Disability Insurance Lawyer Blog

COMMON SENSE CIGNA PROGRAM CUTS DISABILITY ABSENCES BY 15 PERCENT

We take insurance companies to task on a regular basis, so when one of them does something good, we think it's only right to give credit where credit is due.

CIGNA did a study of involving 118,000 individuals from 26 client employers. They identified high-risk individuals, and 80% were assigned to receive outreach and support, including personal health coaching from a nurse advocate, lifestyle management, disease management, employee assistance and vocational stay-at-work programs. As a result, the employees had 15 fewer short-term disability claims among these high-risk individuals, and those disability absences were reduced by five days on average.

While CIGNA's motivating factor is its bottom line, we hope that the results of the study will drive what we consider to be common sense - employees with health problems may do better with more support. A healthy employee decreases costs for insurance companies, enhances a company's productivity and is a healthier individual.

There are additional costs associated with providing the outreach and support, but we are confident that an economic analysis would show that over the long run, that additional expense is considerably less than the cost of more medical care and absenteeism in the work place.

Court Finds Lincoln Life Determination an Abuse of Discretion

A Federal Court in Michigan has reinstated a claimant's long term disability insurance benefits which were were wrongfully terminated by Lincoln Life Insurance. The claimant had been disabled since 2000, and his benefits were terminated by Lincoln Life in June 2008, based upon a determination that the claimant could perform work in a sedentary capacity.

Lincoln relied upon the Dictionary of Occupational Titles (DOT) as a reference, despite the fact that the DOT has not been revised since 1991. On appeal of the claim termination, Lincoln obtained an IME, which not surprisingly found that the claimant's pain was "out of proportion" to the physical examination and diagnostic studies. This is an all too typical comment provided by doctors hired by insurance companies on ERISA disability claims.

Lincoln also relied upon the medical opinion of a nurse, an action that drew skepticism from the Court, which noted that "When a plan administrator's explanation is based on the work of a doctor in its employ, we must view explanation with some skepticism." The Court found that Lincoln's review was limited and that it ignored the claimant's reports of constant pain. The fact that Lincoln ignored prior assessments of limited functionality guided the Court in its decision.

As a result, the Court ordered benefits to be reinstated, and permitted the claimant to seek attorney's fees. Grabowski v. Lincoln National Life Ins. Co.

UNUM COMMISSIONS A STUDY - WE HOPE UNUM CLAIMS ADJUSTERS READ IT

In the same way a large university will conduct a multi-million dollar study to come to a common sense conclusion, disability insurance company UNUM hired a massive global consulting firm to conduct a study which, unsurprisingly, reveals that employee-sponsored disability insurance is important for working Americans as it provides a safety net for employees when they are injured or become ill and cannot work.

The report sings the praises of disability insurance benefits from employers, and is careful to make a political point: employee disability insurance benefits also provides a social value, because when benefits are paid, the likelihood of dependency on public assistance programs decreases, thereby preventing families from falling into distressed financial straits.

At Frankel & Newfield, we understand that concept better than most. After all, our disability insurance law practice is focused on preventing families from falling into distressed financial straits, and so we are pleased that our firm also can also be said to provide a social value.

We think that UNUM should make careful and thorough reading of this report mandatory for their own employees at every level and for the employees at companies they hire - particularly the doctors who do their so-called Independent Medical Exams (IMEs) and Functional Capacity Exams (FCEs). They should all be required to read and analyze the report so they understand more fully the importance of disability insurance to the lives of the people whose claims they deny or delay.

If it seems like your disability insurance company is not so concerned about helping your family from falling into a distressed financial situation, call our office today to learn how we can help. You can reach us at 1-877-LTD-CLAIM (877-583-2524).