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Insurance Claim – Disability Benefits

By: Derek Hawkins//July 8, 2019//

Insurance Claim – Disability Benefits

By: Derek Hawkins//July 8, 2019//

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7th Circuit Court of Appeals

Case Name: Shirley Lacko v. United of Omaha Life Insurance Company

Case No.: 18-2155

Officials: BAUER, ROVNER, and ST. EVE, Circuit Judges.

Focus: Insurance Claim – Disability Benefits

Shirley Lacko filed suit against United of Omaha Life Insurance Company (“United”), challenging United’s denial of her claims for short‐term and long‐ term disability insurance. Those claims were brought pursuant to group insurance policies issued by United to her employer, BKD, Inc., an accounting firm. Specifically, BKD provided two group insurance policies, Group Short Term Disability Insurance Policy No. GUC‐ABF3 (the “STD” plan) and the Group Long Term Disability Insurance Policy No. GLTD‐ ABF3 (the “LTD” plan). Both policies were issued by United, who also served as the claims review fiduciary for claims to STD and LTD benefits.

Lacko based her claims for STD and LTD benefits on the adverse combination of a number of impairments, including but not limited to gastroparesis, diabetes, rheumatoid arthritis, congestive heart failure, breathing difficulties, anxiety, musculoskeletal impairments, and cognitive difficulties related in part to the medication needed to manage the other conditions. The district court opinion details the extensive medical evidence presented to United in support of Lacko’s disability benefits claims. It includes reports from numerous physicians, as well as objective evidence such as MRI, X‐ray, and lab reports. An exhaustive recitation of that evidence, however, is unnecessary to resolve the issues presented in this case. Therefore, we will set forth the evidence only to the extent that it is necessary to decide the issues in this appeal and defer to the district court the more extensive recitation.

Although United initially approved her claims for STD benefits on three occasions for the time period spanning October 12, 2015 through November 22, 2015, it denied STD benefits on June 16, 2016 for the period beyond November 22, 2015, concluding the records failed to demonstrate a change in Lacko’s medical condition at the time she stopped working or subsequently. United also denied her claim for LTD benefits. Lacko then filed this action in the district court under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq., challenging the denial of LTD benefits, and the denial of STD benefits from the period of November 22, 2015 until December 27, 2015 (at which time LTD benefits would apply). The district court granted summary judgment in favor of United, and Lacko now appeals that decision to this court.

Reversed and remanded

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Derek A Hawkins is trademark corporate counsel for Harley-Davidson. Hawkins oversees the prosecution and maintenance of the Harley-Davidson’s international trademark portfolio in emerging markets.

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