Disability Insurance Lawyer Blog

Successful Appeal of UnumProvident Termination of Long Term Disability Insurance Benefits for Surgeon

Our client is a vascular surgeon who suffers from numerous co-morbid conditions, including Chronic and Recurrent Alcoholism, Hepatitis C, Fatigue, Diabetes, Hemochromatosis, Hyperparathyroidism, Lumbosacral Disc Herniations, Degenerative Disc Disease, Facet Arthopathy, Forominal Stenosis, Chronic Pain, Depression, and Anxiety. He was unable to complete all the material and substantial duties of his job as a vascular surgeon within the course of a normal workday. He had filed for and was receiving residual disability benefits for several years when Unum terminated our client's benefits.

Unum relied upon selective portions of medical records and excluded more persuasive information and failed to undertake an appropriate investigation, relying upon biased and goal-oriented paper reviews of the evidence performed by well-known pro-insurer doctors. Making matters worse, Unum failed to appropriately consider our client's occupational requirements in evaluating his ability to be able to perform all of his work activities within the course of a normal work day, and failed to afford our client a "full and fair" review of his claim.

We fought back, and won. Our client is now back on claim as he struggles to cope with his many health issues. If you are facing challenges from many different illnesses at once and are having problems with your long term disability insurance claim, call our office today to learn how we can help.

Disability Insurance Lump Sum Settlement - Taxable or Not?

Many claimants are presented with offers to resolve pending disability insurance claims in exchange for a lump sum settlement with their disability insurance company. An important question in determining whether a claimant can even consider pursuing this option, which is a very personal choice for each claimant, and largely based upon numerous factors, is whether the benefit payment to be paid as a lump sum will be taxable or whether it will be a tax free payment.

While we do not provide tax advice - as we are attorneys who focus our practice on disability insurance claims, and not tax law, a recent decision from the United States Tax Court offers some useful guidance. A claimant had received a lump sum payment to resolve a litigation with his insurance company. While the company provided the claimant with tax documentation, the claimant took the position that the payment was not taxable as it was for his injury. The taxing authorities took the position that it was payment for loss of earnings, and thus taxable. The Tax Court agreed that the payment would be taxable, as it was for the loss of earnings.

However, not every loss of earnings benefit payment is going to be taxable. Where a claimant pays for his or her disability coverage out of post-tax dollars, the benefits are ordinarily tax free.

If you have a disability claim that is being paid, and wish to consider a lump sum settlement, or if your disability insurance company has offered a lump sum settlement, contact us to discuss how to proceed.

ON A TECHNICALITY OF CARE AND TREATMENT

Despite our success in reversing a denied claim for a client suffering from alcoholism and anxiety, the insurance company balked at sending benefit checks. The appeal was granted in June, but up until early November, the insurance company had only paid a portion of our client's long overdue benefits.

After a long and contentious process, we are pleased to report that we have now finally gotten our client's benefits up to date. The insurance company has been trying to apply technical provisions concerning the frequency of care and treatment in an effort to find a way not to pay.

This was not an easy battle. Our client sees many health care providers, although not always in the exact order that the insurance company would like to see. We began working with his mental health provider to bridge the gap in treatment with the other providers that he had seen, thereby overcoming the insurer's technical objections to the claim.

He is currently back on claim with a regular monthly benefit as a result of our tenacity and unrelenting pursuit of his claim.

We don't give up on our clients and their rights to receive disability insurance benefits. Time after time, this persistence has been rewarded with success for our clients and our practice.

If your disability does not follow in the exact pattern that the insurance company would like and you have been denied or payments are being delayed, call our office. We don't give up without a fight - and this is one fight you don't have to go alone.

Own Occupation Policies for Professionals

Think of an "own occ," or "own occupation" policy as a long term disability insurance policy that insures not you the individual, but your occupation. If you are surgeon, the LTD policy is insuring your ability to perform as a surgeon. Not as an office manager, not as a medical sales person: a surgeon. And if you are a specialist, then your insurance policy is insuring your ability to perform the specific tasks of that practice. An orthopedic surgeon performs tasks that are markedly different than a neurosurgeon or a vascular surgeon.

Let's get further into the details. If you are an orthopedic surgeon and a large part of your practice involves setting broken arms, rebuilding knees and hips, you have a very physical practice that requires a fair amount of hand, arm, neck and back strength. A neck injury that makes it impossible for you to hold your head up at a particular angle may mean that you can no longer perform surgery as you did before the injury or illness.

If a disability insurance claim is filed for an own occupation policy, the insurance company cannot insist that you can earn an equivalent and suitable income by teaching and selling orthopedic medical equipment. Your insurance policy insured your ability to perform surgery.

If you are an orthopedic surgeon who is a part owner of a busy practice with several partners, associates and staff, the insurance company may attempt to show that your income is not from your own surgical practice, but from your being an owner of a medical office.

This is a typical strategy from long term disability insurance company. We have helped many clients who are confident that their own occupation policy is in place and think that they will not have to worry when it comes time to file a disability policy. They are surprised and dismayed when benefits from what they thought was a better policy are challenged just as aggressively as an "any occ" policy.

One last thing to consider: we have had situations where the insurance company used Occupational Guidelines that were so out of date as to be ridiculous. It's important to be mindful of the specific tasks associated with your practice - lifting, bending, using large medical devices or small - when the claim forms require job descriptions.

If you have an "own occ" policy and are being asked to describe your job, be careful. This is an area where many claims go from bad to worse. If you have questions, call our office to learn how we can help.