Disability Insurance Lawyer Blog

AGGRESSIVE REPRESENTATION BY FRANKEL & NEWFIELD GETS HARTFORD DISABILITY BENEFITS REINSTATED AND BACK BENEFITS PAID IN FULL

Our client, a Global Product Manager with a large international bank, suffers from a painful orthopedic condition that makes it impossible for him to perform in his job. Hartford went after his disability insurance benefits on several fronts, and we fought back and won.

They started with a peer review, where an outside company hired by the insurance company engages one of its repeat offending paper reviewing doctors to perform a selective review our client's medical records. We had worked with our client's doctors to make sure that their files properly and specifically documented not just his condition, but the severe limitations that his condition created. Our doctors swiftly and thoroughly rebutted the insurance company doctors' claims.

We followed with an aggressive attack on the peer reviewing doctor's opinions, which was clearly falsifying his diagnosis and failing to accurately review medical records. The paper reviewing doctor's opinions were slanted by the peer review company in order to give the insurance company only what it wanted, and not the unbiased and honest review that they are allegedly hired to provide and which is legally required by ERISA, a federal law.

Our next level of attack involved a rebuttal of the insurance company's surveillance, which had videotaped our client in his yard, mowing the lawn for a few minutes. We forcefully attacked their surveillance, relying upon a recent Good Morning America broadcast and case law that revealed the treacherous use of surveillance on disability insurance claimants by Hartford and other insurers.

The results speak for themselves. Our client's claim has been reinstated, and he received full back benefits and reinstatement to his employer's other employee benefits.

Court Rejects "Result Driven" Functional Capacity Evaluation

In the field of disability insurance, a trend that has seen a tremendous surge has been the insurance companies' utilization of Functional Capacity Evaluations ("FCE's"). This trend has caught a number of unsuspecting claimants in a web that has tangled their ability to continue receiving their disability payments.

Thankfully, some courts are beginning to see through these issues. One court recently rejected a claim termination that was based upon a "result driven" FCE. The FCE, which concluded that a claimant could perform greater than sedentary work over an eight hour day, was rejected, in large part because the examiner focused upon the puported self-limiting behavior, rather than relying upon the testing and observations for assessment of functional ability. Lowery v. UNUM Life Ins. Co.

Many insurers seek FCE's even where the policy does not specifically permit the right to conduct such an evaluation. In these instances, we typically aggressively challenge the insurers' right to the evaluation, based upon policy language, as well as legal challenges concerning the reliability of the test results, and medical challenges to the safety of such evaluations.

If your insurer is attempting to compel you to attend an FCE, we strongly urge you to engage counsel to protect your rights.

HOME FOR THE HOLIDAYS for all the wrong reasons?

The holidays are a time of joy and celebration. But if an injury or illness has made it impossible for you to work, the holidays are an especially challenging time of year. If you are up against what seems like a Great Wall of Disability, where the long term disability insurance policy that you counted on has instead become an obstacle that you can neither go around, over or through, it may be time to consider retaining an attorney. If you are not sure what your next move should be, call our offices. You have enough to deal with. We can help.

Court Finds Decision Arbitrary and Capricious

Despite acknowledging that the abuse of discretion standard of review is quite deferential to plan administrators, a court has determined that Harvard's termination of benefits was an abuse of discretion. The Court found the administrator improperly rejected the panoply of supporting physicians, and that the only medical opinions that were unfavorable to the claimant were those procured by the administrator. The Court also was troubled by the failure to consider both Social Security and Workers' Compensation awards.

In language that can be offered to other Courts throughout the country, the Judge stated that while "plaintiffs seldom if ever prevail when the standard [abuse of discretion] is applied. But seldom if ever cannot mean never at all, or the promise made to claimants that federal courts will review their benefits decisions for abuses of discretion would be a cruel and illusory exercise." McGahey v. Harvard University

MSNBC Reports: Job Losses Send Disability Claims Soaring

The impact that the twin forces of a deep recession and an aging boomer population is having on increasing disability claims across the country is no news to Frankel & Newfield. The phone calls and emails received in our office over the last six months are from people between a rock and a hard place. In a kinder economic environment, the workplace might have been more flexible with doctor's appointments and more than usual sick days. Today there's little room for employees with problems, regardless of circumstances. And once a disabled person is out of work, there are fewer opportunities, and fewer options. A formerly healthy and hardworking person who is out of work and applying for disability because of illness or an accident should not be treated like a slacker.

Frankel & Newfield does not represent clients with Social Security claims. If you have a disability claim through a plan offered by your employer or a private disability insurance policy and you are concerned about protecting your benefits, call us.

Prudential Disability Insurance Policyholder - A Successful ERISA Appeal from 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).

Reality TV and Disability Insurance Claims

Reality TV wanna-be's seem to be everywhere lately, taking their search for fame and fortune beyond the bounds of common sense. An interior designer from California appeared on a home improvement show while collecting disability insurance. Sadly for him, an employee for the insurance company was a big fan of the show. He was convicted for insurance fraud and tax fraud and had to pay the private insurance company more than $150,000.

Moral of the story - when you are disabled and on claim, everything you do can and will be used against you. Insurers are going to all lengths to terminate or deny claims. By putting yourself out in the public eye, whether through a television reality show, live radio call-in show, Twitter, FaceBook, MySpace, or any public forum, can and very likely will have a negative impact on your claim.