News Archives - Page 10 of 36 - McKennon Law Group

Robert J. McKennon was named by the American Society of Legal Advocates as one of the top 100 Insurance lawyers in the State of California for 2018.

McKennon Law Group PC is proud to announce that its founder and managing shareholder Robert J. McKennon was named by the American Society of Legal Advocates as one of the top 100 Insurance lawyers in the State of California for 2018. Mr. McKennon has received this recognition every year since 2013. The American Society of Legal Advocates is an invitation-only, nationwide organization of top lawyers in practice today who combine excellent legal credentials with a proven commitment to community engagement and the highest professional standards.

Plan Administrators Cannot Violate their Fiduciary Duties by Failing to Provide Proper Notice of Policy Amendments; ERISA Plan Exclusions/Limits May Not be Enforceable

Summary Plan Descriptions (“SPD”) under ERISA are required to be given to plan participants, and they provide plan participants with the most important summary of plan terms they need to know regarding their ERISA governed plans. ERISA requires SPDs to “be written in a manner calculated to be understood by the average plan participant.” However, plans will sometime issue numerous plan modifications which can add up quickly and require plan participants to read a series of plan modifications in addition to the original SPD in order to determine their available benefits, rights, and obligations. To further complicate matters, benefit determinations may often be made by two separate entities. A Plan Administrator may make an initial appeal decision, and a Plan Director or committee may make a second-level appeal decision. While these tactics may appear to valid despite the confusion they create, a recent Ninth Circuit Court of Appeal decision clarified that an SPD must not only be accurate but also comprehensive, and entities deciding first-level appeals are fiduciaries and cannot avoid liability for misrepresentations even if second-level appeals are made by a separate entity.

In King v. Blue Cross and Blue Shield of Illinois UPS, No. 15-55880 (Ninth Cir. Sep. 8, 2017), Linda King, the wife of a retired UPS employee, participated in a welfare retiree-benefit plan sponsored and administered by Blue Cross and Blue Shield of Illinois (“Blue Cross”). After suffering from an infection requiring immediate surgery and lengthy care, Mrs. King filed a claim under the plan for medical benefits. Blue Cross subsequently denied her claim for benefits claiming the plan had a $500,000 lifetime benefit maximum and would not cover most of her medical expenses. The plan that covered retirees of UPS was governed by a SPD that was issued in 2006 and a series of 12 material modification summaries describing amendments to the plan that were adopted since 2006. This required Mrs. King to read the 2006 SPD and the summaries of plan modifications in order to determine the current language for each benefit provision. Also, Blue Cross claimed some of the provisions applied to the employee plan but did not apply to the retiree plan, although the language in the SPD and modification summaries did not make this clear.

While the SPD mentioned a $1 million lifetime maximum, a subsequent material modification in 2010 limited the lifetime maximum to $500,000. Later, yet another material modification eliminated the lifetime benefit cap, though it was unclear if the cap applied only to the employee plan or if it included the retiree plan. After Mrs. King incurred almost $950,000 in medical bills, Blue Cross sent her an explanation of benefits stating it would only pay a small fraction of her medical bills because she already reached the $500,000 lifetime benefit maximum. Mrs. King filed her first-level appeal with Blue Cross explaining that, among other things, she was previously assured by Blue Cross that her health benefits had no limit. After her appeal was denied by Blue Cross, Mrs. King filed a secondary appeal, this time submitting her appeal to the entity designated by the policy to review secondary appeals, UPS Claims Review Committee (“CRC”). The CRC subsequently denied Mrs. King’s secondary appeal emphasizing that the lifetime maximum was limited to $500,000. Mrs. King filed a lawsuit alleging that both Blue Cross and CRC breached their fiduciary duties in violation of ERISA by failing to reasonably appraise the average plan participant that the lifetime benefit maximum applies to the retiree plan. The district court granted summary judgment to Blue Cross and CRC, and Mrs. King appealed (Mrs. King died while the suit was pending).

On appeal, the Ninth Circuit reversed the decision of the district court. After determining that lifetime benefit maximums are not barred in retiree-only plans, the Ninth Circuit Court concluded that the SPD, as amended by the subsequent modifications, violates ERISA’s statutory and regulatory disclosure requirements because it did not reasonably apprise the average plan participant that the lifetime benefit maximum continued to apply to the retiree plan. The Ninth Circuit criticized the SPD and modification summaries because all of the material modifications would need to be read in conjunction with the SPD to determine available benefits instead of either an amended SPD, cumulative summaries of material modifications, or a comprehensive table of contents being issued allowing participants to verify which SPD terms were amended by the modifications being issued. The Court also criticized improper placement of provisions and font size in the SPD and material modifications.

Blue Cross argued that it did not qualify as a fiduciary under ERISA, since UPS retained the exclusive right and discretion to interpret the terms and conditions of the plan. The Court noted that this argument rested on a misunderstanding of the fiduciary designation in ERISA which includes any person who exercises any discretionary authority or control respecting management or administration of a plan. Since Blue Cross processes and pays claims to plan participants and conducts a first-level appeal for benefit denials, it is required to interpret the plan to determine whether to pay claims a or uphold benefit denials, and any one of these abilities confers fiduciary status under ERISA. It is certain that on remand, Mrs. King (via her estate) will argue that the lifetime cap is not enforceable. The Court’s opinion suggests that this is a viable theory because of the problems with the SPD.

While many ERISA governed plans may be confusing, plan participants should be able to rely upon plan administrators to provide them with accurate information concerning their ERISA benefit plan. This case further confirms that entities rendering decisions on the provision of plan benefits need to assure that plan documents and modifications thereto are easily understood by the average plan participant and cannot escape liability for providing confusing modifications or misinformation by attempting to layer the decision-making responsibility.

McKennon Law Group Gives Back, Donating Over 250 Pairs of Shoes to Soles4Souls

We at McKennon Law Group PC represent policyholders in their life, disability, medical and other insurance disputes to assist them to get their claims paid so they can thrive financially when events in their lives overwhelm them. So, we know the importance of helping those in need. This summer, we hosted a shoe drive for Soles4Souls’ “Go Green” initiative.

For the last several months, McKennon Law Group PC and its attorneys and staff worked together to turn the shoe drive into a very successful one. Through word of mouth and official publications announcing our firm’s work for Soles4Souls in the Los Angeles Times and others, the McKennon Law Group PC received and donated over 250 pairs of shoes.

The Firm’s efforts did not go unnoticed. On August 24, 2017, McKennon Law Group PC received a letter from the charity’s CEO, Buddy Teaster, thanking the Firm for its substantial commitment to those in need. He commented that Soles4Souls recognized the successful drive required “a lot of effort and commitment” on the Firm’s part and that the Firm’s “work will help improve the lives of many hurting people around the world.”

At McKennon Law Group PC, we believe in giving back to the community, which is why we took such an interest in participating in the Soles4Souls’ initiative. We will always look for innovative ways to give back and are glad to play a role in this charity’s continued success!

LA & Orange County Disability Insurance & ERISA Attorneys Fight The Standard Claim Denials

At McKennon Law Group PC, we fight for your right to receive benefits from life, general liability, long-term care and disability insurers like The Standard. We understand insurers like The Standard because we know insurers like The Standard. McKennon Law Group PC’s attorneys, including its founder, Robert J. McKennon, represented insurance companies in the past. At our firm, we know how to get life and disability insurance claims paid.

The Standard began in 1906, when Leo Samuel founded the Oregon Life Insurance Company. At the time, many worked as loggers in the timber industry, which was a physically dangerous profession. In part because federal and state disability benefits did not yet exist, many in the timber industry relied on life insurance to protect from future injury. However, most of the insurers were located on the east coast, which drastically increased processing times. Mr. Samuel recognized the need for a life insurance company that would be better situated to serve the timber industry. So, he started the west coast company that would later become The Standard. Over the years, The Standard continued to grow and was one of the first companies to provide ‘waiver of premiums’ for permanently disabled employees. Today, The Standard has over forty offices across the country and over 2,700 employees. Although the name changed, The Standard remained in Oregon, with its current headquarters located in Portland.

At the McKennon Law Group, we frequently appeal and litigate long-term disability and other benefits claims denied by The Standard and have been very successful. We often represent clients against The Standard because they deny many claims, mostly group long-term disability and life and accident claims. We have a proven track record representing clients against The Standard.

How does The Standard Deny Life and Disability Insurance Claims?

The Standard denies claims based on many reasons including, but not limited to, the following:

The Standard asserts the medical evidence does not support the life or disability claim
The Standard asserts the claimant did not provide adequate medical support for the life or disability claim
The Standard asserts the claimant did not provide documentation or proof of loss evidence in a timely manner
The Standard asserts the medical condition which is the subject of the claim is a pre-existing condition
The Standard asserts the insurance application contained materially false information, and thus the policy can be rescinded
The Standard asserts surveillance of the claimant suggests that the claimant is not totally disabled
The Standard asserts the claimant’s policy has lapsed for failure to pay premiums
The Standard asserts an exclusion in the life or disability policy precludes coverage for the claim

What Should Disability or Life Insurance Claimants Look for When The Standard Denies a Claim?

The Standard improperly investigating the claim
The Standard improperly obtaining opinions from unqualified persons/supposed experts
The Standard improperly misreading or misinterpreting medical records
The Standard improperly hiring and using biased “independent” medical reviewers and examiners
The Standard improperly denying a claim without any medical examination
The Standard improperly refusing to acknowledge subjective disabling conditions such as mental disorders, autoimmune disorders, fibromyalgia, and chronic fatigue syndrome because there is no objective evidence of the condition
The Standard improperly asserting a pre-existing condition
The Standard improperly attempting to rescind the policy
The Standard improperly denying a claim with the intent to wear the claimant down to a lower settlement
The Standard improperly over-relying on surveillance evidence to conclude a claimant can work
The Standard improperly over-relying on social media evidence to conclude a claimant can work
The Standard improperly failing to have a meaningful dialogue with the claimant
The Standard improperly failing to distinguish findings by the Social Security Administration to deny a disability claim

If you feel you have a wrongfully denied claim for disability, life, long-term care or other insurance involving The Standard, the McKennon Law Group PC will doggedly pursue your benefits

Choosing an attorney to represent you when you find yourself in the vulnerable position of having your disability, life or long-term care denied is an important decision. You must have an aggressive and experienced disability, long-term care, health and life insurance attorney who will fight hard for you. If your claim for health, life, accidental death or dismemberment, short-term disability or long-term disability insurance has been wrongfully denied or suddenly terminated, fill out a free consultation form or call (949) 387-9595 to schedule 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 ERISA and non-ERISA, bad faith insurance claims.

San Francisco and Los Angeles Disability Insurance and Life Insurance Claim Attorneys Fight Hartford Claim Denials

If an insurance company The Hartford suddenly terminated your benefits, you can trust in McKennon Law Group PC to fight to have your wrongful denial reversed and claim for benefits reinstated. Our firm pursues your right to receive benefits from life, general liability, long-term care and disability insurers like The Hartford. At our firm, we understand insurers like The Hartford better than just about anyone. McKennon Law Group PC’s attorneys, including its founder, Robert J. McKennon, represented similar insurance companies for over 24 years. At McKennon Law Group PC, we use our significant experience and focused attention to get your life and disability insurance claims paid.

The Hartford began in 1810 as a fire insurance company, protecting its customers by employing its own fire department. In 1835, a fire destroyed New York’s financial district and Eliphalet Terry, then president of The Hartford, called a meeting where several pledged their personal fortunes to help pay the claims. Today, The Hartford offers an array of insurance and investment products, including automobile insurance, homeowner’s insurance, business insurance, annuities and mutual funds. The Hartford also offers employee benefits, including group life and accident, with supplemental and voluntary programs; group disability, with options for both short-term and long-term disability; group retiree health plans integrated with Medicare and additional voluntary benefits programs. The Hartford also offers related services, including absence management, which coordinates with state and federal leaves for disability claims and estate guidance, beneficiary assistance and other programs.

In our practice we often represent clients against The Harford because they deny many claims, mostly group long-term disability and life and accident claims. We have a proven track record representing clients against The Harford.

How does The Hartford Deny Life, Long-Term Care and Disability Insurance Claims?

The Hartford denies claims based on many reasons including, but not limited to, the following:

The Hartford asserts the proof of claim you provided does not support the life, long-term care or disability claim
The Hartford suggests the claimant did not provide adequate medical support for your life, long-term care or disability claim
The Hartford asserts you provided inadequate documentation or proof of loss evidence or that you failed to provide such evidence in a timely manner
The Hartford asserts the condition which is the subject of your claim is a pre-existing condition
The Hartford asserts the insurance application contained materially false information, and thus the policy can be rescinded
The Hartford asserts surveillance of the claimant suggests that you are not totally disabled
The Hartford asserts your policy has lapsed due to nonpayment of premium
The Hartford broadly interprets an exclusion in the life, long-term care or disability policy to preclude coverage for the claim

What Should Disability or Life Insurance Claimants Look for When The Hartford Denies a Claim for Life, Health, or Disability Insurance Benefits?

Did The Hartford conduct a thorough and unbiased investigation into all potential bases for coverage?
Did The Hartford take the opinion of its own, unqualified persons/supposed experts over the medical evidence you provided in support of your claim?
If The Hartford did properly retrieve relevant medical records, did they improperly misread or misinterpret those records in support of your claim?
Did The Hartford’s denial rely on the opinion of a reviewer that appears to be biased? Did the reviewer ignore relevant medical evidence or mischaracterize the content of a conversation with your primary care doctor?
Did The Hartford deny your claim without requesting an in-person medical examination, even though you were willing to be examined?
Did The Hartford refuse to acknowledge illness, injury or other symptoms for which only subjective evidence exists, such as mental disorders, autoimmune disorders, fibromyalgia, and chronic fatigue syndrome? Did the denial state that you failed to provide “objective evidence” in support of the illness or injury preventing you from performing the duties of your occupation?
Did The Hartford improperly assert that your illness or injury is a pre-existing condition, wrongly attempt to rescind the policy or simply deny the claim with the intent of wearing you down so as to pay you a lower settlement?
Did The Hartford improperly over-rely on surveillance of you engaging in activities as support that you can perform the activities of daily living? Did The Hartford do so without properly considering or characterizing the actual duties of your occupation?
Did The Hartford improperly over-rely on social media evidence, from accounts such as Instagram, Facebook or other forms of social media to conclude you can work?
Did The Hartford improperly fail to engage in a “meaningful dialogue” with you so you knew what you needed to get your claim paid?
Did The Hartford wrongly fail to distinguish the findings by the Social Security Administration to deny your disability claim?

If you have a wrongfully denied claim for disability, life, long-term care or other insurance involving The Hartford, contact McKennon Law Group PC and pursue every avenue to your benefits

Choosing an attorney to represent you when you find yourself in the vulnerable position of having your disability, life or long-term care claim denied is key to the success of your insurance matter. You need a skilled, aggressive and experienced advocate in your corner. If your claim for health, life, accidental death and dismemberment, short-term disability or long-term disability insurance has been wrongfully denied or suddenly terminated, fill out a free consultation form or call (949) 387-9595 to schedule 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 ERISA and non-ERISA, bad faith insurance claims.

Los Angeles and Orange County Insurance Bad Faith and ERISA Claim Attorneys Fight Reliance Standard Claim Denials

If your claim for insurance benefits has been denied, you can trust in the attorneys at McKennon Law Group PC to fight to have your benefits reinstated. Our firm works on insureds’ behalf, exhausting every avenue to secure their benefits from life, general liability, long-term care and disability insurers like Reliance Standard. At McKennon Law Group PC, we understand insurers like Reliance Standard because we used to represent insurers like Reliance Standard. We specialize in collecting insurance benefits after insurers like Reliance Standard deny disability and life insurance claims, whether the claim is governed by ERISA or state insurance laws. At McKennon Law Group PC, our unique experience gives us the knowledge and ability to get your life and disability insurance claims paid.

Reliance Standard Life Insurance Company, commonly referred to as Reliance Standard, offers a wide variety of employee benefits coverage including disability income and group term life insurance coverage. Reliance Standard provides coverage in most states, including California, but does not offer insurance in New York, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. In New York, First Reliance Standard Life Insurance Company offers insurance products, not Reliance Standard.

Reliance Standard works with its sister companies, Matrix Absence Management, Inc., and Safety National Casualty Corporation to manage a full range of employee absence services. Matrix partners with employers to manage disability claims and related government disability programs such as workers’ compensation and family leave. Safety National offers claims management, evaluation and other similar services. Reliance Standard, as well as Matrix and Safety National, are all members of the Tokio Marine Group, which also boasts members in property and casualty insurance, including First Insurance Company of Hawaii and Philadelphia Insurance Companies, the latter also offering professional liability insurance.

We see Reliance Standard often when they deny our clients’ claims. They issue many group life and disability insurance policies governed by ERISA. We have a demonstrated successful track record against this insurer.

Reliance Standard May Deny a Life, Long-Term Care or Long-Term Disability Insurance Claim in a Variety of Ways

In a claims denial letter notifying you that your claim has been denied, Reliance Standard might rely on any of the reasons discussed below:

Reliance Standard might assert that the written proof you were required to provide does not actually provide the requisite support for your life, long-term care or long-term disability policy
Reliance Standard might claim that you provided insufficient medical support, even though you may have supplied all the requested medical authorizations
Reliance Standard asserts you provided poor documentation of proof of loss or they might assert that the proof you did provide was untimely
Reliance Standard might conduct a pre-existing condition investigation and then determine that the condition excludes you from coverage under the policy
Reliance Standard may attempt to rescind your policy because it claims that, when you applied for insurance, the answers you provided on the application contained materially false information
Reliance Standard might hire a third-party company to record and report surveillance on your daily activities and then use that evidence to determine that you are not disabled
Reliance Standard might improperly lapse your policy, alleging nonpayment premium
Reliance Standard may expansively interpret an exclusion to its own benefit

What Should Disability or Life Insurance Claimants Look for When Reliance Standard Denies a Claim for Life, Health, or Disability Insurance Benefits?

Did Reliance Standard conduct a detailed and thorough investigation into all the potential reasons for coverage?
Did Reliance Standard’s denial letter refer to the opinions of clinical consultants or peer review physicians who never examined you or contacted you or your doctors?
Did Reliance Standard properly pursue all the relevant medical information, and if it did, did it misinterpret those records or that medical evidence to deny your claim?
Did Reliance Standard have an expert review your claim, but the opinion appears biased? Did the expert fail to review all the relevant medical information?
Did the consulting doctor or claims examiner ignore relevant medical evidence or mischaracterize the content of a conversation with your primary treating doctor?
Were you willing to subject to an in-person medical examination, with a doctor of Reliance Standard’s choosing, but Reliance Standard never requested that you be examined?
Did Reliance Standard ignore your illness, injury or other symptoms because it asserted that objective medical evidence did not support your claim? Is subjective evidence the primary form of evidence with regard to your illness, such as mental disorders, autoimmune disorders, fibromyalgia and chronic fatigue syndrome?
Did Reliance Standard improperly assert that your illness or injury is a pre-existing condition, wrongly attempt to rescind the policy or simply deny the claim with the intent of wearing you down?
Did Reliance Standard improperly over-emphasize the significance of surveillance of you engaging in activities as support that you are not totally disabled? Did Reliance Standard do so without properly considering or characterizing the actual duties of your occupation?
Did Reliance Standard fail to reasonably engage or communicate with you regarding what you needed to submit in order to adequately support your claim?

If you have a wrongfully denied claim for disability, life, long-term care or other insurance involving Reliance Standard, contact McKennon Law Group PC and we will single-mindedly pursue your benefits

Choosing an attorney to handle your recently denied claim for disability, life or long-term care benefits is a critically important decision. Disability, life and other forms of insurance denials are devastating to you and your family and you need a skilled and talented advocate in your corner. If your claim for health, life, accidental death or dismemberment, short-term disability or long-term disability insurance has been wrongfully denied or suddenly terminated, fill out a free consultation form or call (949) 387-9595 to schedule 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 ERISA and non-ERISA, bad faith insurance claims.

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