Disability Insurance Lawyer Blog

Frankel & Newfield Wins ERISA Appeal for Ad Agency CEO Denied by Dearborn National

Frankel & Newfield recently won an ERISA appeal against Dearborn National on behalf of a patient whose illness transformed him from a creative man whose success was based on his brilliance and analytical abilities to one who struggles to maintain more than one thought at a time.

While his denial may have been the result of a clerical error at first, the fierce fight that we had to undertake to get him the disability benefits that he was entitled to is further proof to us of the heartlessness of disability insurance companies.

Our client was a CEO at an advertising and marketing agency suffering from Hypertrophic Cardiomyopathy. This is a cardiac condition, often genetic in nature where, in very simple terms, portions of the heart muscle become extremely thick. It is difficult for the heart to pump blood, forcing the heart to work harder. He underwent open heart surgery to remove part of the enlarged heart muscle, during which time he suffered a cerebral hypoxia. There was not enough oxygen getting to his brain, and the brain suffers damage that impairs the person's ability to function. At worst, a hypoxic episode can cause death. At best, it leads to brain damage.

Our client no longer has the ability to think and act as he had before the surgery, and can no longer perform the functions and duties that are required from a CEO at a creative and fast-paced business. Dearborn National wanted to play a dating game with his future.

We proved that the insurance company had made an error by terminating our client's coverage before his employment ended.

We took a highly aggressive approach, providing professional opinions of his treating doctors and numerous published peer-reviewed medical studies that confirmed that a substantial proportion of patients after cardiac surgery experience measurable impairment in their mental capabilities.

Our client was awarded the benefits that he was owed and is now being paid on claim.
Not everyone who undergoes open heart surgery is able to return to their previous life. For those individuals, disability insurance is supposed to be the lifeline that lets them and their families live with dignity and financial security. If your disability insurance company wants to cut off your lifeline, call us today to learn how we can help.

Court Finds Aetna Abused its Discretion in Terminating Long Term Disability Claim

The reliance upon conclusory opinions of non-examining medical reviewers did not support Aetna's claim determination, according to a Federal Judge in Michigan. The Court took issue with Aetna's embrace of these hollow opinions, which were strongly contradicted by the claimant's treating doctors, each of whom clearly opined that the claimant was unfit to work, on the basis of clinical evidence and direct observation.

Further supporting its decision, the Court noted that Aetna failed to explain why it arrived at a different conclusion than the Social Security Administration, other than to note that Social Security relies upon different criteria. The Court was troubled by this lack of meaningful consideration, along with the wholesale adoption of the paper reviews, which were not based upon any examination or evaluation of the claimant.

Accordingly, the Court reinstated benefits.

Fura v. Federal Express Corp. LTD Plan

Prudential found to Abuse Discretion on Long Term Disability Claim

A Federal Judge in Louisiana has determined that Prudential's claim determination, to terminate long term disability benefits that had been payable for several years, did not have a rational connection to the facts, and has reinstated the claim and awarded attorneys fees.
The claimant, who suffered from orthopedic injuries following a slip and fall down stairs, had several surgeries, and enjoyed the support for her claim from numerous treating doctors.

Despite the fact that the claimant secured Social Security Disability insurance benefits, Prudential terminated the claim alleging that she no longer had support for her ongoing impairment. Prudential chose an adversarial posture with the claimant throughout the appeal process, and ultimately, simply adopted the opinion of a paper reviewing, non-examining physician. Prudential relied upon well known insurance pandering entities, including Reliable Review Services (RRS) and Dr. Richard Kaplan, a doctor who markets himself to insurers, for the claim review.

The Court was troubled by Prudential's wholesale adoption of the non-examining physician's opinion, to the complete exclusion of the support from claimant's treating providers. Based upon this, the Court determined that Prudential abused its discretion.

Tesch v. Prudential Ins. Co.

LEXIS NEXIS NAMES DISABILITY INSURANCE LAWYER BLOG A TOP 50 INSURANCE LAW BLOG

For the second time, Frankel & Newfield is pleased to report that Lexis Nexis, a leading global publisher, has named Disability Insurance Lawyer as a top 50 Insurance Law Blog of 2011.

Our blog reports on our own cases, trends in disability insurance law, timely news about the insurance industry and individual companies, and useful links, as well as expert analysis of disability insurance law cases that have significant impact on this area of law.

We are proud that our efforts to inform and educate have once again been recognized by this prestigious organization. Click here to visit and subscribe to the blog. If you have any questions or would like to speak with a partner, please call our office at 877-LTD-CLAIM (877-583-2524).

DISABILITY LAWYERS REVERSE DENIAL OF AN AETNA DISABILITY CLAIM FOR CHRONIC FATIGUE SYNDROME PATIENT

After a diagnosis of Chronic Fatigue Syndrome (CFS) and fibromyalgia in his late 30's, our client spent more than fourteen years fighting to keep working. To us, that is a sign of determination and commitment.

To Aetna disability insurance, filing a claim for disability many years after the diagnosis was a red flag, and they denied his claim based on one cognitive study. Their attitude - what had changed that led him to file a claim now, when he had managed his conditions for so long?

The cumulative effects of his conditions over time had simply become too much, despite his resolve to keep going. Chronic Fatigue Syndrome and Fibromyalgia weren't his only challenges. He also suffered from muscle twitching and severe muscle spasms, sleep problems (insomnia, non-restorative sleep), headaches, and costochondritis (rib pain). He endures chronic widespread pain from the Fibromyalgia, severe fatigue, and the cognitive side effects of his medications.

It probably would have been easier for him to file for disability years ago. But he loved what he did - it was challenging, afforded a comfortable lifestyle for his family, and he was good at it.

As Chief Financial Officer for a large retail furniture store, our client was responsible for directing and coordinating all financial affairs, negotiating contracts, preparing and analyzing budgets, and preparing reports outlining the company's financial position in areas of income, expenses, and earnings based on past, present and future operation. This position required strong cognitive and mathematical skills and a high level of performance and management abilities.

Aetna relied upon some cognitive testing to claim he was malingering. We developed an aggressive attack that brought together reports from many of his health care providers. This included his therapists, who proved their observations of deteriorating cognitive and memory skills, paired with other doctors who supported this position.

We were successful in getting him the payments that he should have received when the claim was initially filed, and he is being paid on claim, as he originally should have.

Employees Value Benefits More than Ever Before -- Surprised?

Another in a series of fine studies commissioned by UNUM shows that employees are happy to have disability insurance as an employee benefit. How would they not?

This study, the third in a series, shows that employees appreciate the opportunity to have disability insurance to protect their income and savings from illness and injury, says a VP at Unum. The importance of disability insurance protection was rated at an 8 on a scale of 1 to 10.

We hope that these employees don't all have Unum policies. After all, history is the best teacher, and history has taught us that Unum is among the most likely to deny claims. But we didn't need to do a study to tell you that....

We also believe that anyone who is employed today is happy to have a job, and understands that a job with benefits is the best of all possible worlds. Sometimes, however, the disability insurance coverage provided by an employer is barely worth the paper it is written on, with numerous exclusions, limitations and the claim handling techniques employed and designed to frustrate claimants in their pursuit of benefits.

If you have a Unum disability policy through your employer and you have been denied, your claim is being delayed, or you are considering filing a claim, give our office a call to learn how we can help. Or if you have LTD coverage with another insurer, with similar issues, we can help.