuries. These policies are divided into two categories: "accidental death" policies and "accidental means" policies. "Accidental death" policies have very broad coverage and insure for essentially any death that is not expected or intended by the insured. Here is an article that I wrote on the subject.
If due to a sickness or accident you are unable to work, you may be entitled to something called "disability" benefits. You don't need to be disabled in the traditional sense to recover. You just have to be unable to perform the substantial and material duties of your normal occupation in the usual and customary way. If you become disabled, make sure to submit your claim right away. Below is a list of the different kinds of benefits to which you might be entitled:
Group Disability Coverage
Many people have disability insurance through their employer. You will need to check with your human resources department. Benefits are usually divided into short-term disability benefits ("STD") and long-term disability benefits ("LTD"). If your claim is denied, we can help.
Individual Disability Coverage
Some people purchase their own individual disability insurance through an agent or directly from a disability insurance company. If you are self-employed or want coverage in addition to that provided by your employer, an individual policy will protect you if you are no longer able to work. If your claim is denied, we can help.
If you are injured on the job, you are entitled to payments through the workers compensation system. We do not handle these types of cases, but we can refer you to a specialist.
California State Disability
The State of California will pay disability benefits for the first year of disability, sometimes called EDD or SDI benefits. They are ordinarily very good about paying such claims.
Social Security Disability
The Social Security Administration will also pay you disability benefits if you cannot work. You do not have to be 65 or older to qualify. These benefits are not related to retirement. You can submit a claim through any Social Security office. Initial claims are sometimes denied, requiring an appeal. We do not handle these types of cases, but we can refer you to a specialist.