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Just How Bad Are Insurance Companies?

Pretty bad. Let's look at just one insurance company - Standard Insurance Company. This company has a history of biased claims administration as illustrated by several federal court decisions. In Oster v. Standard, 759 F.Supp.2d 1172 (N.D. California, Jan. 5, 2011), Standard abused its discretion, among other things, because “[It] did not comply with its obligation as an ERISA fiduciary to adhere to ‘higher-than- marketplace quality standards on insurers' or ‘discharge [its] duties' in respect to discretionary claims processing ‘solely in the interests' of Oster, its claimant,” referencing Metropolitan Life Ins. Co. v. Glenn, 128 S.Ct. 2343, 4 2345 (2008), citing 29 U.S.C. 1104(a)(1), and instead, treated claimant “as an adversary during the claims process [casting] doubt on the credibility of its decision on appeal.”) In Nevitt v. Standard, 2009 WL 4730316 (N.D. Georgia., December 3, 2009), Standard's decision to terminate Nevitt's benefits based on the plan's mental disorder limitation was found to be substantively unreasonable as Standard's reviewing doctors  glossed over the issue of Nevitt's migraine pain and failed to directly address the opinions of Nevitt's treating physicians who explained at length why his migraines incapacitated him for five to eight days a month,” and “Standard's consultants fail to appreciate the physical and mental demands of the active practice of law.” In Sacks v. Standard, 671 F.Supp.2d 1148 (C.D. California, November 30, 2009), the Court found “that an analysis of the case-specific factors establishe[d] that Standard's claim decision was tainted by its financial interest,” “Standard failed to investigate the claim adequately,” and  Standard abused its discretion in making the determination that Plaintiff was not disabled from her own occupation within the meaning of the Plan.  Finally, in Dinh v. Standard, 2007 WL 2298319 (D. Colorado, August 7, 2007), the court found that Standard abused its discretion by asserting the claimant was not disabled because she could perform sedentary to light occupation, when it made no attempt to recognize the cognitive demands of the claimant's position as a professional executive recruiter; the court also indicated “a fair inference from the record is that all those who reviewed this application for Standard had a bias against it and were predisposed to reject the views of those who supported (plaintiff).” Accordingly, federal courts in California, Colorado and Georgia have found that when Standard acts as judge in its own cause it places its interests above those of its insureds. Additionally, there is a February 26, 2009, piece from Good Morning America (GMA), entitled  Man with MS Fights for Long-Term Disability Insurance.  The article indicates “It was the expert opinion of 11 doctors that Tucker had [multiple sclerosis], but [Standard's] doctor said there wasn't enough evidence. In an official report, [Standard's doctor] said, ‘th diagnosis of multiple sclerosis is not supported ... and the patient could return to a sedentary work activity.'” Standard paid the claimant a day after GMA called Standard for a comment but denied GMA was the reason it decided to pay. In other words, Standard has a history of biased claims administration. Unfortunately, it is no better or worse than most of the insurance companies that provide long term disability coverage. We litigate nationally against big insurance companies (Aetna, Unum, Hartford, Prudential, Standard, Guardian, CIGNA, MetLife, Sun Life, Liberty Mutual, Mutual of Omaha, and so on).


Seth has always been compelled to excel, whether it meant earning his Eagle Scout as a teenager, participating in theater, debate and varsity football in high school, his Rhodes Scholar candidacy in college, or opening his own law firm. He also perseveres in situations others might shy away from, whether it involves sky-diving, rappelling down a mountain, white-water rafting, participating in marathons and triathlons, writing a novel, or lecturing nationally to large audiences about the vagaries of ERISA.


Seth is committed to serving disabled individuals. He is proud of his work in prominent organizations such as the American Association for Justice (AAJ), the Tennessee Bar Association (TBA) and Hospice. Seth is past-Chair of both AAJ's & TBA's Disability Law Sections, past-President of the Chattanooga Trial Lawyers Association, a 2-time recipient of the Pro Bono Excellence Award, and a 7 year member of the Board of Directors for Hospice of Chattanooga.