John Stennett and Barbara Casino have years of experience in successfully handling disability claims. A quick perusal of the below listed cases reflects a sampling of STENNETT & CASINO’s numerous successes and highlights the issues that arose in those cases.
Mr. Allen’s work required heavy lifting. He injured both is lower and upper back while at work. Prudential paid Allen disability benefits for 24 months acknowledging that he could not return to his old occupation. After 24 months the definition of “total disability” in the policy changed from an inability to perform one’s “own occupation” to an inability to perform “any occupation.”
Prudential terminated Allen’s disability benefits after 24 months claiming that he was able to perform a sedentary occupation. Prudential also asserted that the limitation in the policy for “self-reported symptoms” to 24 months of benefits also applied because Allen’s limitations were based on pain and fatigue which could not be objectively verified. Prudential thus considered his pain and fatigue “self-reported symptoms” which were limited to 24 months of benefits.
Stennett & Casino put Mr. Allen through functional capacity testing that objectively measured his limitations and supported his inability to perform “any occupation” on a full-time basis. They also pointed out that the “self-reported symptoms” limitation only applies to diagnoses which are based on self-reported complaints not on limitations which are based on self-reported complaints such as pain and fatigue. Thus with the numerous objective findings on MRI, x-ray and discogram’s showing 2 herniated discs as being the sources of Mr. Allen’s pain, the “self-reported symptoms” limitation did not apply.
Mr. Buschauer had a bipolar disorder that was generally controlled by medication. However, one side effect of the medication was an ability to focus. Life Insurance Company of North America (LINA) paid disability benefits to Buschauer for 7 years. During those 7 years he attempted to return to work on 4 separate occasions. In each of his attempts to return to work he first reduced his medication so that he would be able to function in the workplace. However, on each occasion his attempt to return was unsuccessful due to a reemergence of his bipolar symptoms of severe anxiety, depression racing thoughts and impulsivity.
The first 3 attempts to return to work were monitored by LINA. The last attempt Buschauer attempted on his own. When LINA found out about the 4th attempt to return to work they cut off his benefits after obtaining a medical record review by a psychiatrist indicating that there was no medical evidence that would preclude Buschauer from returning to work.
Because LINA failed to have Buschauer examined by a psychiatrist, Stennett & Casino sent him to an independent psychiatrist for examination. The independent psychiatrist confirmed Buschauer disability citing the 4 failed attempts to return to work and I his problems with consistently focusing on a job.
Stennett & Casino also pointed out that the court’s are very skeptical of insurers who rely on pure paper reviews, particularly where the condition is diagnosed clinically and the symptoms are subjective in nature. In Salomaa v. Honda LTD Plan, 637 F.3d 958 (9th Cir. 2011) the disabling condition was fibromyalgia (a condition that cannot be diagnosed by objective tests). The Court took note that the defendant insurer relied solely on paper reviews, and stated:
An insurance company may choose to avoid an independent medical examination because of the risk that the physicians it employs may conclude the claimant is entitled to benefits. The skepticism we are required to apply because of the plan’s conflict of interest requires us to consider this possibility in this case. The medical record by physicians who actually examined Salomaa is entirely one-sided in favor of Salomaa’s claim. The plan rejected its opportunity to see if there was another side.
Stennett & Casino obtained a settlement providing Buschauer with the benefits he was seeking.
Mr. Fritch was a scientist who loved his work. However, he had a terrible back that interfered with his ability to continue his job. Fritch underwent 5 separate back surgeries. After each back surgery following a period of rehabilitation he returned to his job.
Fritch was only able to return to work from home for a few weeks following the 5th surgery. When he returned to his surgeon it was discovered that the hardware surgically placed in his back had failed due to osteopenia. Fritch underwent a final 6th surgery to correct the problem. He never recovered sufficiently from the 6th surgery to consistently return to work.
United of Omaha paid benefits following the 6th surgery. But, approximately 8 months later they terminated the disability benefits based on their doctors’ opinion that Fritch should have recovered sufficiently from the 6th surgery to return to sedentary work.
Stennett & Casino filed suit in federal court in behalf of Mr. Fritch. The court found that the evidence presented by Stennett & Casino was more persuasive than the evidence submitted by United of Omaha and entered judgment in favor of Mr. Fritch for all benefits due under the policy.
Reliance Standard terminated Ms. Jarillo’s disability benefits after paying for 5 years following a low back injury. Reliance Standard claimed that Jarillo’s back had improved with time allowing her to return to a sedentary occupation.
Reliance Standard also claimed that her chronic pain diagnosis was contributed to by depression and anxiety. The policy contained a two-year limitation for disability benefits related to mental illness which Reliance Standard asserted was triggered by her depression and anxiety thus further limiting her benefits.
Stennett & Casino were able to establish that Ms. Jarillo’s back condition had not improved and that her depression and anxiety were a direct result of her long-term pain and limitations associated with her back condition. Judgment was obtained against Reliance Standard for the full amount of benefits under the policy.
Mr. Hoffman’s late wife Phyllis was a long-time employee of ATS until her terminal illness forced her to leave her job. She was on long-term disability until her death approximately one year later. ATS’s employee benefit plan provided that an employee “whose employment terminates for any reason other than malfeasance, retirement or voluntary resignation shall be entitled to… severance pay.” ATS denied Hoffman’s request for severance pay claiming that Ms. Hoffman’s departure from work was a “voluntary resignation” precluding her from receiving severance benefits. Hoffman asserted that leaving work because of a disability that rendered her incapable of performing her job duties did not constitute a “voluntary resignation.”
Stennett & Casino had to pursue Hoffman’s claim all the way to the Ninth Circuit Court of Appeals. The Ninth Circuit agreed that it was not “sensible to understand [an] inability to work due to disability as a voluntary termination of employment.” Citing Steffen v. United life Ins. Co., 697F. 3d 917, 936 (9th Cir. 2012). Hoffman was awarded the severance benefits he sought.
Ms. Krasne became disabled in January 2007, and remained continuously disabled as a result of a tumor pressing on her brain stem and damaging her lower cranial nerves. Her symptoms included radiating headaches, severe chronic pain in her neck and jaw, and physical weakness and fatigue. She also suffered both visual and auditory impairments. Life Insurance Company of North America (LINA) paid disability benefits until April 2018 when she was advised that her disability benefits would be terminated. LINA made this decision after having two medical doctors of their choosing examine her and conclude that although her vision, hearing problems, and pain might preclude her from working for extended periods of time, they did not disable her from work.
Krasne underwent a Functional Capacity Evaluation which addressed her disability through testing in a work place environment and concluded that Krasne would be unable to perform even a partial workday at a sedentary level due to her visual limitations, hearing impairment and chronic pain.
LINA failed to respond to the administrative appeal submitted by Stennett & Casino on behalf of Krasne. Thus Stennett & Casino filed suit which resulted in an immediate payment of the claim by LINA.
Mr. Robertson was in an accident in his early 20s that resulted in him becoming a paraplegic. Despite his ability disability he went back to school to learn a trade in computer science. He thereafter worked for 17 years in the computer field until his back became so painful. So much that he could no longer even sit in his wheelchair for extended periods of time. He then tried working from home while laying on his back but was a unsuccessful.
Hartford paid disability benefits to Robertson for several years but then suddenly terminated those benefits after receiving medical records that reflected that he had fractured toe while waterskiing. This raise suspicions with Hartford so they thus obtains video surveillance of Robertson going to several stores with his wife to go shopping on December 23 for his children.
The waterskiing injury was the result of a birthday present consisting of a specially equipped chair for waterskiing (waterskiing was big in his family). He attempted to use the chair on one occasion and immediately fell injuring his toe. He never used the chair again. Despite these facts and a function capacity evaluation and vocational evaluation that supported Robertson’s disability, Hartford continued to deny disability benefits relying on their doctors review of records. However Hartford failed to provide the doctor with the functional capacity evaluation (FCE) which was obtained by Stennett & Casino.
Stennett & Casino filed suit in Federal court on behalf of Mr. Robertson against Hartford Insurance Co. The court ruled in Robertson’s favor citing the fact that since Hartford’s doctor was not provided the FCE report as part of his review his conclusions were “unreliable.”
At age 36 Ms. Watts was advised by her physician to stop working due to her diagnosis of lupus, fibromyalgia and associated symptoms related to those diagnosis. She received disability benefits through her employer’s disability plan insured by MetLife. However, after 2 years MetLife terminated her benefits based on surveillance video of Watts and the examination and report of a physician retained by MetLife.
The physician concluded despite her many problems based on the surveillance she was capable of daily activities of lathing and probably capable of working at her old job. However, he was unable to comment on whether she would be able to “function within the average stress of a workplace.” MetLife also had Watts’ medical records reviewed by a physician who concluded that there were no “objective abnormalities necessitating restrictions and limitations.”
Watts was subsequently awarded Social Security disability benefits. That determination was submitted to MetLife, but the only response from MetLife was to demand that Watts reimburse MetLife $27,000 in overpayments due to the retroactive award of Social Security disability benefits.
Stennett & Casino filed suit on behalf of Watts. At trial the court found that Metropolitan Life abused its discretion in denying Watts disability benefits. The court found that the quality and quantity of the medical evidence supported a finding that Watts was disabled and that MetLife placed excessive reliance on surveillance video that was ambiguous at best. Judgment was entered in favor of Watts for the benefits owed under the plan.
Mr. Wheeler was working overseas in the Persian Gulf as a Coxswain Mechanic. His job was considered heavy work. He was lifting, with a wench, a 520 pound unmanned underwater vehicle out of water during a storm when he was hit by the craft throwing him to the deck landing on his lower back.
As a result of the incident, Wheeler sustained injuries to his back, fractured ribs, exacerbated a right shoulder injury and suffered PTSD with symptoms of anxiety, severe depression and sleep disturbance.
Wheeler’s job required the ability to do heavy lifting and work on the high seas and all kinds of whether. Following the incident, Wheeler was unable to return to his prior job but was temporarily provided light work. MetLife refused to pay any disability benefits based solely upon a review of medical records. Most of Wheeler’s records of treatment in the Middle East were unavailable. MetLife’s doctor reviewing what little records were available opined that there were no objective findings to support any limitations or restrictions even though Wheeler’s treating doctors found him to be disabled. The policy did not require objective findings to support disability.
Stennett & Casino filed suit in federal court and during mediation was able to obtain a favorable settlement on Wheeler’s behalf.