Jury Finds for Plaintiff in California Denied Disability Insurance Lawsuit

Santa Rosa, CA A California woman who was denied disability insurance payments to which she was entitled under the terms of her policy was awarded more than three-quarters of a million dollars by a federal jury. The award provides solace to claimants who allege similar denials by an industry that appears to turn down claims as a matter of course.

In a report published by The Press Democrat (2/18/14), it was revealed that plaintiff Cassaundra Ellena was healthy when she was hired as a redevelopment manager by the Community Development Commission of Sonoma County (the Commission). While the 51-year-old plaintiff was diagnosed with Lupus in 2008, there were no outward signs of the disease when she applied to the Commission and was subsequently hired at a salary of $102,000 in 2009. The report indicated Ellena worked for the Commission from 2009 through 2010.

According to the denied ERISA disability report, the plaintiff soon after began exhibiting symptoms consistent with the auto-immune disease, including fever, chest pain and shortness of breath. Her worsening symptoms precluded Ellena from continuing in her job, and she applied for disability benefits according to California Insurance Law.

However, Sonoma County’s long-term disability (LTD) carrier - Standard Insurance Company (Standard Insurance) - denied Ellena’s claim on grounds that the plaintiff’s symptoms were partially alleviated through the use of special medications. The carrier also claimed doctors were of the opinion that Ellena could, indeed, continue working.

Undaunted, Ellena contacted a California denied disability insurance lawyer and litigated in an effort to prove her symptoms as valid and to reverse the carrier’s denial. During a seven-day trial, it was revealed that the professional opinions of medical experts consulted by the disability carrier were not universally shared. To wit, other doctors testified that Ellena was, in fact, debilitated by the disease. Sharing that view was the head of the Lupus Clinic at UC San Francisco.

In their view, jurors determined that Standard’s underwriters focused solely on the information leading to the denial of the claim, and did not take into account the bigger picture. To that end, the jurors found for the plaintiff.

Ellena was awarded a total of $873,000 - less attorney’s fees - which represented the collective sum of her disability payments from the time she first applied for California insurance claim help, through to her 67th birthday. The money was to be paid in a lump sum.

At the time of the California ERISA-denied claim report, it was not known if Standard Insurance planned to appeal. Sonoma County employs a total of 3,000 persons, the majority of whom are represented by Standard for LTD benefits. The case is Ellena v. Standard Insurance Company et al, Case No. 3:2012cv05401, California Northern District Cou