Winning Your Long-Term Disability Claim with BenGlassLaw

A dentist can’t practice dentistry anymore, everyone agrees he’s disabled, and he still loses his long-term disability benefits. That’s not a shocking medical story, it’s a contract story, and it’s exactly why we recorded this breakdown of Caraba v Paul Revere from the Seventh Circuit Court of Appeals. If you’re a doctor, dentist, lawyer, or other high-earning professional counting on an “own occupation” disability policy, the fine print around “other gainful occupation” can decide whether you get paid or get cut off.

We walk through what happened when Dr Caraba’s hip and back problems ended his chairside work, but his other income streams continued. Paul Revere paid benefits while investigating, then terminated the claim based on a policy definition that required not only inability to perform the important duties of his occupation, but also that he not be engaged in any other gainful occupation. We explain why that second clause can turn a seemingly straightforward dentist disability claim into a denial, even when disability is undisputed.

You’ll also hear a segment of real appellate oral argument where the court presses both sides on what “gainful occupation” should mean when the term is undefined, whether prior earnings should matter, and when a policy is truly ambiguous. We connect the legal debate to practical planning: how to review your long-term disability insurance, how side gigs and consulting can affect eligibility, and why a pre-claim strategy consult can save years of litigation.

If you want more episodes like this, subscribe, share this with a colleague who has disability coverage, and leave a review so more professionals can find the show.

This podcast is brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA. To the extent that these episodes include oral argument recordings from real courts, these recordings are in the public domain and free to everyone to use as they see fit.

By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.

If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

This is a case that Ben Glass argued in the 4th Circuit Court of Appeals in November. It involved a former Cox Enterprises employee who's benefits were terminated by Aetna, the plan administrator, after seven years of payments.

Ben argued that Aetna violated ERISA claim regulations in several ways, including ignoring the social security determination that the claimant remained disabled. 

Ever wondered why insurance companies can suddenly terminate benefits after years without warning? Here we argued that Aetna failed to engage in meaningful dialogue with Smith. Discover how these missteps can affect unrepresented individuals and the critical role of clear communication and adherence to regulatory standards in protecting their rights.

Join us as we dissect the complexities of remanding long-term disability cases and the intricacies involved in evaluating chronic pain patients' work capacity. With cases like Harrison and Gagliano, we highlight the contentious issue of paper reviewers challenging in-person medical opinions and the importance of a thorough review of all medical evidence. The discussion sheds light on the standards insurance companies must meet and emphasizes the need for fair and unbiased determination of work capacity and benefits entitlement.

We also delve into the distinct differences between Social Security and ERISA evaluations, exploring how these systems impact claimants' ability to perform gainful activity. With a focus on fiduciary responsibilities, this episode underscores the importance of objective evidence and the need for insurers to remain unbiased and curious throughout their decision-making processes. We aim to equip you with invaluable insights into the legal landscapes of disability claims, ensuring that individuals like Jeremy Smith receive the fair treatment they deserve.

This podcast is brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA. To the extent that these episodes include oral argument recordings from real courts, these recordings are in the public domain and free to everyone to use as they see fit.

By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.

If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

In this episode, we explore a financial advisor's battle against the wrongful termination of his long-term disability benefits. He was a financial advisor at Fulton Financial Corporation, where he began working in 2009. In 2014, he started experiencing severe pain and numbness in his legs and feet, progressively losing his ability to stand, walk, and drive. By 2015, his condition had deteriorated to the point where he could no longer work. After consulting with specialists, he was diagnosed with neurogenic muscular atrophy and diabetic polyneuropathy.

Following his diagnosis, the claimant filed for long-term disability benefits, which Reliance Standard initially approved, acknowledging his inability to work. However, in October 2017, despite no improvement in his condition, Reliance Standard ordered an independent medical examination (IME), which concluded that he was still capable of working. As a result, Reliance Standard terminated his benefits in December 2017.

The claimant challenged this decision through the company’s internal appeals process, submitting updated medical records that confirmed his ongoing disability.

Curious about the full story and its potential impact on others facing similar challenges? Listen to our podcast as we delve into the court's ruling and the broader implications for long-term disability claims.

This is the oral argument in the third circuit court of appeals.

This podcast is brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA. To the extent that these episodes include oral argument recordings from real courts, these recordings are in the public domain and free to everyone to use as they see fit.

By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.

If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

The episode revolves around the denial of the claimant's claim for long-term disability benefits. The claimant was an employee at Procter & Gamble for many years. His role required him to perform various duties, which he could no longer carry out due to medical issues. Specifically, in June 2012, he underwent gallbladder removal surgery for gallbladder cancer. Following his surgery, he was initially approved for total disability benefits under the company’s Disability Benefit Plan.

However, in April 2013, after undergoing an Independent Medical Examination (IME) and a Functional Capacity Evaluation (FCE), it was determined that he was only partially disabled. The evaluations indicated that while the claimant could not perform the tasks required for his line operator position, he was capable of performing medium-demand-level work on a full-time basis, subject to certain limitations. Consequently, Procter & Gamble transitioned him to partial disability benefits, which ended after 52 weeks.

The claimant appealed the decision on several grounds:

1. Failure to produce the correct plan documents, specifically a 2012 plan which was referenced but never provided.
2. Inconsistencies in the definition of "totally disabled" provided to treating doctors versus the plan's definition.
3. Failure to consider new evidence submitted during the appeal, including vocational assessments and additional medical records.

The core of the case rests on whether the denial of benefits was handled appropriately, both procedurally and substantively. LET'S TUNE IN!

This is the oral argument in the Eighth circuit court of appeals.

This podcast is brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA. To the extent that these episodes include oral argument recordings from real courts, these recordings are in the public domain and free to everyone to use as they see fit.

By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.

If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

Can an insurance company really decide you're no longer disabled based on just one medical record?

This episode begins with the story of Dr. Rohr, an anesthesiologist who had to stop practicing due to crippling hand and finger tremors in 2007.

After a decade of receiving long-term disability benefits, a controversial 2017 reassessment by Sun Life concluded that his tremors had ceased, causing a heated debate about who must prove that the disability continues.

Hear about Dr. Potts, who initially claimed the tremors were gone, and Dr. Honig, who later confirmed their persistence. We discuss how these discrepancies impacted Sun Life's decision to terminate benefits and their failure to seek further evaluations.

The episode examines the internal biases within Sun Life's communications and the flawed reasoning behind their conditional offer to reconsider the decision if additional proof was provided.

TUNE IN for a straightforward look at how these issues connect in the world of disability benefits.

This is the oral argument in the Eighth circuit court of appeals.

This podcast is brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA. To the extent that these episodes include oral argument recordings from real courts, these recordings are in the public domain and free to everyone to use as they see fit.

By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.

If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

DISCOVER how one woman's struggle with her insurance company highlights the difficulties of getting long-term disability benefits. 

Occupation: Insurance sales agent.

Medical Condition: Persistent and severe pain in the neck, shoulders, upper extremities, and lower back.

Despite extensive treatments like surgery, injections, medication, acupuncture, and physical therapy, the claimant's pain persisted, making it impossible for her to perform essential job tasks such as prolonged sitting and frequent typing.

She filed for long-term disability benefits with Lincoln Life Assurance Company due to severe pain impacting her ability to work. However, Lincoln denied her claim, stating that the medical evidence did not support a finding of total disability and suggesting ergonomic accommodations as a solution.

THE CLAIMANT APPEALED, arguing that Lincoln failed to consider substantial medical evidence and her subjective symptoms. 

Join us as we break down the issues, explore the legal arguments, and discuss what this means for anyone trying to get disability benefits.

This is the oral argument in the Ninth circuit court of appeals.

This podcast is brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA. To the extent that these episodes include oral argument recordings from real courts, these recordings are in the public domain and free to everyone to use as they see fit.

By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.

If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

LISTEN TO THIS EPISODE to find out how a founder and innovator fought against his insurance company for his long-term disability claim. The primary issue was whether Aetna's denial was random and unfair, particularly when their own hired consultants acknowledged Daniel's severe limitations.

The CLAIMANT suffered from neuromyelitis optica (NMO), a severe neurological condition also known as Devic's Disease. Despite extensive treatments, including chemotherapy and various medications, his condition progressively worsened, leading to significant impairments that he claimed prevented him from working.

He applied for a long-term disability claim, but Aetna denied his application on the basis that the medical evidence did not support a finding of total disability as defined by their policy. This decision was made despite the opinions of the claimant's treating physicians, who provided consistent evidence of his inability to work.

The claimant's team filed an appeal against Aetna, arguing that the insurance company ignored substantial medical evidence and failed to consider his subjective symptoms, which were well-documented by multiple physicians.

JOIN US as we unravel the complexities of this case and discuss the broader implications for those seeking disability benefits.

 This is the oral argument in the 2nd circuit court of appeals.

This podcast is brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA. To the extent that these episodes include oral argument recordings from real courts, these recordings are in the public domain and free to everyone to use as they see fit.

By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.

If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

IN THIS EPISODE, we take a closer look at the story of a former employee at a dental supply company who suffered a traumatic brain injury from a fall down a flight of stairs. Despite thorough treatment, she continued to suffer symptoms that ended her career.

The claimant applied for long-term disability benefits but was denied on October 17, 2019. However, she didn't give up and appealed the decision, but unfortunately, her appeal was also turned down on August 31, 2020.

Subsequently, she took her case to court, arguing that the insurance company wrongly refused her benefits. Claiming that Sun Life Assurance wrongly denied her benefits from her job's benefit plan, she took legal action under the Employee Retirement Income Security Act (ERISA) in December 2020. Her case exemplifies how complicated and tough it can be to deal with insurance companies.

JOIN US as we break down her case, explore why her claims were denied, and discuss what this means for others trying to get disability benefits. Hear about her journey and the challenges she faced in getting the support she needed.

This is the oral argument in the 2nd circuit court of appeals.

This podcast is brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA. To the extent that these episodes include oral argument recordings from real courts, these recordings are in the public domain and free to everyone to use as they see fit.

By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.

If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

THE CLAIMANT was a former employee at Wright Medical Technology. He was suffering from the side effects of prostate cancer treatment when he applied for long-term disability benefits.

But, his insurance company, Hartford Life and Accident Insurance Company DENIED HIS CLAIM because they stated they did not have enough proof of loss to evaluate his disability, specifically citing missing medical records necessary to make a decision.

On April 11, 2020, the claimant filed an administrative appeal with Hartford, providing additional evidence to support his claim. Despite being required to issue a final decision within 45 days, Hartford failed to do so.

HE ARGUED that this failure meant his administrative remedies should be deemed exhausted, allowing him to bring his case to federal court. Substantial evidence included additional medical records supporting his disability claim.

LISTEN NOW to learn how to handle similar situations and protect your rights with long-term disability claims. Don't miss the INSIGHTS from our LEGAL EXPERTS.

This is the oral argument in the 2nd circuit court of appeals.

This podcast is brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA. To the extent that these episodes include oral argument recordings from real courts, these recordings are in the public domain and free to everyone to use as they see fit.

By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.

If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.

TUNE IN to find out why the DSM (Diagnostic and Statistical Manual of Mental Disorders), often seen as the ultimate guide, might not be as reliable as we think. Discover why re-evaluating these standards could be key to making insurance claims fairer. 

The claimant, employed by the School of Visual Arts, began receiving long-term disability benefits from Hartford Life Insurance Company in May 2010 due to her bipolar disorder.

Bipolar Disorder: This condition led to her becoming disabled in 2009, and she subsequently began to collect long-term disability benefits in May 2010. Bipolar disorder, classified as a mental disorder under the DSM-IV, was the primary reason for her disability​.

In May 2012, Hartford terminated her benefits based on the Plan's 24-month cap for disabilities resulting from mental illnesses. The Plan, which incorporates the long-term disability insurance policy issued by Hartford, has a provision that limits benefits for disabilities resulting from mental illness to 24 months. Since bipolar disorder is listed as a mental disorder in the DSM-IV, Hartford applied this 24-month cap and terminated her benefits accordingly.

The claimant filed an internal appeal, arguing that bipolar disorder is a biologically based illness and should be considered a physical condition, not subject to the mental illness cap.

This is the oral argument in the 2nd circuit court of appeals

This podcast is brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA. To the extent that these episodes include oral argument recordings from real courts, these recordings are in the public domain and free to everyone to use as they see fit.

By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.

If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.