Disability Insurance Lawyer Blog

CLASS ACTION LAWSUIT AGAINST SEVERAL MASSIVE INSURANCE FIRMS

Just in case you ever question whether or not your decision to fight back when the long term disability insurance claims adjuster terminates or denies your claim, last week's decision by the United States Court of Appeals for the Third Circuit will easily rest any concerns you may have about whether or not it's worth pursuing.

The Court document starts with the allegations of "massive conspiracies throughout the insurance industry" made by purchasers of commercial and employee benefit insurance. These purchasers allege that the insurance companies entered into deceptive schemes with brokers to allocate their purchases among insurance companies. In other words, rather than compete against each other for business, the insurance companies and the brokers were making decisions about which company would sell to which purchaser.

It was alleged that the conspiring brokers directed the purchasers to the desired insurance companies and accepted contingency commission payments that were built into the fees being paid for the insurance premiums.

The heart of the decision is a somewhat technical matter - The Court of Appeals determined that the District Court's decision to dismiss the charges was wrong, that the case needs to be reopened and charges need to be considered under the anti-trust and anti-racketeering laws.

But the fundamental issue - of trust - is the same that underlies all of the cases that we work on. You pay the premiums on these insurance policies, trusting that if you should ever need to file a claim, the insurance company will pay the benefits as described in your contract.

If you find yourself in a situation where the insurance company claims that you have no claim, call our office to learn how we can help.

Successful Appeal Reverses Termination of Benefits for Prudential Policyholder

Our client was a highly successful, high earning Financial Advisor for a prestigious investment house. Despite a long history of low back pain, our client had kept working. He refused to give up trying to relieve the pain and get his normal life back. He explored every treatment option available, undergoing multiple surgeries and the use of powerful pain medications. Nothing helped, and his condition worsened over time.

His work as a Financial Advisor required high level cognitive thinking, performing financial analysis of client assets and investment portfolios as well as developing and maintaining client relationships.

When he could no longer focus or concentrate due to the pain, and was unable to sit for more than a few moments at a time, this hard working professional was forced to recognize that he could no longer work. Upon the strong recommendation of his doctors, he stopped working and filed a claim for long term disability benefits with Prudential. His claim was immediately approved, and benefits were issued - but not for long.

After four months of benefits, Prudential abruptly terminated his claim. Our client was stunned. His condition had not improved, on the contrary, he had undergone yet another unsuccessful surgical procedure days before the termination.

Prudential denied the claim based only on a nurse review of his medical records. The reviewing nurse did not contact his treating doctors for any updated medical reports before terminating benefits.

We filed an appeal on our client's behalf, attacking Prudential's careless claim review. We also provided additional support from our client's physicians, who had consistently supported his disability. We also clearly outlined the extensive duties of our client's occupation, to prevent any question of his ability to perform the tasks of his profession.

Our approach was successful. Upon reviewing the appeal, Prudential agreed that the claim termination was made in error and reinstated our clients claim, paying all past due benefits as well.

If you have been unfairly terminated, call our office to learn how we can help. This is one battle you don't have to fight alone.

LexisNexis® Announces Top 50 Blogs 2009 Insurance Law Community

We are pleased to report that our Disability Insurance Lawyer Blog has been selected by NexisLexis®, one of the nation's leading legal publishers, as one of its top 50 Insurance Law Community blogs.

We devote a lot of time to keeping the blog current and are proud that our efforts have been recognized by one of the leading national law publishers.

PRESIDENT OBAMA TO TWEAK ERISA - BUT CAN HE REALLY FIX DISABILITY CLAIMS DENIALS?

The Associated Press reports that the Obama administration will make changes to boost consumer protection for workers and family members, including claims for disability insurance policies.

The Labor Department wants to fix the current appeals process for disability and health insurance as governed by ERISA (the Employment Retirement Income Security Act). ERISA was first put into place to protect worker's retirement funds from unscrupulous employers, but the insurance industry discovered that under the law, it has long been used as a way to make disability claim appeals next to impossible for the ordinary policy owner to negotiate.

We applaud the president's decision to fix a problem that affects millions of Americans every year. The disability appeals process is a minefield of problems that are baffling to consumers, and the deck always seems stacked in favor of the insurance company.

But before the celebrations begin, a few solemn thoughts - the insurance industry is one of the single most powerful lobbying groups on Capitol Hill. Just as the health insurance bill was delayed as it became mired in lobbying efforts and strategic maneuvers, it is likely that this consumer rights bill will face the same fate. Expect disability insurance and health care insurance appeals to receive a lot of attention in the national press over the next six months.

We hope that the reported bright lights of potential reform will have an impact on the insurance companies, who have fought tooth and nail for their right to deny and delay disability claims with no downside for their shareholders.

But if you have a disability claim that is being denied, or your disability insurance claims are being delayed with repeated requests for more information, we urge you not to wait until this legislation is passed. Reform could be a long time coming, and there is no way to know for sure what the ultimate result will be.

If you have a disability claim and can't wait for the new rules in the spring, call our office. We have helped many American workers whose rights to a fair and just treatment by a disability insurance company have been trampled on by uncaring insurance companies. Call us today to learn how we can help you.

RESIDUAL BENEFITS UNDER LONG TERM DISABILITY INSURANCE POLICIES

We represent many clients regarding residual claims, a challenging area of disability insurance law where we feel our practice shines. A residual disability benefit is a disability that causes an insured's income to fall more than 20% below its pre-disability level. This percentage varies with the policy, and some companies include a loss of time requirement or the inability to perform some duties.

One of our clients owns two private policies. This is a smart, albeit expensive, strategy that creates maximum income protection. Ideally, each policy has different features so that what one does not cover, the other will. He was being paid residual disability benefits under the first policy only. The second policy did not offer residual benefits, only total disability benefits, so he had not filed a claim.

However, over time his condition led to the loss of the use of both of his feet. He was not able to walk at all and could only work by using a scooter. He was still able to drive, but that was the only meaningful use of his feet.

He contacted us to help develop a strategy for pursuing a total disability claim under the presumptive disability portion of his non-residual policy. This policy provision allows for total disability benefits even while working in the case of the complete loss of feet, hands, eyes, ears, etc. The insurance company challenged this, claiming that our client was still driving and so he had not actually lost total use of his feet.

With skilled and determined legal research, we were able to demonstrate that the law would indeed support benefits where the insured lost all practical use of the legs.

Getting the treating doctor to support the loss of practical use was the next step in the process and we were successful with this. His support helped tip the scales in favor of convincing the insurance company to pay total disability benefits.

As a result, our client will now receive a full monthly benefit under the policy, regardless of whether or not he continues to work.

If your disability insurance policy has a residual disability benefit clause, don't wait until your disability has caused your income level to plummet. Call our office and learn how we can help.

FRANKEL & NEWFIELD WINS FOR PRINCIPAL LONG TERM DISABILITY POLICY HOLDER DENIED EVEN THOUGH IN-HOUSE DOCS SAY HE IS DISABLED

Our client has an orthopedic disability that exacerbated an existing psychiatric disability, which became so devastating that he was no longer able to work. His significant ankle problems (diagnosis of tarsal coalition and osteoarthritis of the foot) created a condition of intense chronic pain, which magnified a clinically diagnosed obsessive-compulsive disorder and major depression and anxiety.

He had a long term disability insurance policy with Principal, and after two years of being on claim, Principal cut off his benefits and declared that he could work in another occupation.

Our client had been the owner/operator of a convenience store. The specific tasks of his "job" included everything from forecasting sales, ordering products, managing employees, bookkeeping, stocking shelves, marketing, and all the tasks of a business owner, plus everything that his store employees did - from making coffee to cleaning the floors to selling lottery tickets.

He was compelled to undertake a psychiatric IME (Independent Medical Exam) despite the fact that Principal's own in-house psychiatrist said that a medical records review alone supported his claim of disability.

Usually the in-house physician is the first to agree with a claims manager that a disabled person is fit for work. It was not a cheap exam either -Principal paid more than $5,000 for the exam - and much of the report was supportive of his disability. Principal ignored that.

The psychiatric IME was followed by a vocational assessment, which we discovered had been done using many outdated resources, including the GOE - Guide for Occupational Exploration - a guide published in 1979 and based on research conducted in the 1960s that is used primarily by high school guidance teachers to help teenagers determine possible career paths.

After the psychiatric and vocational exams were done, the next tactic was the use of surveillance. The videotapes clearly showed that our client was disabled. Principal actually tried to redact all references to the surveillance in the claim file.

We worked closely with our client to obtain good supporting statements from family members and strong narrative reports from his treating psychologist and psychiatrist. Our client is back on claim and receiving benefits on a regular basis.