Disability Insurance Lawyer Blog

New Jersey Chronic Fatigue Syndrome Association Presentation

I had the honor of being invited to provide a presentation to the New Jersey Chronic Fatigue Syndrome Association on October 18, 2009. The conference was held at the Sheraton Eatontown, and was well attended. The presentation was entitled "Professional Advocacy by Objective Documentation and Active Intervention on Behalf of the CFS Patient."

It was a great opportunity to share insight about the disability claim process to the patient community suffering from this somewhat amorphous, misunderstood medical condition, and to offer support to the claimants who all too often struggle to find medical practitioners willing to be their providers and advocates for disability claims.

The presentation was well received, and afterwards I was able to spend additional time in various one on one sessions with individual claimants to discuss their specific claim concerns. These types of forums are always rewarding since there are so many claimants who are unable to access legal advocates during these difficult and challenging times.

The conference presentation can be accessed here.

If you or someone you love suffers from CFS and you are having problems with a disability claim or wish to be well prepared before making a disability claim, call our offices at 1-877-LTD-CLAIM (877-583-2524) to learn how we might help.

Liberty Life's Decision was Abuse of Discretion

A recent case from the Federal Court in New York has demonstrated that it is an abuse of discretion to terminate a claimant where liability had been accepted for a lengthy period of time, with no change in the claimant's condition. Smith v. Liberty Life Assurance Co. of Boston (N.D.N.Y. 2009).

The decision serves to re-affirm the vitality of arguments that have been successfully lodged by claimants that where a claim has been approved due to the severity of a condition, absent a marked change in the condition in terms of improvement, it is improper for an insurer to alter its prior claim determination, or as stated by the Court "decisions to terminate benefits in the absence of a change in condition....are arbitrary and capricious." The Court also chastised the insurer for crediting the opinion of a "newly hired" physician to review records, which appeared as "physician shopping".

We have unfortunately seen this type of conduct as a recent trend, with insurers going after older files with renewed vigor, hoping to find files to terminate benefits. If your insurer is engaging in similar conduct, please contact our offices to discuss how we can assist you in fighting back against such improper conduct.

The Importance of Limiting the Insurance Company's Contact with Your Treating Physician

Often, when reviewing a claimant's eligibility for benefits, an insurance company will attempt to contact the claimant's treating physician via a "peer-to-peer" telephone call. In these instances, an in-house physician or nurse reviewer will contact a treating physician in order to "clarify" a claimant's functionality. However, more times than not, these calls will end up harming a claim.

This happened to one of our clients, who retained our firm after her claim had been terminated by CIGNA. When reviewing her eligibility for benefits, CIGNA contacted one of our client's health care providers to ask his opinion as to her disability. However, this doctor was not our client's primary physician, was not treating her for her disabling conditions, and in fact, had not evaluated her in over a year. As a result, this doctor claimed that our client was not disabled and was more than capable of returning to work, and even suggested that CIGNA refer her claim for special investigation. Needless to say, within a few months of this conversation, our client's disability claim was terminated.

For this reason, we act as a mediator to closely monitor all contact the insurance company has with our clients' treating providers. Even if your treating physician is supportive of your disability, their statements are often twisted or taken out of context by the insurance company in order to support an adverse benefit determination. Thus, we highly recommend limiting all correspondence with your treating providers to written requests, as well as limiting which providers the insurance company is authorized to contact.

If you have concerns about your long term disability insurance claim, at any stage of the claims process, call our office and learn how we can help. Call us at 1-877-LTD-CLAIM (1-877-583-2524).

Prudential Disability Insurance Policyholder - A Successful ERISA Appeal by Frankel & Newfield

Despite bringing in one of the insurance industry's big guns for hire - a doctor whose practice is more focused on helping insurance companies keep a healthy bottom line than with patient care - Frankel & Newfield has won an ERISA appeal for yet another client.

The Prudential disability insurance policyholder was a Vice President with a global financial company, with a disability insurance policy commensurate with her income level. She suffers from several severe orthopedic conditions, including coccydydnia and lumbar radiculopathy. She is unable to sit in a car or at a desk, and the intense pain makes it impossible for her to perform at the high levels that got her to the senior position she held.

Prudential first delayed, then denied the claim. We knew that the high dollar value of the monthly benefit was the real reason the disability insurance company was trying to stop her claim. We also knew that she could not work, and deserved the benefits in her policy. Prudential brought in an insurance doctor whose presence always signifies a serious and expensive claim. We were ready.

Effectively utilizing our client's treating physician, we delivered a powerful rebuttal to the peer review and clearly demonstrated that our client was entitled to the benefits in her contract. Today, she is back on claim, receiving monthly checks, and we continue to manage her claim to make sure that her interests are protected.

If you are having trouble with a Prudential disability insurance claim, call our office toll-free at 1-877-LTD-CLAIM (1-877-583-2524).

California Insurance Commissioner Announces Settlement with Life Insurance Company of North America - LINA

California's insurance commissioner Poinzer announced that the California Department of Insurance has reached a $600,000 settlement agreement with LINA - Life Insurance Company of North America (an insuring subsidiary of CIGNA) - to resolve allegations of disability insurance claims handling violations from February 2005 - June 2006. In addition to the settlement, LINA is to implement changes in its policies, procedures and practices and is going to review any claims that were denied between January 2005 through December 2007.

An on-site examination of claims handling practices conducted by the California Department of Insurance exposed business practices that are best described as outrageous. Decisions were made before medical records were even requested. There were many examples of LINA adjusters ignoring substantial new information after claims had been denied.

We know that this is business as usual for many disability insurance companies, but we congratulate the California Department of Insurance for recognizing that these practices are against the law and doing something about it.

A disability insurance battle is not something a policyholder can easily fight. It took the legal and political muscle of a state insurance commissioner to force LINA to make changes. If you are having a problem with your disability insurance claim, or are about to file a claim and don't want to go it alone, call our office at 877-LTD-CLAIM (877-583-2524). Leverage our experience in fighting these fights. You are not in this alone.