Disability Insurance Lawyer Blog

CIGNA AGAIN TAKEN TO TASK FOR CLAIM HANDLING

Another Federal Judge has seen through the ERISA quagmire and has found that CIGNA's claim handling conduct was improper, and that the claimant provided sufficient evidence to demonstrate that he remained disabled. The Court awarded retroactive benefits with interest.

The Court was impressed with the evidence presented by the claimant demonstrating entitlement to any occupation benefits, based upon the support from his treating doctors, who had long standing treatment relationships with the claimant, and who articulated functional restrictions and limitations. The Court also determined that the record demonstrated that CIGNA cherry-picked selective items of evidence in order to support its claim decision. The Court also found the TSA (Transferable Skills Analysis) to be flawed, and upon considering the totality of the evidence, found the claimant to still be disabled.

Jones v. CIGNA Group, W.D.N.Y. 2011

ProHealth.com publishes article on Investigation Tactics used by Disability Insurance Companies for Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) Patients

We continue to tell our clients that if they are about to file a disability claim, they must consider anything they post on any social media website, from FaceBook to Twitter to LinkedIn and beyond to be open to the public.

Any information that can be obtained will be found and used against their claim. We provide detailed information on claimant investigation for visitors to the ProHealth.com website. Click here to read the article.

Avoiding the Disability Claim 'Brush-Off' Article Published on ProHealth.com

Because Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS) patients face unique obstacles from disability insurance carriers, we are contributing a series of articles for ProHealth.com, a popular website that combines commerce with information on proactive health management. The first two articles have been among the top five articles viewed by visitors to the site for several weeks. The first article focuses what FM and CFS patients need to know about long term disability insurance. Click here to read the article.

US Supreme Court Ruling Redefines Employee Right to Bring Lawsuits in Court, Even Under ERISA

The United States Supreme Court has issued a ruling in CIGNA v. Amara on May 16, 2011 (Case No. 09-804, 2011 U.S. LEXIS 3540) that reverses nearly two decades of law which limited employees rights to take their employers to court under ERISA. The implications for long term disability claims when policies are an employee benefit are staggering.

Presently, an employee whose claim is denied is forced to go through a severely restrictive administrative process, where the insurance companies serve as judge and jury. The employee cannot bring a case in court until all administrative remedies have been exhausted - at which point many give up the battle, while others go on to fight their case in Federal Court.

It is an overly burdensome process, heavily weighted against the employee. However, the decision in Amara opens the door to allowing federal courts to hear disputes against a fiduciary (the employer or the insurance company) about the terms of an ERISA benefit - in this case, long term disability insurance policies.

In its simplest form, CIGNA wrote up summaries of changes to its employee pension plan that characterized the plans as being far more generous than they actually were. Employees brought a class action lawsuit demanding that CIGNA had a fiduciary responsibility to them to provide the better benefits as described in the summaries. At the district court level, the district court found that this was not a case of poor editing but a deliberate act to provide misleading information. Both the district court and U.S. Court of Appeals for the Second Circuit gave that relief to the employees. CIGNA appealed to the U.S. Supreme Court, and lost.

The case encompassed many complex issues but at its essence, the core issue revolves around the right of employees to bring a lawsuit against a fiduciary and obtain monetary compensation for damages.

In providing guidance to the District Court on remand, the Supreme Court in Amara significantly expands the power and substance of the remedies available under ERISA. The language of the decision affirms that where there is a violation of the terms of an ERISA plan or the requirements of the Act itself for which no remedy exists elsewhere in the Act, as in Amara, that equity will provide a remedy. This has enormous implications for the rights of employees whose long term disability insurance benefits have in the past been held to the very strict guidelines of ERISA.

We believe that Amara will have a significant impact on the rights of employee policyholders, but how lower courts follow this ruling will only become clear over the course of time. If you are not able to obtain disability insurance benefits and your claim is being denied or delayed, call our office to find out how this decision may impact your claim, and how we may help.

To read the actual decision, click here.

DISABILITY ATTORNEYS FRANKEL & NEWFIELD WIN AGAINST PRUDENTIAL DENIAL OF CLAIM

Our client is a 53 year old woman who had a successful career as a billing analyst. The position required a high cognitive level, making informed decisions about complex financial transactions and fiscal responsibility for a multi-million corporation.

Her disability includes severe chronic pain that is the result of degenerative disc disease in the cervical and lumbar spine, spondylolisthesis, lumbar stenosis, facet arthropathy, and ligamentum hypertrophy. The excruciating constant pain made it impossible for her to concentration on complex transactions. Pain killers interfered with her ability to perform the mental tasks of her position.

Prudential denied her claim for disability benefits, relying exclusively upon the biased opinion of a paid medical consultant, who reviewed selective portions of her medical records. There was no in-person medical examination, even though the policy allowed for as many examinations as reasonably necessary at Prudential's expense.

The improperly done medical assessment was matched by an equally improper and inadequate employment assessment. Prudential relied on the Medical Disability Advisor (MDA) guidelines. This is a notorious sourcebook in the insurance industry, created and edited by Dr. Pressley Reed, a non-practicing medical doctor whose company provides disability management services for insurers and administrators. The MDA purports to be edited by a long list of "medical specialists," most of who are employed in the insurance field.

This is an extreme case of the inherent conflict of interest that exists when sources are being paid by the insurance company to provide a report that suits the insurance company's end.

Prudential made no efforts to obtain any further testing, despite obvious and substantial discrepancies between the findings of our client's treating physician and Prudential's paper reviewing consultant, even though the policy allows for as many examinations reasonably necessary at Prudential's expense.

Our defense was detailed and thorough, providing evidence of unequivocal objective medical support for her disability, including numerous MRIs of the lumbar spine and the cervical spine, medical records, supporting statements, and an independent medical examination report. Her benefits were reinstated and she is on claim.

If you have a condition that precludes you from performing the tasks of your occupation and the disability insurance company has denied your claim without an in-person physical exam, it is likely that their medical review is incomplete and/or inaccurate. Don't accept the denial. You can fight back, and you don't have to go it alone. Call our office today to learn how we can help.