Confidential
Settlement – $470,000Judge
Court
USDC Southern District of California
Attorneys
Plaintiff
Thomas M. Monson
(Miller, Monson, Peshel, Polacek & Hoshaw)
Defendant
Experts
Plaintiff
Roy A. Kaplan
(medical)
Fred R. McFarlane
(medical)
Behrooz A. Akbarnia
(medical)
Facts
The plaintiff, a 57-year-old man was insured under an own-occupation total disability plan through his employer, administered by defendant insurance company. The plaintiff became disabled from his desk job on May 29, 1993. Following a one-year "elimination period," defendant paid long-term disability (LTD) benefits beginning May 30, 1994. Defendant videotaped plaintiff, a former competitive expert tennis player, playing low-level tennis in August 1994. On April 1, 1995, the defendant terminated payment of LTD benefits. The plaintiff appealed through the administrative process, and he and his treating physicians demanded that independent medical examinations (IME) be performed, but the defendant refused. The plaintiff sued the plan and defendant insurance company seeking his benefits. At the early neutral arbitration conference, defendant agreed to the IMEs, and the parties designated two agreed-upon medical specialists and a vocational specialist. All experts agreed with plaintiff's treating physicians, concluding plaintiff was totally disabled from his desk job occupation and was limited to a maximum of 2 hours sitting, 2 hours standing in an 8-hour day. The parties each submitted confidential settlement conference statements to the magistrate and settled the matter. The plaintiff brought this action against the defendant alleging ERISA violations.
Settlement Discussions
The plaintiff made a settlement demand for $311,000 (past benefits); $20,000 (interest); $8,500 (costs - reimbursement of $1,348 estimated Social Security carve-out of benefits if an August 1997 Social Security application was not granted; two-year reassesment of own-occupation total disability through the end of the policy period, September 2001. The defendant offered $330,000 cash, future benefits reinstated with COLA from April 1995, no interest, no costs.
Injuries
The plaintiff claimed he suffered severe multi-level spine disease and that defendant improperly denied him LTD benefits.
Other Information
The settlement was reached approximately ______ years and _____ months after the case was filed. A settlement conference/ arbitration /mediation was held on ____/____/19_____ before ________________ (name) of _________________ (affiliation or court) resulting in __________________ . ANY INTERESTING EXPERT TESTIMONY?
For reprint rights or to order a copy of your photo:
Email
jeremy@reprintpros.com
for prices.
Direct dial: 949-702-5390