Disability Insurance Lawyer Blog

Met Life Denies Long-Term Disability Benefits and Frankel & Newfield Overturns On Appeal

Our client had worked as a Payroll Manager for a large advertising firm for over 17 years, when, as a result of a motor vehicle accident, she sustained a severe injury to her left foot, fracturing her left calcaneus. Despite undergoing surgery on her foot a few weeks after the accident, our client soon developed a number of other difficulties, including post traumatic subtalar joint arthritis in her left foot, which continued to cause her severe pain and discomfort. The motor vehicle accident had also aggravated an old back injury, which resulted in increased pain throughout her back. In addition, our client became severely depressed, due to the pain she was suffering and the dramatic changes in her lifestyle that had resulted from the accident.

Although our client had attempted to continue working from home following the accident, the combination of her physical and mental limitations soon overcame her ability to function in that capacity. In fact, the stress of keeping up with her job requirements was hindering her recovery. Thus, based on the recommendations of her treating physicians, our client stopped working and subsequently filed a claim for long term disability benefits with MetLife.

At that point, she came to Frankel & Newfield. We assisted in preparing an appeal of MetLife's determination. Working closely with our client and her treating physicians, we gathered additional support for her disability from both her physical and mental conditions. The final appeal included both objective and subjective evidence of our client's impairments, as well as medical literature describing the nature of her severe injuries. In addition, our client was approved for Social Security Disability benefits during this time, further evidence of her disability which was also incorporated into the appeal.

Based on the extensive medical, legal, and factual support provided in the appeal by Frankel & Newfield, MetLife subsequently overturned its denial, determining that our client was disabled from both her physical and mental condition and thus entitled to her long term disability benefits.

Prudential Terminates Benefits and Frankel & Newfield Overturn on Appeal

Our client, a 37-year old graphic designer and creative manager for one of the world's largest luxury goods corporations, was diagnosed with a tumor of the spinal cord that extended into the brainstem, accompanied by two cysts, one below the tumor and one above the tumor.  Our client underwent surgery to remove the tumor. After the surgery, our client went for intensive inpatient physical and occupational therapy. 

She continued to experience dizziness, vertigo, poor mobility, generalized weakness, lack of fine motor skills, and paralysis of both the upper and lower extremities after the surgery and continues to experience these neurological deficits today.  These neurological deficits prevent our client from being able to use her hands to do simple everyday things, like eat a cup of soup with a spoon, hold a cup of coffee, or park where there is a parking meter because she does not have the fine motor skills to pick up a quarter and put it in the meter.  Our client has the continuing support of her doctor, a highly respected and renowned board-certified neurologist whose medical specialties span over 20 years and include neurology, clinical neurophysiology and electromyography.   

Our client was on claim with Prudential for four and a half years when they terminated her claim on the basis that she was no longer disabled.  Before terminating her claim, Prudential did a paper review of our client's medical records, sent our client to an "independent" medical examination and a functional capacity examination, conducted an Employability Assessment, and eventually conducted surveillance on our client. In the administrative appeal, we attacked the selective review of our client's medical records by Prudential's Medical Director, the credentials of the doctor who conducted the "independent" medical examination and her results, the fact that Prudential distorted the findings of the Functional Capacity Examination that actually supported our client's disability, the flawed results of the Employability Assessment, and the surveillance. 

By aggressively attacking each step in Prudential's process of terminating our client's benefits and including more objective medical evidence and test findings that continue to support our client's disability, we were successful in having Prudential overturn their termination on appeal, and our client's benefits have been reinstated.

Organic Brain Dysfunction Not Subject to Limited Benefit Period

Many ERISA disability policies contain a limited benefit period for impairments caused by or contributed to any mental or nervous disorder.  There has been much litigation over these issues, and one court has recently determined that organic brain dysfunction did not invoke the mental illness limitation in LINA's policy.  Jewell v. LINA

Interestingly, the court evaluated both the objective and subjective information in the file, and noted that while the objective evidence, which included EEG and CT scans, supported Defendant's position, the subjective medical evidence, and the well supported opinions of the only neurologist who opined favored Plaintiff's contentions.

The lesson to be learned as claimants is that the support of the treating doctor is critical to the success of the claim.

Disability Insurance and Severance - Successful Claims Require Strategic Planning

Employees struggling to stay at work and perform their jobs despite illness or injury feel trapped between a rock and a hard place.  If they stop working, they won't be able to make a claim for disability, as they will no longer be considered an "active employee," a requirement to be eligible for coverage.  But if they go out on disability, will they be the first ones laid off,  potentially losing other employee benefits?

Frankel & Newfield helps clients navigate these difficult situations, making critical and strategic decisions based on our years of experience in long term disability insurance claims and litigation.   We discuss a time frame for pursuing the claim, acknowledging and dealing with the inherent difficulties, and issues of gaining medical support.   Our clients have a clear picture of their options, and can make an informed decision about discussing their disability with their employer, filing a claim, at the same time that they are navigating the severance process. 

Dealing with a disability insurance claim and severance at the same time is serious business, and a misstep could have severe financial repercussions.  If this is your situation, speak with one of the partners to learn how we can help you. Call our office at 1-877-LTD-CLAIM (877-583-2524) today.

CIGNA'S Wrongful Denial is Overturned by Frankel & Newfield

Our client worked for one of the largest hotel and timeshare corporations in the world as a Director of Sales and was responsible for over $1.5 million in revenue each year for the company.  Our client went out of work in late 2008 due to morbid obesity, dyspenia with exertion, extreme fatigue, severe obstructive sleep apnea, difficulty walking, trouble sleeping, major depressive disorder, obsessive-compulsive disorder, mitral insufficiency, concentric left ventricular hypertrophy, trivial tricuspid insufficiency, and atrial arrhythmias.

When he went out of work, our client was literally unable to walk more than a few feet without experiencing shortness of breath and numerous pains throughout his body.  Our client filed for long term disability benefits with his insurance company, CIGNA, and was denied on the basis of CIGNA's erroneous conclusion that he was capable of performing full-time sedentary work.  After learning of this denial, our client hired our firm to submit the appeal on his behalf.

In denying the client's initial long term claim, CIGNA conducted a selective paper review of our client's medical records; and, instead of appreciating the requirements of his specific job, CIGNA used the generic job description of a light-duty sales person.  We worked with our client to ensure that CIGNA had all of the most current medical records, test results, and a copy of the client's actual job description. All of this information was included with the appeal, and we successfully demonstrated to CIGNA that our client suffered from numerous co-morbid conditions that were supported with objective evidence and that these co-morbid conditions must be taken into consideration as such, not in isolation from each other.  Based upon all of the information submitted in the appeal, our firm was successful in having CIGNA overturn their original decision and the client's benefits were awarded to him.