San Francisco, CAA woman who filed an insurance lawsuit after being denied disability benefits has been awarded $873,000 by a federal jury. The jurors disagreed with the insurance company, who argued that there were medications that could help the woman work.
According to The Press Democrat (2/18/14), Cassaundra Ellena had to leave her job as a redevelopment manager because of symptoms related to lupus. Although she had been diagnosed with lupus when she took the job, she was not at that point showing symptoms. After she began work, Ellena reportedly began suffering debilitating symptoms, including chest pain and shortness of breath.
Despite notes from her doctor indicating that Ellena could not work, the long-term insurance company denied her benefits, claiming that Ellena could take special medications so she could work. Jurors found that the insurance company acted in bad faith by looking only at certain information in denying the claim and found in favor of Ellena, awarding her $873,000.
In denying claims, insurance companies are frequently accused of favoring their own doctors’ opinions over those of other medical professionals or at the very least of ignoring the findings of outside doctors. Insurance companies are often accused of denying claims on the basis that a claimant is not disabled, even with notes and reports from other doctors. In some cases, insurance companies argue that the claimant is not disabled and in other cases they argue there are measures the claimant could take to return to work. Either way, the end result is that the claim is denied.
In Ellena’s case, according to reports, even a judge with the Social Security Administration had found that Ellena was disabled from having any job, but still the insurance company denied her claim, arguing that she could work.
The lawsuit is Ellena v. Standard Insurance Co, et al, Number 3:12-cv-05401.
Meanwhile, some Vietnam veterans have filed a lawsuit to receive their benefits. According to KSWO (3/4/14), some veterans were discharged under “other-than-honorable” conditions after developing post-traumatic stress disorder. Because of their discharge, they were not eligible for benefits until post-traumatic stress disorder was recognized as a psychiatric disorder in 1980. At that point, the discharges should have been upgraded, but Vietnam veterans are still having their claims denied.
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