ERISA Disability and Health Case Histories and Random Musings by an ERISA Disability Lawyer

Mark Twain said, "Write what you know."   Over the past 25 years, I have handled just about every kind of long term disability claim denial case there is, everything from heart attacks, strokes, cancer, diabetes, fibromyalgia, degenerative disc disease, accidental injury, IBS, headache syndromes, broken eardrums, diabetes  to somatoform disorder.  I have also handled numerous health benefit claim denials for medical providers.


All ERISA claims have two things in common: (1) The facts of each case are unique; and (2) the law is always the same (until it changes).  So I thought it might be interesting to take some histories from the cases I know best, my own, and write a short blog post for each one.  Although each one is different, the same issues surface again and again. It seems insurance companies can only come up with so many ways to screw over claimants.   After a couple of decades, a lawyer can get pretty good at identifying the pattern.  Read through the posts that interest you.  And you too may see the patterns I see every day.  I have only included full client names in those cases that were litigated; and thus, are a matter of public record.


Also, from time to time, I may throw in some commentary about the practice of law in general and some perspectives about the life of a sole practitioner ERISA lawyer. 

July 31, 2020

Rader Programs, Inc. vs. Honda of America Mfg., Inc. (Aetna) CV 00-00041 AHM

The Patient was a 55 year old male from Ohio, who suffered major depression and morbid obesity, having gained over 100 lbs. to a weight upon admission of 320 lbs.  He had health insurance cover...

May 10, 2020

 Jessica D. (Aetna / Highmark Blue Cross Blue Shield) 

Jessica was admitted to the hospital for treatment.   Upon admission, she presented an insurance card, which indicated she was insured by Highmark Blue Shield – PPO.  Shortly after admission, the hospital conta...

February 3, 2020

Robert Collins v. Liberty Life Assurance Company of Boston, a.k.a. Liberty Mutual, 988 F.Supp.2d 1105  (CD, Cal. 2013) CV 12-05990

Mr. Collins was leading a normal life before he was struck down by disability. He had served with honor in the United States Marine Corps R...

November 24, 2019

Rick R. (Plan administered and insured by Massachusetts Mutual Life Insurance Co.)

Rick R. was admitted to a residential treatment center, where he underwent 30 days inpatient care for treatment of alcohol dependence.  Prior to admission the facility called Mass. Mutual...

August 26, 2019

Rickey Thomas Sebo v. Metropolitan Life Insurance Company, Allstate Long Term Disability Plan, CV  99-10770 HLH;  (9th Cir. Case No. 00-55765)

I hold a profound belief that “A is A”.  For those who are not students of logic, that’s Aristotle’s “Law of Identity”.  S...

July 14, 2019

Patricia L. (Toys-R-Us / Self-funded plan administered by Mediplan)

Patricia L. was admitted to a treatment facility with a diagnosis of bulimia with major depression.  She was placed on a routine protocol program, including medication and psychotherapy and discharged 2...

June 8, 2019

James C. (The Hartford)

James C. suffered multiple medical problems that were clearly debilitating.  All three of his treating physicians agreed that he was totally disabled from performing the duties of any occupation.  He had coverage with the Hartford, which insured...

April 11, 2019

Spencer Recovery Centers, Inc., vs. Blue Cross Blue Shield of Michigan (Related Cases) Case Nos: SACV 00-786 DOC, SACV 00-787 DOC, SACV 00-788 DOC

This case involved three claims for health benefits for three patients treated at a residential treatment facility, providi...

March 1, 2019

Michael A.  (Aetna) 

Michael was admitted to a residential treatment facility for rehabilitative treatment of alcoholism.   His entire stay at the facility was case-managed and approved in advance by Aetna, with written “certification notices” issued to the treatme...

January 20, 2019

Mary Z.

Mary was admitted to an acute-care inpatient psychiatric facility treatment facility diagnosed as suffering major depression.  Upon admission she was a 48 year old female with a history of childhood sexual abuse, who presented a serious suicide risk. 


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Rader Programs, Inc. vs. Honda of America Mfg., Inc. (Aetna) CV 00-00041 AHM

The Patient was a 55 year old male from Ohio, who suffered major depressio...

Claims administrator believed ERISA gave it discretion to dishonor "medical necessity" certifications.

July 31, 2020

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