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Disability Insurance Results

Representative Cases Involving Disability Claims

Following are examples of actual disability verdicts and settlements obtained by Pillsbury & Coleman. Additional results can be reviewed when you speak with an attorney at our firm. If plaintiff or insurance company names do not appear it is because confidentiality agreements are in place restricting that information.

ORTHOPEDIC CONDITIONS

Sherilee Aragon v. Liberty Mutual Life Insurance Company. An active and successful 35 year old web designer for the University of California fell from a horse breaking her back in three places. She developed debilitating and chronic back pain that prevented her from sitting for extended periods of time, as was required by her job. She had visited many physicians and unsuccessfully sought a variety of treatment including two failed back surgeries. The insurance company paid her for a while, but when it realized her claim would likely be permanent it cut off her benefits. In doing so, it sent investigators to conduct surveillance, misinterpreted her medical records, and obtained biased reviews of her records by physicians paid to produce biased reports. Pillsbury & Coleman successfully obtained benefits for our client after a trial in which the jury found that the insurance company had acted in bad faith.

Anesthesiologist disabled by necrotic bone in her foot. Our client was a 45 year old anesthesiologist who developed avascular necrosis of the largest bone in her foot as a result of long-term steroid use for chronic ulcerative colitis. Avascular necrosis is bone death resulting from an interruption in the blood supply to the bone which caused severe pain particularly while bearing weight. As an anesthesiologist, she could not medicate her pain on workdays and increasingly began to miss days of work at a time when she could not bear weight on her foot at all. She stopped working to properly treat her pain and applied for benefits. After initially approving her claim, the insurance company hired investigators to spy on her who filmed her driving a car and walking two blocks to a doctor's appointment with a visible limp. Despite the support of her primary care doctor, pain specialist and the records of multiple orthopedists with whom she consulted, the insurance company denied her claim. It contended that since she had worked with this condition for over ten years, she should continue to be able to work with the condition. Although she required round-the-clock morphine, vicodin and fentanyl, the company contended that because she had a "tolerance" for those narcotics, she would not be impaired from being an anesthesiologist while on those medications. After filing suit and taking the depositions of the claims staff and consulting physicians, Pillsbury & Coleman settled the matter.

Macias v. California Law Enforcement Agency

Police officer in her 30s disabled from a back injury suffered in the line of duty. After months of conservative treatment, our client underwent a disc replacement surgery. The surgery not only failed but made her pain worse, requiring high levels of narcotic pain medication just to enable her to get out of bed. She submitted a claim for disability under a plan provided by the city as a benefit of employment. Without understanding her medical condition, her symptoms or the policy language, her insurance company denied her claim for disability. It falsely claimed that the far less protective law of ERISA applied to her claims, and not state laws which afford full redress in the event the insurance companies denies claims unreasonably. After filing suit, we discovered the insurance company failed to train its staff and failed to apply appropriate insurance claims handling standards. Despite being admonished by at least one major court to the contrary, the company continued to convey to claimants that their claims were not governed by state law. After winning pre-trial motions on several key issues, including that California law applied, the matter settled.

40 year old dentist disabled by severe knee problems. Our client's orthopedic condition made it very difficult to stand throughout the day while performing dental procedures on his patients. Our client had a disability policy which paid benefits totally nearly $3 million. The insurance company denied the claim on the grounds that our client's knee problems were not severe and, in any event, he could accommodate those problems with special chairs and equipment. Pillsbury & Coleman filed suit claiming that it was impractical and dangerous for our client to practice dentistry in the manner in which the insurance company wanted him to just so that it would not have to pay benefit. Our client could not perform dentistry in the usual and customary manner in which his occupation was performed. The case settled successfully.

Womack v. UnumProvident, General American Life Insurance Company, and Protective Life Insurance Company

Dentist Permanently Disabled Due to Multiple Serious Injuries and Conditions. Dr. Womack had to sell his dental practice after a boating accident in which he suffered compression fractures in his thoracic and lumbar spine. His recovery was compromised by severe osteoporosis, and he later suffered a ruptured tibial tendon necessitating major reconstructive surgery that failed and left him with permanent nerve damage and Complex Regional Pain Syndrome. Amazingly, Unum terminated payment of benefits. Pillsbury & Coleman obtained a summary judgment order from the federal district court holding that "a reasonable jury could find Plaintiff's evidence to be clear and convincing proof of malice, fraud, or oppression." Pillsbury & Coleman achieved a successful settlement shortly thereafter.

Graphic artist disabled by failed three level spinal fusion. Our client's disability insurer initially denied his claim on the ground that it was pre-existing, even though the evidence in the claims file clearly demonstrated it was not. Next, the insurance company justified its denial claiming that because he could "sit and stand at will" at work, he was not disabled. In fact, his occupation required constant sitting and the use of narcotic pain medication precluded the kind of sustained concentration he needed on the job. When our client presented this evidence to the company, the company then claimed his current disability was "irrelevant" because he had not demonstrated he was disabled for the first three months he was on claim. Pillsbury & Coleman was able to favorably settle the case.

Office Manager disabled by back injury. Pillsbury & Coleman successfully settled this disability case against UNUM on behalf of an office manager who had broken her back in a catastrophic car accident. After an unsuccessful spine surgery, our client was unable to sit upright for any length of time and could no longer work any office job. After initially paying benefits, when the insurance company learned our client was soon to be married, it hired private investigators to sneak into her wedding disguised as guests. The investigators filmed her short wedding dance with her new husband and the insurance company contended that if she could dance for several minutes, she could work fulltime in a gainful occupation.

HAND AND UPPER EXTREMITY CONDITIONS

Dr. Randall Chapman v. UnumProvident Corporation

Jury Verdict: $31,700,000.00

Eye surgeon disabled by severe anxiety and phobia. Dr. Chapman was an eye surgeon who practiced medicine for 20 years until the late 1990's when he started to experience extreme anxiety, including panic attacks, shaking hands, diarrhea, vomiting and sleepless nights. He voluntarily took himself off the surgery schedule and was diagnosed by a psychiatrist as having a "specific phobia," a condition in which a person reacts with excess panic to a particular stimulus. No longer able to safely operate on patients, Dr. Chapman's retired from eye surgery and submitted a claim to UNUMProvident, his disability insurance company. UnumProvident failed to have Dr. Chapman properly examined by an unbiased physician. The insurer falsely claimed that his condition could be treated successfully. It falsely claimed that he was not an eye surgeon and called him a fraud. Ultimately, his claim was denied in order to meet monthly and quarterly termination goals. After a three month jury trial during which we revealed that UnumProvident's claims department intentionally interpreted his medical records in a manner calculated to result in a denial of his claim, the jury found that Dr. Chapman was totally disabled from his occupation and was therefore entitled to disability benefits for the rest of his life, amounting to $1,551,301, plus emotional distress damages of $125,000 and punitive damages of $30 million. After the trial, the judge reduced these amounts to disability insurance benefits of $1,112,405, emotional distress damages of $15,000, and punitive damages of $5 million.

Gilmore v. Liberty Life Assurance Company of Boston

Computer programmer partially disabled by complications from cervical arthritis. Our client is a dedicated and successful computer programmer who developed arthritis of the neck from years of working in front of a computer. She underwent an anterior cervical spinal fusion surgery, and was later involved in a car accident which fractured the screws inserted in her neck for the spinal fusion. The client underwent a second surgery, but her physical recovery was slow and she began experiencing increased neck pain, arm pain, and headaches that interfered with her work. She applied for Long Term Disability benefits, which the insurance company initially approved. However, after the client eventually returned to work on a part-time basis, the insurance company terminated her partial disability benefit, alleging that our client's part-time working restrictions were not supported by "objective medical evidence" of her pain. Pillsbury & Coleman filed suit to recover our client's benefits and obtained a favorable ruling on a motion for judgment, whereby the court accepted the client's self-reported complaints of pain as sufficient proof of her disability and rejected the insurance company's claims.

Opinion and Order

Judgment

Obstetrician/gynecologist disabled by a severe bilateral failure of the thumb joints. Our client's bilateral CMC joint subluxation precluded the performance of many of his most important and most lucrative occupational duties, including the delivery of babies and obstetrical surgery. As a result, he suffered a precipitous drop in income, but continued to work. The insurer argued that because the doctor could still perform some of his former duties, he was not disabled under the policy. Pillsbury & Coleman obtained a favorable ruling on a motion for judgment rejecting the insurer's claims. The case settled shortly thereafter.

Periodontist with disabled hand. Our client accidentally cut off his thumb when working with a table saw. While doctors were able to sew it back on, he was left with decreased feeling in his thumb. His occupation required him to use fine surgical instruments while operating in patients' mouths. This was both difficult and dangerous. His policy required his insurance companies to provide disability benefits when he was unable to do the duties of his own occupation. Benefits were $10,000 per month until age 65. The insurers accused the insured of intentionally cutting off his thumb and demanded that he provided medical updates every month, despite the fact that there was no treatment that could improve his condition. Pillsbury & Coleman obtained all of the client's benefits.

Dental Hygienist Disabled by Carpal Tunnel Syndrome. Pillsbury & Coleman successfully settled the claim of a dental hygienist permanently disabled from her prior occupation as a dental hygienist due to the onset of carpal tunnel syndrome and overuse syndrome.

MIXED TISSUE/FIBROMYALGIA/CHRONIC FATIGUE

Human Resources Director with mixed tissue disease. Our client has been a in human resources for 30 years, most recently with Price Waterhouse Coopers. Her work involved long hours and extensive travel. She became disabled as a result of fibromyalgia, chronic fatigue syndrome and related conditions. She was covered under an ERISA policy provided by her employer. The total benefits she should have been paid over the life of her policy were approximately $1 million. The insurance company denied her claim on the grounds that her medical records disclosed evidence of complaints of fatigue before she joined the employer and it denied her claim on the ground that it was excluded as a pre-existing condition. Pillsbury & Coleman contended that her whatever prior complaints she had, her condition had not been diagnosed and had gotten significantly worse after the pre-existing condition look back period had expired. The case was successfully settled.

NEUROLOGICAL DISORDERS

In-house Attorney Disabled Due to Parkinson's Disease. Our client had been diagnosed with Parkinson's Disease several years before it had progressed to a point that required him to finally retire. Pillsbury & Coleman helped shepherd him through the disability claim submission and process resulting in the successful and timely payment of his claim.

Human Resources Vice President Disabled by Post-Polio Syndrome. Post-Polio Syndrome afflicts more than 250,000 Polio survivors in the United States. Post-Polio Syndrome presents a debilitating return of Polio symptoms, including fatigue, muscle and joint pain, and muscle weakness, all of which become progressively worse over time. Pillsbury & Coleman represented one such Polio survivor after her disability insurer denied benefits. It claimed that, because she slowly reduced her work hours as her condition progressed and did not obtain a disability certification from her doctor immediately before she stopped working altogether, that she had simply made a lifestyle choice to retire. Pillsbury & Coleman successfully opposed the insurer's argument that ERISA applied and immunized it from state law liability for bad faith and punitive damages and successfully settled the case shortly before trial.

BRAIN INJURIES

Oster v. Standard Insurance Company

Pillsbury & Coleman won a suit on behalf of a disabled computer programmer against Standard Life Insurance Company. Our client was involved in a serious car accident in which he suffered traumatic brain injury. Standard terminated his ERISA disability benefits, relying upon a paper review by one of its medical consultants that concluded our client's unsuccessful attempts to return to work after the accident demonstrated he was no longer disabled. In a published opinion, the Honorable Saundra Armstrong of the Northern District of California found that Standard abused its discretion in terminating benefits by, among other things, using biased physicians to disagree with our client's treating physicians' disability assessment. Pillsbury & Coleman also prevailed on an attorneys' fee motion, resulting in a published opinion in which Pillsbury & Coleman partner Terrence J. Coleman was "recognized as an 'ERISA expert' by the Northern District of California and is a frequent speaker and writer on ERISA and insurance litigation issues."

Big Law litigation partner disabled by brain damage caused by chronic, undiagnosed sleep apnea. Although the insurance company's own in-house medical consultants agreed he had cognitive deficiencies demonstrated by neuropsychological testing, the insurance company denied his claim claiming that he was a malingerer who was pretending not to be able to work to collect benefits which amounted to a fraction of his former income. The insurance company hired investigators to spy on and film our client for several days. The insurer claimed that because he was seen driving, buying coffee and talking on a cellphone, he could work as a high level law firm litigation partner. Using state of the art neuropsychological evidence and marshalling the medical and collateral evidence demonstrating a severe and tragic condition which ended the client's career at its zenith, Pillsbury & Coleman were able to negotiate a favorable settlement in the matter.

Advertising executive disabled by traumatic brain injury. A 40 year old advertising creative director fell on his bathroom floor and suffered a occipital skull fracture which resulted in chronic brain damage. Our client had to relearn how to walk and continued to have severe balance problems, chronic dizziness and, as a result, nausea and vomiting, involuntary jerking movements of his body and frequent migraine headaches. Our client's disability insurer, Prudential, had an independent neuropsychological evaluation of him which found that he suffered from permanent brain damage which precluded return to fulltime work. Undaunted by the facts, Prudential then had our client secretly surveilled for a record 19 days, which depicted him walking to a coffee shop, driving a car and attending a musical performance. Prudential determined that he stopped work at the peak of his career as a matter of "choice" and terminated his benefits. Pillsbury & Coleman filed suit and the matter successfully settled.

SLEEP APNEA AND OTHER SLEEP DISORDERS

45 year old anesthesiologist with narcolepsy. Our client's condition rendered him totally disabled from his occupation because it was dangerous for him to be in the operating room with his condition. Our client had a disability policy which provided benefits of approximately $1,500,000. The insurance company claimed that the insurance policy has mistakenly been issued to him without evaluating his medical history and that he was not eligible for coverage. It refused to pay his benefits claiming that he had no insurance policy. Pillsbury & Coleman filed suit alleging that it had in fact issued the policy and was bound to live up to the promises it made. His case was successfully settled.

International law firm partner disabled by brain damage caused by chronic, undiagnosed sleep apnea. Although the insurance company's own in-house medical consultants agreed he had cognitive deficiencies demonstrated by neuropsychological testing, the insurance company denied his claim claiming that he was a malingerer who was pretending not to be able to work to collect benefits which amounted to a fraction of his former income. The insurance company hired investigators to spy on and film our client for several days. The insurer claimed that because he was seen driving, buying coffee and talking on a cellphone, he could work as a high level law firm litigation partner. Using state of the art neuropsychological evidence and marshalling the medical and collateral evidence demonstrating a severe and tragic condition which ended the client's career at its zenith, Pillsbury & Coleman were able to negotiate a favorable settlement in the matter.

CANCER AND CANCER TREATMENT

Silicon Valley Sales Executive Disabled Due to Rectal Cancer and Complications From Chemotherapy Treatment. Our client was a successful sales executive in the electronics industry who had been diagnosed with rectal cancer. An aggressive course of chemotherapy successfully attacked the cancer, but left him with persistent bouts of fatigue and cognitive impairment. After his ERISA disability benefits were terminated following an exam by Dr. Neena Madireddi, Pillsbury & Coleman successfully appealed the denial, convincing the insurer to reinstate his benefits without the need for litigation.

Property Manager disabled by the effects of breast cancer and chemotherapy. Breast cancer treatments our client her with a variety of symptoms, including peripheral neuropathy, depression, fatigue, paresthesias and cognitive effects. She also suffered from low back pain, foot pain and thyroid disease. The Social Security Administration determined that she was unable to work in any occupation. Our client's claim was subject to review by the insurance company because of a sanctions agreement with the California Department of Insurance.

60-Year-Old Insurance Agent Disabled Due to Post-Radiation Gastrointestinal and Lumbar Spine Problems. Our client beat testicular cancer in his 20s, but the radiation treatment he received decades earlier progressively deteriorated his abdomen and lumbar region to the point that he could no longer work as a successful insurance agent due to constant intestinal blockages and spinal instability. Even though he could no longer actively sell and market new policies, his disability insurer denied his claim for benefits totaling more than $1.5 million, contending he didn't meet the policy's definition of total disability because he could continue to service existing clients. The case successfully settled before trial.

PSYCHIATRIC AND MENTAL HEALTH CONDITIONS

Dr. Randall Chapman v. UnumProvident Corporation

Jury Verdict: $31,700,000.00

Eye surgeon disabled by severe anxiety and phobia. Dr. Chapman was an eye surgeon who practiced medicine for 20 years until the late 1990's when he started to experience extreme anxiety, including panic attacks, shaking hands, diarrhea, vomiting and sleepless nights. He voluntarily took himself off the surgery schedule and was diagnosed by a psychiatrist as having a "specific phobia," a condition in which a person reacts with excess panic to a particular stimulus. No longer able to safely operate on patients, Dr. Chapman's retired from eye surgery and submitted a claim to UNUMProvident, his disability insurance company. UnumProvident failed to have Dr. Chapman properly examined by an unbiased physician. The insurer falsely claimed that his condition could be treated successfully. It falsely claimed that he was not an eye surgeon and called him a fraud. Ultimately, his claim was denied in order to meet monthly and quarterly termination goals. After a three month jury trial during which we revealed that UnumProvident's claims department intentionally interpreted his medical records in a manner calculated to result in a denial of his claim, the jury found that Dr. Chapman was totally disabled from his occupation and was therefore entitled to disability benefits for the rest of his life, amounting to $1,551,301, plus emotional distress damages of $125,000 and punitive damages of $30 million. After the trial, the judge reduced these amounts to disability insurance benefits of $1,112,405, emotional distress damages of $15,000, and punitive damages of $5 million.

Rader v. Sun Life Assurance Company of Canada

Former police officer disabled by major depression and alcohol abuse. Kenneth Rader, Jr. was a public servant and at one time a police officer in Northern California. In July of 2010, Rader was diagnosed with major depression and alcohol abuse. Shortly after being diagnosed, he was terminated from his employment. Then, his conditions spiraled out of control: he cashed out his retirement account, withdrew from society, and began drinking 18-30 beers a day. Finally, in September 2011, he was hospitalized and diagnosed with alcohol-induced encephalopathy, a type of permanent brain damage caused by excessive alcohol consumption. With the help of his parents, Rader applied for disability benefits under an insurance policy he had with Sun Life back in 2010. After Sun Life unreasonably denied his claim for disability benefits, Pillsbury & Coleman brought suit for breach of contract and bad faith. Sun Life claimed that Rader was not disabled when he was terminated from work, and that he was actually spending his time having fun, taking vacations and socializing with friends. The company moved for summary judgment on these arguments, and the Court rejected them all, ruling instead that a jury could find that Rader was disabled due to major depression and alcohol abuse back in 2010; that Sun Life's claims handlers ignored medical and other evidence in its file; failed to follow up with Rader's diagnosing doctor even though they admitted they couldn't read the doctor's handwritten medical notes; and that Sun Life's internal policies encouraged and rewarded claims handlers to deny claims. It also ruled that Sun Life was not entitled to terminate benefits because Rader was not under the regular and continuous care of a doctor between July 2010 and September 2011, as this was a clear and obvious misapplication of the policy's terms. With the victory, the case will move on to trial, currently set for July 14, 2014.

Order

Gilmore v. Liberty Life Assurance Company of Boston

Computer programmer partially disabled by complications from cervical arthritis. Our client is a dedicated and successful computer programmer who developed arthritis of the neck from years of working in front of a computer. She underwent an anterior cervical spinal fusion surgery, and was later involved in a car accident which fractured the screws inserted in her neck for the spinal fusion. The client underwent a second surgery, but her physical recovery was slow and she began experiencing increased neck pain, arm pain, and headaches that interfered with her work. She applied for Long Term Disability benefits, which the insurance company initially approved. However, after the client eventually returned to work on a part-time basis, the insurance company terminated her partial disability benefit, alleging that our client's part-time working restrictions were not supported by "objective medical evidence" of her pain. Pillsbury & Coleman filed suit to recover our client's benefits and obtained a favorable ruling on a motion for judgment, whereby the court accepted the client's self-reported complaints of pain as sufficient proof of her disability and rejected the insurance company's claims.

Opinion and Order
Judgment

Garcia-Pardini v. MetLife

Human Resources Manager disabled by Major Depression. Our client's ERISA disability benefits were terminated by Metropolitan Life Insurance Company after its in-house psychiatrist disagreed with the treating physician's disability assessment. Pillsbury & Coleman obtained a summary judgment order permitting the case to go to trial, after which the case successfully settled.

35 year old school administrator with severe and chronic mental illness involving delusions, hallucinations and suicide attempts. Our client had been hospitalized extensively including treatments with electroconvulsive therapy. Our client had a disability policy from her employment which paid her benefits until age 65 if she was unable to do her job. The insurance company paid her total disability benefits for 13 years and then suddenly terminated her benefits claiming that she could now return to work, despite the fact that her condition had not improved. The insurance company based its decision on the fact that our client volunteer work on behalf of a mental illness support organization for a few hours a week. Pillsbury & Coleman sued and presented evidence showing that our client's condition had not improved, that she was still suffering from a significant and permanent mental illness and that she was getting along and contributing to society as best as she could. We were also able to avoid ERISA preemption because our client's policy was issued through a religious institution, an exception to ERISA's harsh restrictions. The case was successfully settled.

Trial lawyer who developed disabled by severe tinnitus, headaches and mental illness. Our client's condition was so severe she could no longer effectively practice law due to the maddening distraction of constant noise in her ears. She was also clearly suffering from depression, anxiety, obsessive compulsive disorder and was suicidal. She made a disability claim under her private disability policy. The insurance company denied her claim on the grounds that there was no "objective" evidence of her condition. When she demonstrated she was disabled by her psychiatric symptoms the insurance company contended that because she had begun treating a the psychiatrist after she stopped working, she had no "occupation" from which to be disabled. After Pillsbury & Coleman took several claims representatives depositions, the insurance company settled the case.

Surgeon disabled by Post-Traumatic Stress Disorder resulting from his attempted murder. Our client was a surgeon disabled by severe post-traumatic stress disorder after being shot in a murder attempt. After healing from his gunshot wounds, our client continued to suffer from severe depression, attempted suicide multiple times, and abused drugs and alcohol before successfully entering rehabilitation. He ultimately lost his medical license.

Our client filed for disability insurance but his claim was rejected. His disability insurer contended that he was not disabled in that he was not precluded from being a surgeon because psychological testing indicated he was highly intelligent and had no demonstrable memory deficits.

The client then hired Pillsbury & Coleman. After we defeated the insurer's attempt to dismiss the case and the claim for punitive damages in summary judgment, the case settled.

CARDIAC CONDITIONS

Senior Vice President and Regional Sales Manager Disabled by Aortic Dissection and Marfan Syndrome. Pillsbury & Coleman successfully overturned the denial of benefits owed to a Senior VP and Regional Sales Manager who suffered an aortic dissection that nearly killed him. Through an administrative appeal under ERISA, our client's insurer finally accepted he was totally disabled, but then proceeded to miscalculate his benefits, necessitating litigation. In a published decision, the Northern District of California determined that Sun Life Insurance Company wrongfully calculated benefits and awarded our client all benefits due.

Banker Disabled by Severe Diabetic Neuropathy. Pillsbury & Coleman successfully appealed a denial of benefits to a highly paid bank executive who could no longer work due to the severe chronic pain resulting from chronic diabetic neuropathy. His disability was exacerbated by sleep apnea and from the sedating side-effects of the pain medication he required to function.