McKennon Law Group, Author at McKennon Law Group

If you need long-term disability benefits after a disabling sickness or disabling injury, you should be advised and represented by a California disability insurance claims attorney with the McKennon Law Group. For more than seventy years, the McKennon Law Group has advised and represented California families and consumers whose claims for insurance benefits have been wrongly and unfairly denied.

The California State Disability Insurance program provides short-term disability insurance benefits to eligible workers who are unable to work because of a non-work-related illness or injury, pregnancy, or childbirth. While that program pays most workers 60 percent of their wages for up to a year, this state does not have a public, long-term disability insurance program.

Do You Have Private Long-Term Disability Coverage?

Many private insurance companies offer long-term disability insurance coverage, but even if you are a paid-up policyholder, an insurance company may reject your claim for long-term disability benefits or expect you to provide extensive and detailed evidence of your disability.

Individual disability insurance policies are usually governed by state laws, while most of the group insurance policies that are provided by employers in California are governed by the federal Employee Retirement Income Security Act of 1974 (ERISA).

When Should You Contact an Attorney?

If you believe that an insurance company or employer has wrongly denied your disability benefits claim under ERISA, you should consult an attorney – at once – at the McKennon Law Group. We’ve handled thousands of disability insurance claims, and we know how to resolve disability claim disputes that involve both individual policies and ERISA-governed group policies.

If your claim for long-term disability benefits under an ERISA group plan is denied, you must pursue at least one appeal directly with the insurance company before you will be allowed to file a lawsuit. Let a California disability insurance attorney at the McKennon Law Group handle that appeal on your behalf.

What Compensation Can a Lawyer Help You Recover?

If your claim for disability benefits through an individual insurance policy is denied, you may be able to bring a bad faith lawsuit against the insurance company, and you may also be entitled to substantial further compensation for the suffering caused by the wrongful denial of your claim.

However, if your claim for long-term disability benefits is based on an ERISA-governed group plan, there will be some restrictions on the compensation you may recover. With either type of insurance policy, an attorney for insurance claims at the McKennon Law Group can offer you reliable, comprehensive legal advice regarding the best way to move forward.

There is No Charge for Your First Legal Consultation

If your claim for long-term disability benefits has been rejected – or if your claim has been delayed for no apparent or discernible reason – call the McKennon Law Group today to learn more or to schedule a no-cost, no-obligation initial legal consultation. Take advantage of the opportunity to learn where you stand legally and to receive sound, personalized legal advice.

Let us put more than seventy years of legal experience to work on your behalf. You can contact the McKennon Law Group by calling (800) 682-4137 or by completing the contact form on this website. Our law offices are located in San Francisco, San Diego, Los Angeles, and Newport Beach.

According to the California Department of Insurance, most Californians cannot afford nursing home care – at an average cost of $6,000 per month – and are worried about the cost of growing older. Purchasing a long-term care insurance policy is one solution to this dilemma facing an aging California population. Long-term care insurance can be invaluable to elderly persons who can no longer care for themselves. These insurance policies typically cover nursing home costs and in-home care at your own residence if you are unable to care for yourself. But even if you are one of the lucky few that has LTC insurance, unfortunately, we regularly see long-term care insurers that do not honor their policy obligations.

The California legislature recently created a Long-Term Care Insurance Task Force within the Department of Insurance. California Insurance Commissioner Ricardo Lara just appointed six members to the Task Force with preeminent credentials. The Task Force will explore how to design a statewide affordable long-term care insurance program including whether an increase in payroll taxes might allow for the program to be publicly subsidized. An article on the Task Force is copied below. You can learn more about the Task Force at http://www.insurance.ca.gov/0500-about-us/03-appointments/ltcitf.cfm#about.

Hopefully, the Task Force will result in long-term care insurers honoring their contract obligations more frequently. That is doubtful in our opinion. That is not the goal of the Task Force. Moreover, insurers are in the business of making money. To do that successfully, an insurer must take your premiums and pay out as little in claims as possible. In our experience, Department of Insurance actions usually do not change an insurer’s conduct in a particular claim.

So, what should you do if your long-term care insurer wrongfully denies your claim? Relying on this new Task Force will not change your claim denial, and the Task Force is not even scheduled to create a potentially publicly subsidized long-term care insurance program for several years. You should hire an experienced California insurance bad faith or ERISA lawyer to represent you. If your claim for long-term care, long-term disability, life, accidental death, retirement or health benefits has been denied, you can call (949) 387-9595 for a free consultation with the attorneys of the McKennon Law Group PC, several of whom previously represented insurance companies and are exceptionally experienced in handling both ERISA insurance claims and non-ERISA California insurance bad faith claims.

Commissioner Lara Appoints Members to the California Long Term Care Insurance Task Force

SACRAMENTO, Calif. — Insurance Commissioner Ricardo Lara today announced his six appointments to the new Long Term Care Insurance Task Force, established within the California Department of Insurance by legislation that he strongly supported to help address the long-term care services and insurance needs of older Californians.

“Our new Long Term Care Insurance Task Force will explore greater options for Californians to help them age with dignity and security,” said Commissioner Lara. “With their deep experience in insurance, culturally competent care and services, and the health needs of older Californians, these Task Force members are ready for the challenge of envisioning a statewide insurance program that is sustainable and meets the needs of our growing diverse population. The health disparities exposed by the current pandemic on our aging population and the services and supports they will need in coming years make this Task Force even more critical today.”

Created by the legislative passage and Governor Gavin Newsom’s signing of AB 567 (Calderon, Chapter 746, Statutes of 2019), the Task Force will, under Commissioner Lara’s leadership, explore how a statewide long-term care insurance program could be designed and implemented to expand the options for people who are interested in insuring themselves should they encounter functional or cognitive disability that requires long-term care, services, and supports. The 15-member Task Force includes the Insurance Commissioner, who will serve as its Chair, as well as the Director of the California Department of Health Care Services (DHCS) or his designee, the Director of the California Department of Aging or her designee, six individuals appointed by the Commissioner, four individuals appointed by the Governor, one appointment made by the Speaker of the Assembly, and one appointment made by the Senate Committee on Rules.

“The lack of affordable long-term care is a serious threat to the well-being of many Californians, and yet another symptom of the systemic inequities in our health and social support systems,” said DHCS Director Will Lightbourne. “I’m pleased to join this task force and work on solutions that will increase access to long-term care and help provide healthy and dignified lives for our aging populations.”

“Affording the care we need as we age, so we can live where we choose in the community, is a top priority for the thousands of Californians we heard from in developing the Governor’s Master Plan for Aging, released in January,” said California Department of Aging Director Kim McCoy Wade. “Innovative public private leadership and partnership, such as this new Task Force provides, are essential to developing effective and equitable solutions. I’m eager to work with Commissioner Lara and members of the Task Force to move this important work forward.”

Over the next two years, the Task Force will meet to discuss establishing a statewide long-term care insurance program and prepare a feasibility report for the Commissioner, the Governor, and the Legislature by January 1, 2023. The recommendations made by the Task Force in the feasibility report will then be analyzed in an actuarial report to ensure an adequate benefit within a solvent program which, if approved by the Task Force, will be submitted to the Legislature by January 1, 2024.

The first meeting of the inaugural Task Force is expected in early spring 2021. More details are available at http://www.insurance.ca.gov/0500-about-us/03-appointments/ltcitf.cfm.

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Media Notes:

Newly appointed members include:

Dr. Lucy Andrews, is Director of Nursing and CEO for At Your Service Nursing and Home Care. Dr. Andrews presently serves as Board Chair for the California Association for Health Services at Home (CAHSAH) and is the former Vice Chair of the National Association for Home Care and Hospice in Washington, DC. She is also a recipient of the Lois Lillick Award, which honors advocacy and expertise in the home care industry. Dr. Andrews joins the Task Force as a representative of hospice and palliative care providers.

Grace Cheng Braun, MSPH is President and CEO of WISE & Healthy Aging, which administers the City & County of Los Angeles’ Long-Term Care Ombudsman Program (the largest Ombudsman program in the state, and second in the nation) and Elder Abuse Prevention Services. The community-based, nonprofit social services organization also operates two adult day care centers and other care coordination and enrichment programming for older adults and caregivers of the elderly in Los Angeles. She is also a member of the Steering Committee of both the Los Angeles Alliance for Community Health and Aging (LAACHA) and the Westside Older Adult Services Network, which promotes health and service equity in the Los Angeles community. Cheng Braun joins the Task Force as a representative of adult day services providers.

Michael Mejia is Senior Vice President, Operations for Atria Senior Living where he leads Atria’s operations in the Western U.S. and currently oversees operations at 43 Atria communities in California, including 33 with memory care neighborhoods. He joined Atria in 1998 and since then has overseen operations in Texas and Kansas as Regional Vice President and served as Senior Vice President previously in the Central, Southeast, and Southwest divisions. He is also a member of the California Assisted Living Association (CALA) Board of Directors. Mejia joins the Task Force as a representative of residential care facilities for the elderly.

Doug Moore is the Executive Director of the United Domestic Workers of America (UDW/AFSCME Local 3930) which represents more than 140,000 In-Home Supportive Services (IHSS) providers and family child care providers across California. Moore also serves as International Vice President of AFSCME. He was appointed by the State Assembly to the California Task Force on Family Caregiving in 2017. In 2019, he was appointed to the Governor’s Task Force on Alzheimer’s Prevention and Preparedness. Moore joins the Task Force as a representative of independent providers of in-home personal care services.

Dr. Karl Steinberg, M.D., C.M.D., has been a skilled nursing facility and hospice medical director in San Diego County for over 25 years and cares for patients in nursing homes, assisted living facilities, and small board-and-care facilities. He is President-Elect of AMDA – The Society for Post-Acute and Long-Term Care Medicine, a national organization representing physicians and medical directors working in various post-acute and long-term care settings, and is a delegate to the American Medical Association and the California Medical Association. Dr. Steinberg joins the Task Force as a representative of long-term care health professionals.

Tiffany Whiten is Senior Government Advocate at SEIU California State Council where she oversees and coordinates state legislative and administrative policy development on many SEIU-California policy priorities, including assisted living, IHSS, nursing homes, adult day care, developmentally disabled, and other long-term care sectors as well as racial and social justice issues. She not only represents and advocates on behalf of long-term care providers, workers, and consumers, but is also a family caregiver to her mother with Alzheimer’s. Whiten’s previous roles include working as an Associate with Niemela Pappas and Associates, a Consultant for Senator Mark DeSaulnier, a Legislative Aide to Senate Majority Leader Ellen Corbett, and a Legislative Aide to Senate President pro Tempore Don Perata. Whiten joins the Task Force as a representative of family caregivers.

Insurance companies often base denials of disability claims on the mere review of the available documentation in the existing claims files. It is cheaper for them to do so and by using their own paper reviewer, they reduce the risk of an unfavorable report after completion of a significantly more expensive independent medical examination. By carefully selecting the paper reviewers, the insurance companies can obtain some “evidence” of a basis for denial of claim benefits. But how much value do such reports have, particularly if they conveniently fail to address substantial evidence of disability in the reports of the claimant’s treating physicians in the claims file?

In a recent disability benefits decision involving Unum Life Insurance Company (“Unum”), Rios v. Unum Life Ins. Co., 2020 WL 7311343 (C.D. Cal. Dec. 10, 2020), the court reviewed the denial of a disability claim under a de novo standard of review and determined that the claimant was entitled to disability benefits.

Claimant Yolanda Rios worked as a User Support Specialist for large national law firm, Arnold & Porter Kaye Scholer, L.L.P., until she made a claim for disability benefits with Unum. Claimant’s specific job at Arnold & Porter required constant sitting as well as intense concentration and logical thinking. Her Regular or Usual Occupation in the national economy required “constantly sitting” for more than 5.5 hours in an 8-hour day, and it required “focus and concentration.” Rio’s primary disabling condition was “back and leg pain (sciatica) related to multi-level degenerative lumbar disc disease, stenosis, radiculopathy, and ‘severe disc narrowing at L4/5.’” Unum initially approved and paid long-term disability benefits based only on her anxiety and depression and not on any physical impairment, but Unum agreed to further evaluate her physical complaints.

Unum based its denial on a “paper review” of the records which arbitrarily failed to adequately address the claimant’s own testimony regarding pain. The medical reviewer ignored substantial evidence of “excess pain” throughout the claimant’s medical records. Unum had the opportunity to medically examine the claimant and chose not to do so while knowing of the evidence of Rio’s significant pain in the medical records. The court’s disability finding was further supported by the Social Security Administration’s determination that the claimant was “less than sedentary” and, therefore, disabled from “any gainful occupation.” Although the favorable SSA ruling was not dispositive, the court, following applicable Ninth Circuit precedent, found it to be relevant.

The Rios court criticized Unum’s paper review because it conflicted with substantially all the medical evidence, and it faulted Unum for failing to conduct a medical examination of the claimant. The court held that Rios was disabled under both the “own” and “any” occupation standards and faulted Unum’s reviewer for numerous misstatements and inaccuracies. It noted that at least five treating doctors or health care providers had documented that she was taking drugs that affected her concentration, that she had memory problems and that her muscle relaxant did not allow her to work. Because her current job required the ability to focus on a task for some length of time and the ability to use reasoning consistently in her regular and usual occupation as required in the national economy, Rios was disabled under both standards.

The court found that Unum arbitrarily discredited Rios’ testimony of her pain, and her testimony was supported extensively in the medical records. And, Unum did not bother to conduct its own medical examination of the claimant. Unum’s failure to do so “‘raise[s] questions about the thoroughness and accuracy’ of its benefits determination.” Rios, 2020 WL 7311343, at *3, citing Montour v. Hartford Life & Acc. Ins. Co., 588 F.3d 623, 630, 634 (9th Cir. 2009). The court was skeptical of the opinions of Unum’s non-examining experts because it found that the opinions of the examining physicians were “entirely one sided in favor of [Plaintiff’s] claim.” Rios, 2020 WL 7311343, at *3, citing Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 676-679 (9th Cir. 2011).

Rios is instructive in demonstrating the relative lack of evidentiary value a court should attribute to such one-sided paper reviews. The ruling recognizes that the insurer had the opportunity to obtain better evidence of the actual current condition of the claimant through a medical examination, and that the insurer should not benefit from its failure to engage in such examination. And, of course, one-sided paper reviews that completely fail to consider abundant evidence of disability are entitled to little, if any, consideration. In addition, Rios underscores the need for claimants to supplement the evidence in the claim file with additional favorable evidence. In particular, Ms. Rios benefited from the supplementation of the record to include the approval of her SSA benefits, which approval occurred after her claim was submitted and was, therefore, not available for consideration at the time of the insurance company’s denial of benefits.

The involvement of skilled ERISA attorneys can make an important difference in the likelihood of a favorable outcome in these matters. McKennon Law Group PC focuses its practice on assuring the most favorable presentation of such reasonably available evidence to the court and the opposing party. Its expertise in handling these matters can be seen in the numerous rulings in favor of claimants. If you believe that an insurance company or benefits administrator has unfairly handled your claim for disability benefits, we urge you to contact us for a free, no-obligation, case evaluation. Let us see what we may be able to do to help you get the benefits you deserve.

McKennon Law Group PC is proud to announce that its founding partner, Robert J. McKennon, has been recognized as one of Southern California’s “Super Lawyers” for Insurance Coverage and appeared in the 2021 edition of Southern California Super Lawyers magazine. Mr. McKennon has been recognized as a “Super Lawyer” for 11 years in a row, and in 2020 received a special designation as a 10-Year “Super Lawyer,” a rare designation achieved by less than 1% of attorneys.

Each year, Super Lawyers magazine, which is published in all 50 states and reaches more than 14 million readers, names attorneys in each state who attain a high degree of peer recognition and professional achievement. The Super Lawyer designation is given to less than 5% of lawyers nationally after being nominated and voted on by their peers. Mr. McKennon has received this Southern California Super Lawyer designation every year from 2011 through 2021.

Mr. McKennon and his firm have also received numerous other awards and recognitions (click here).

A California Federal District Court has granted a motion for summary judgment under F.R.C.P. Rule 52 in favor of a disability claimant, holding that an insurer must consider a long-term disability (“LTD”) claim in accordance with the correct classification of the claimant’s “occupation” as determined by the claimant’s “actual duties.”

In McCulloch v. Hartford Life and Accident, 2020 WL 7711257 (N.D. Cal. 2020), the plaintiff suffered from “involuntary tremors and body jerking, fatigue, and cognitive impairment” that, inter alia, affected her ability to drive. Id., *1. The insurer denied the disability claim and ensuing appeal, whereupon the “plaintiff filed a complaint against [the insurer], alleging a cause of action under 29 U.S.C. § 1132(a)(1)(B) to recover LTD benefits under the terms of [the insurer’s] Plan.” Id.

The Court found that, after having been bitten by a tick, the plaintiff developed various symptoms, including an impairment of “cognitive capacity”, whereupon one of her physicians wrote to the insurer, “I believe that [claimant’s] health issues are serious and limiting. She cannot work because of cognitive impairment as corroborated by her decidingly [sic] abnormal SPECT scan.” Id., *4. The insurer, however, determined that plaintiff’s occupation involved “light work” in the workplace, and denied the claim on the ostensible basis that “plaintiff’s medical records ‘did not provide any objective exam findings or other assessments to support the severity of … symptoms’ and did not state specific work restrictions.” Id., *5. Although the plaintiff appealed on the basis of the reports of several health care practitioners, the insurer denied the appeal on November 20, 2019. Id., *7. Notably, on August 30, 2020, the Social Security Administration (“SSA”) awarded the plaintiff monthly benefits because “under SSA’s rules, [the claimant] became disabled on March 12, 2018.” Id., *8.

The Court observed, “the issue before this Court is whether plaintiff qualifies as disabled under the Plan’s ‘Your Occupation’ definition” and whether the plaintiff was disabled thereunder. Id., *7. The Court first addressed the plaintiff’s “occupation.” The term, “Your Occupation,” was defined in the LTD Plan as “the [e]ssential [d]uties of the job [claimant] is performing for [her] [e]mployer.” Id. Observing that a determination of disability must be based on the plaintiff’s “actual duties”, the Court held that the insurer applied the incorrect definition of “occupation;” rather than “light work” as proffered by the insurer, the plaintiff’s “occupation involved concentration, frequent driving, traveling by airplane, and keyboarding.” Id. *7-8.

The Court then concluded that the plaintiff was, in fact, disabled under the foregoing definition of “occupation.” The Court rejected the insurer’s assertion that the plaintiff’s “real problem seems to be that she found her job and lifestyle extremely stressful.” Id., *8. Rather, because “[o]bjective tests support plaintiff’s disability”, the Court concluded that “plaintiff’s condition prevents her from driving and significantly impairs her physical and cognitive ability” such that “the Court finds that plaintiff is disabled under Hartford’s LTD Plan.” Id., *8-9. In reaching this conclusion, the Court was not persuaded by the insurer’s consulting physicians, concluding that the consultants neither correctly addressed the actual work required of the plaintiff nor the effects of her disability thereon. Id., *9-10.

McCulloch underscores that a disability claim must be evaluated under the proper classification of a claimant’s “occupation” as determined by the claimant’s actual duties. In making this determination, evidence is relevant as to the effects of the disability on the tasks inherent to the claimant’s actual work. Accordingly, delineating the claimant’s actual duties may preclude an insurer from introducing evidence not relevant to the claimant’s “occupation.”

We have significant experience in handling ERISA and non-ERISA disability insurance cases in which an insurer denied a claim based on a lack of objective evidence or a claimant has a disability condition that is subjective in nature and difficult to prove and measure. If your insurer or plan administrator has denied your disability claim, please contact McKennon Law Group PC for a free consultation so that we may assess your matter.

In the January 4, 2021 issue of the Los Angeles Daily Journal, the Daily Journal published an article written by the McKennon Law Group PC’s Robert J. McKennon entitled “ERISA Ruling Expands Protection for Employees, Beneficiaries.” The article addresses a recent case by the Ninth Circuit Court of Appeals, Beverly Oaks Physicians Surgical Center, LLC v. Blue Cross and Blue Shield of Illinois, which found that while anti-assignment provisions in ERISA matters are valid and enforceable, plan administrators can waive the right to assert and enforce these provisions when their actions are inconsistent with the provision or they are aware that the claimant is acting as an assignee. This opinion will greatly benefit employees who have medical insurance and sign agreements with their medical providers to assign their rights to collect payment from their health insurers. The Ninth Circuit’s opinion will be not only useful for claimants/employees who have health insurance claims, but also those who have disability, life or other employee benefit claims as the decision in Beverly Oaks will serve to prevent employers and insurers from making misrepresentations regarding ERISA plan terms and/or taking actions inconsistent that which they had previously represented.