Disability Insurance Lawyer Blog

Chiropractic Economics Magazine Features Article by Frankel and Newfield

The September issue of Chiropractic Economics features an article by Attorneys Jason Newfield and Justin Frankel on navigating the minefields of long term disability insurance claims. Several recent cases indicate that courts are finally starting to understand that when the same company who pays a claim also decides the merits of the claim, the insurer cannot be truly fair and impartial.

While these judicial decisions are encouraging, too many other courts have remained ignorant on this critical issue, and thus it is still necessary to be proactive, cynical and informed before filing a claim.

We work with many chiropractors who originally felt that their experience dealing with the paperwork of health insurance claims meant they could easily manage the disability insurance claims process. They were surprised when they learned how different, and difficult, disability claims can be. For testimonials from other professionals who have engaged the firm, please visit our website.

Claim Decision Reversed; Not the Result of Deliberative, Principled Reasoning Process

A Court in Michigan has reversed the denial of a disability claim under ERISA, where the administrator failed to engage in a full and fair review, largely because it based its decision upon the conclusory evaluations of its hired doctors. These hired doctors simply rejected the opinions of the treating physicians, and the administrator simply adopted those conclusions, despite extensive evidence in the record supporting impairment.

The Court reconciled the Supreme Court's holding in Black and Decker v. Nord, and found that the administrator simply failed to fully address any contrary evidence without meaningful explanation. The selective review of records furthered the Court's concerns about the lack of a full and fair review. Unfortunately, the Court remanded the claim to the administrator for further consideration.

Dockery v. USG Corp. Retirement Plan (E.D. Mich. 2009)

CIGNA Disability Insurance Pays a Claim - But Only After Lawsuit Begins

Our client was an Equity floor trade on the New York Stock Exchange, working in a highly competitive and demanding job that requires total concentration, critical thinking and peak performance at all times. The ability to take action quickly and confidently was central to his daily work as he made split second decisions to trade, buy or sell millions of dollars in equities.

When he developed Tinnitus, a ringing or noise in the ears, resulting from an Acoustic Neuroma, he was unable to hear, and his ability to sleep and concentrate began to degrade. An Acoustic Neuroma is a benign brain tumor that occurs near the eighth cranial nerve that connects the brain to the inner near. Like a surgeon who loses the ability to see, our client no longer had the physical capacity to perform the tasks of his job.

The treating and evaluating doctors include some of the most distinguished and outstanding physicians in the field. They include a) the Director of Otology-Neurotology and Associate Professor of Otolaryngology at Mount Sinai School of Medicine, b) the Chairman of the Department of Neurosurgery at Mount Sinai, c) the Vice-Chairman of the Department of Otolaryngology- Head & Neck Surgery, Director of the Center for Facial Reconstruction, and Co-Director of the Center for Cranial Base Surgery at St. Luke's-Roosevelt Hospital, who is also the Director of Cranial Base Surgery and an Associate Professor of Clinical Otolaryngology at Columbia University College of Physicians & Surgeons and d) the Chairman of the Department of Neurosurgery at St. Luke's-Roosevelt Hospital and Co-Director of the Center for Cranial Base Surgery, a world leader in the complex neurosurgical treatment of cranial base tumors.

CIGNA denied his claim based on a paper review of his records by a Registered Nurse and a Medical Director. However, the poor quality of the review became glaringly apparent upon an analysis of the evidence. These two CIGNA employees never actually reviewed all of the evidence, but, rather, reviewed only selective materials, and the review contained an overwhelming number of discrepancies, inconsistencies and omissions. CIGNA kept delaying our appeal, to a degree even more outrageous than usual.

Based upon CIGNA's violation of the time requirements, we filed a lawsuit charging CIGNA with failing to issue a timely decision on our appeal, and while the lawsuit was in process, CIGNA woke up and reversed its decision. Our client is now being paid his past due benefits and is back on claim. He will never be able to function as a floor trader again, and it is likely that his daily life will continue to be a difficult struggle, but at least he is being paid according to the terms of the contract he signed with CIGNA.

You don't have to be a high-income trader with world-class doctors to fight for your disability insurance policy benefits. Call our office at 877-LTD-CLAIM (877-583-2524). You are not in this alone.