Disability Insurance Lawyer Blog

FRANKEL & NEWFIELD EDUCATE DENTISTS ON DISABILITY INSURANCE ISSUES AT GREATER LONG ISLAND DENTAL MEETING

The law firm of Frankel & Newfield was pleased to show our support for the dental community by participating in this year's GLIDM. Dentists, orthodontists, periodontists, oral surgeons, dental hygienists, dental practice administrators and others in the dental professional gathered at the Huntington Hilton for a day developed to the arts and science of dentistry. During the evening session on April 21, Justin Frankel presented a program on disability insurance geared to the specific needs of dentists.

Many of Frankel & Newfield's disability insurance clients are dentists, and the firm is experienced with the special challenges faced by dentists. We have seen a multitude of issues during the claim process, and have observed some interesting trends with regard to insurance company claim practices.

Several members of the audience were in the process of considering whether or not to file a claim. They were particularly interested in the issues presented by primary care physicians who, while trying to be helpful, actually harm their patient's claim. In-house insurance company physicians call the primary care physician and attempt to elicit information on the claim during what appears to be a friendly, colleague-to-colleague telephone call. The phone call is anything but friendly. Their real goal is to find information that can be used to delay or eventually deny a claim.

Justin Frankel warned audience members that at no time should their primary care physician have direct contact with the insurance company physician. Any medical records that the physician sends to any representative of a disability insurance company should be carefully reviewed by a professional with experience with disability claims. Certain language describing not just the disability, but the impact that the disability has on the dentist's ability to practice, needs to be included in the medical records.

This is but one of the ways that disability claims can easily become ensnared in a tangle that benefits the insurance company and not the policyholder.

If you are a dentist and have questions about your disability insurance policy or your claim, call our office today. Let experienced disability insurance lawyers who understand the special challenges you face help you.

FRANKEL & NEWFIELD WINS ERSIA APPEAL AGAINST CIGNA FOR GEORGIA MAN WITH HIV/AIDS

Our client was a 44 year old man from Georgia, working as management consultant for a large financial management firm. He filed a claim for disability insurance when his illness, HIV/AIDs, became too debilitating and he could no longer work. His monthly benefit was sizable - and CIGNA denied his claim from the very start.

Our client suffered from side effects of medication, a borderline personality disorder, insomnia, cognitive dysfunction, fatigue, muscle and joint pain. He had been a very high-producing and successful consultant, but was no longer able to perform the tasks of his occupation.

CIGNA denied his claim based on two separate reviews that were conducted by two registered nurses. One evaluated his physical condition, and the other conducted a psychological evaluation. The same day that his claim was denied, a job description was requested.

Had an occupational analysis been properly done, it would have clearly showed the high cognitive levels that were needed to perform his occupation. Similarly, a proper medical review would have revealed the extent of his disability. Unfortunately, he had to fight for his benefits - but fortunately, he hired an experienced law firm that was able to win an ERISA appeal for him.

Long term disability insurance denials are often a product of poor medical reviews. The difference between those who eventually receive their benefits and those who do not are often the difference between those who fight back and those who accept the insurance company's decision.

Frankel & Newfield aggressively fight back for our clients. If you have been denied, call us. This is one battle you do not have to fight alone.

ERISA APPEAL AGAINST THE HARTFORD REINSTATES BENEFITS FOR COLORADO RESIDENT

Disability benefits were being paid to our client, a 51 year old man who was a high performing, high income insurance agent from Colorado. Working in the insurance business is no guarantee that a disability insurance policy claim will go smoothly - there's no 'professional courtesy' in this business.

Our client had a host of serious diseases: angina, coronary artery disease, myocardial infarction history, atherosclerosis, neutropenia hypertension, hypercholesterolemia, diverticulitis, thoracic outlet syndrome, cervical spine bulging discs, presyncope episodes, and thrombocytopenia. In layman's terms, heart disease was the leading cause of his being disabled, but in addition to heart disease, he also suffered from serious gastrointestinal and orthopedic problems.

The Hartford paid his benefits for a period of time, and then in June 2009 denied his claim following a medical records review and an employability assessment. But what Hartford considers a medical records review is not what you might expect. The medical review was not by a cardiologist, a gastroenterologist or even an orthopedist. It was a medical case manager, who only reviewed medical records from two of his eight physicians.

The employability assessment was less than a full paragraph - hardly enough to review a well-paid, high performing insurance professional.

We are certain that the real reason for the sudden cut off was the level of benefits: Hartford had been paying him $5375 a month. He was 51 when he could no longer work. That's an expensive claim.

Our ERSIA appeal made a very thorough and aggressive attack on their vocational analysis, which failed to review the specific tasks of his position and was poorly done. The same aggressive attack of the medical records made it clear that Hartford's denial of his benefits was outrageous.

We succeeded in having Hartford overturn their own termination, and our client's benefits have been reinstated.

The insurance company's decision to delay, deny or terminate claims should never be accepted as a final decision by anyone who has a disability and cannot work. Time and time again we see individuals like our client who are facing enormous health challenges and are cut off by the insurance company. If you have a similar situation, call us - we can help.

GOOD MORNING AMERICA REPORT ON DISABILITY INSURANCE COMPANY TACTICS SPARKS FLOOD OF CALLS

Good Morning America investigative reporters Chris Cuomo and Gerry Wagschal have reported on several cases on claimants whose benefits were cut off after disability insurance companies used undercover surveillance videos. The response to these reports has been dramatic, and a follow up broadcast aired this week in response to the flood of calls generated by the story.

The idea that a private investigator would videotape claimants walking into a doctor's office is unpleasant, but not surprising. We're also not surprised by the number of people who have had the same experience. Frankel & Newfield has represented clients where surveillance videos were used in an attempt to cut off benefit payments. When it comes to tactics, undercover surveillance is just the tip of the iceberg.

If you are being paid disability benefits, it's likely that you have been or will be observed by an investigator and videotaped, particularly if your benefit payments are high or if you have been on claim for an extended period of time. We're not paranoid - just realistic.

Call our office today to speak with an experienced disability insurance lawyer. You are not in this alone - we can help.

Benefits Awarded to Chronic Fatigue Claimant

A Federal Court has determined that a claimant suffering from Chronic Fatigue Syndrome satisfied her burden of demonstrating that she was unable to perform the material duties of any occupation, entitling her to reinstatement of her disability insurance benefits. The Court held that the claimant had medical evidence of her condition (CFS), had subjective complaints which served as evidence of her impairment, along with strong support from her treating providers. Further supporting the opinion from the Court was Social Security's determination of impairment.

The Court rejected the arguments from the insurer, who relied upon the results of a Functional Capacity Evaluation (FCE), in an effort to show that the claimant had residual functional capacity for work. As support for why the Court rejected the FCE, the Court noted that the conclusion of work capacity was not supported by the DOL classification of sedentary work, and that the FCE testing was not of enough duration to sustain an extrapolated finding of functional ability. The Court also rejected surveillance evidence, which the insurer sought to utilize to buttress its claim determination.

Finally, the Court rejected the insurer's effort to rely upon a mental and nervous disorder limitation in the policy, which could have significantly curtailed the claimant's benefits. Rather, the Court determined that the depression symptoms were secondary to her CFS.
The Court thus awarded benefits, interest and attorneys fees.

Perryman v. Provident Life & Acc. Ins. Co. Ariz. D. Ct. 2010.

Court Reinstates Claimant with Orthopedic Impairments

A Federal Court in Michigan has ordered Met Life to reinstate the claim of a Bearing Point employee, whose claim had been terminated on the basis of a paper review by a well known insurance company provider. The Court took issue with a number of aspects of the claim handling, in reaching the result that Met Life abused its discretion. The Court noted that even the arbitrary and capricious standard of review "has some teeth" and considered numerous aspects of the claim handling to be indicative of a financially conflicted fiduciary.

The Court was troubled by the failure to provide any consideration to the opinion of the claimant's treating physician, as well as failure to even mention Social Security's favorable findings. The Court also took issue with Met Life's paper reviewing physician's inconsistent report, and the fact that Met Life terminated the claim despite not demonstrating any improvement in the claimant's condition, after accepting liability of the claim for years and despite worsening of the condition as revealed by medical testing.

It is clear that some courts embrace the review proceeding with some meaningful scrutiny, and thus, are able to appreciate the significant level of conflict influencing the claim process. This case highlights a common theme seen in many orthopedic disability claims. Lanier v. Met Life Mich. D. Ct. 2010

JUSTIN FRANKEL TO ADDRESS DENTAL PROFESSIONALS AT GREATER LONG ISLAND DENTAL MEETING - DENTISTS FROM NASSAU, SUFFOLK, QUEENS, NEW YORK COUNTIES

As a result of years of repetitive movements and maintaining awkward positions, typically for long hours, dentists tend to have back, shoulder, arm, wrist, hand, head and neck problems. Many find themselves struggling to continue to practice, or completely unable to practice, and so dentists, orthodontists, periodondists and other dental professionals file disability insurance claims. Disability insurance companies love to sell policies to dentists - they can afford high premiums for these private policies - but they hate paying on claims.

Many of Frankel & Newfield's disability insurance clients are dentists, so we know the special challenges faced by members of this profession. We have seen a multitude of issues during the claim process, and have observed some interesting trends with regard to insurance company claim practices.

On Wednesday, April 21, 2010, Mr. Frankel will address the Greater Long Island Dental Meeting (GLIDM) with a program titled "What Your Insurance Company Doesn't Want you to Know About Long Term Disability Insurance." The program, from 6:00 PM - 9:00 PM will prepare attendees should they ever have to file a claim.