Disability Insurance Lawyer Blog

Hartford Insurance Terminates Fibromyalgia Claimant - We Win the Appeal

Our client was on claim with The Hartford for three years when they stopped paying her disability benefits, based on a paper review of her medical records and the results of an Employability Analysis. We represented her with an administrative appeal, and had her benefits reinstated.

Our client suffers from Fibromyalgia, degenerative disc disease, major depression, hyposomnia, hypothyroidism, and chronic headaches. She has been suffering from these conditions since 1998. She was employed with a major university as a top-level administrative assistant, responsible for maintaining a large portion of the University's website that is updated minute-by-minute, with news and information for events, activities, alerts, bulletins and news stories pertaining to students, parents, alumni, faculty, and staff. Her job required her to be available seven days a week, after hours and on weekends, to provide 24-hour monitoring and updating.

Approximately eight years ago, our client began having problems keeping up with deadlines because of the Fibromyalgia related severe fatigue and muscle pain, along with the symptoms of other conditions, and the side effects of the numerous medications she needed daily. When she was no longer able to perform the tasks required of the position, she applied for her long-term disability benefits and was approved.

Our client received long-term disability benefits until June 2009, when The Hartford determined that she was no longer disabled and could go back to work full time. The Hartford paid for an extremely selective review of her medical records by an outside vendor, who could not possibly be neutral, since The Hartford was signing his check! The vocational analysis reported that our client had recovered and was able to perform her own occupation as administrative assistant, even though there had been no change in her medical condition since the time that The Hartford itself had determined that she was disabled.

In the administrative appeal, we attacked the selective review of our client's medical records by the third-party vendor, the credentials of the reviewing doctor (or lack thereof), and highlighted all of the errors in the vocational analysis that The Hartford conducted.

By aggressively attacking each step in The Hartford'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 The Hartford overturn their termination on appeal, and our client's benefits have been reinstated.

FRANKEL & NEWFIELD WARNS CLAIMANTS - DIAGNOSIS WITHOUT TREATMENT CAN PUT YOUR DISABILITY INSURANCE CLAIM AT RISK

Filing a disability insurance claim without being under the care of a physician and without undertaking a course of treatment for the disability puts claimants in a vulnerable position. To the insurance company, no treatment means no disability - and no disability means no benefits.

This is especially true for individuals suffering from symptoms that overlap.

An example: Chronic Fatigue Syndrome (CFS) manifests in a number of varied symptoms, including overwhelming fatigue, cognitive and neurological problems, irritable bowel syndrome (IBS), vertigo, muscle and joint pain, to name a few.

But what if that diagnosis is mixed in with untreated sleep apnea? One of the most pronounced symptoms of sleep apnea - a condition where breathing repeatedly stops and starts during sleep - appears to be the same as CFS. So an untreated case of sleep apnea combined with a diagnosis of CFS equals a denied claim from an insurance company.

Frankel & Newfield has represented many individuals suffering from the effects of Chronic Fatigue Syndrome (CFS) with great success. If you are suffering from CFS or sleep apnea and are not in treatment for either condition, you may be putting your future at risk. To learn more, call our office at 877-LTD-CLAIM (877-583-2524).

Your first objective is to care for your health. Our first objective is to protect your disability benefits. Together, we can find the solution. Call Frankel & Newfield today at 877-LTD-CLAIM (877-583-2524).

Appeals Court Reverses, Grants Retroactive Benefits

The Ninth Circuit Court of Appeals seems to "get" it. The Court reversed a decision that was favorable to an insurer, granting the retroactive payment of benefits to a claimant who has had numerous hip revision surgeries, and was getting paid Social Security Disability benefits.

The Court found that the quantity and quality of the medical evidence supports the claim, where the Court rejected the insurer's argument that a lack of objective evidence existed, where the Court embraced the consistent use of strong paid medication, and where a Functional Capacity Evaluation ("FCE") supported a finding of impairment. The Court found that the insurer failed to credit reliable evidence. The complete disregard of the Social Security determination further informed the Court's decision.

LINCOLN NATIONAL DENIES DISABILITY CLAIM TO CLINICAL NEUROLOGIST; FRANKEL & NEWFIELD OVERTURNS DENIAL AND GETS BENEFITS REINSTATED

Our client was a successful Clinical Neurologist, practicing in the area of movement disorders in a busy hospital with a focus on complex, advanced stages of Parkinson's disease and dementia. Her tasks required the ability to perform physical and labor intensive activities while working at an equally high level of analysis and cognitive abilities.

She developed a number of complex symptoms, including severe fatigue, weakness, muscle atrophy, shortness of breath, and painful muscle cramps and spasms. These were later diagnosed as early motor neuron disease, nueromitochondrial disorder, and pulmonary insufficiency.

Our client was no longer able to perform the tasks of her highly demanding occupation. She filed a claim for short term disability benefits with Lincoln and was denied, based on a paper review of the medical records conducted by a staff nurse.

In preparing her appeal, we worked closely with our client and her treating physicians to further develop the medical support in the record, clearly documenting the tasks that her job required, and the restrictions and limitations of her illness. We vigorously attacked the credibility of Lincoln's paper medical analysis, highlighting the many flaws in their medical review, and made it clear that they had failed to fully and properly review our client's medical records and to understand the tasks required for her to perform her profession.

We won the appeal, and Lincoln paid our client the short-term benefits that she deserved. This has set the stage for her making a claim for long term benefits. Without this positive outcome, she would not have been able to file for long term benefits, even with another disability insurance company.

The appeal was represented by Justin Frankel, a partner at Frankel & Newfield. He has helped many professionals who had demanding and complex careers when their disability insurance companies have resorted to a simplistic paper review of claims. If you would like a free consultation, call Frankel & Newfield at 877-LTD-CLAIM (877-583-2524).

FRANKEL & NEWFIELD WINS APPEAL AGAINST MET LIFE FOR EXECUTIVE WITH FIBROMYALGIA, CHRONIC FATIGUE SYNDROME

A claimant had applied for benefits under the disability insurance policy that she paid for through employee deductions. She filed a claim when Fibromyalgia, Chronic Fatigue Syndrome and multiple medical problems made it impossible for her to perform the tasks associated with her highly demanding position, which required her to be able to analyze extremely complex business situations, manage a team of fast-paced brilliant business advisors and prepare highly analytical reports.

Met Life denied her claim, based solely on a paper review of her medical records. Frankel & Newfield took a two-pronged approach. We worked with our client and her doctors to develop a strong vocational case that detailed the complex nature of the work that she and the subordinates she was responsible for were required to perform. This specific vocational approach made it clear that she was required to think at a very high level, think clearly, to make complex decisions and recommendations, and work through problems in the face of intense deadlines, working continuously until the problems were solved and reports were prepared.

The second part of our tactic was to clearly prove that her medical conditions, Fibromyalgia and Chronic Fatigue Syndrome and other medical problems, had undermined her mental and physical ability to perform at high levels, in a demanding and fast paced atmosphere.

The appeal was filed in early November 2009 and within only several weeks, the appeal succeeded. This quick resolution was due to the hard work of disability insurance attorneys Justin Frankel and Jason Newfield, who have dedicated their practice and their careers to helping claimants.

We have represented many policyholders who have claims against Met Life and many who suffer from the debilitating effects of Fibromyalgia and Chronic Fatigue Syndrome (CFS). We represent clients nationwide, in appeals, litigation, settlement and policy buy-outs). If you are facing a problem with a disability policy, or are preparing to file a disability claim, please call us at 877-LTD-CLAIM (877-583-2524) or click here to send us an email.