Disability Insurance Lawyer Blog

Court Determines Reliance Standard Abused its Discretion on Remanded Claim

Reliance Standard Insurance apparently failed to appreciate guidance from the Court, where it had previously remanded a claim back to perform an appropriate review of the claimant's eligibility for long term disability insurance benefits. Initially, the Court remanded the claim to Reliance Standard, permitting the claimant to supplement the record with evidence of his job responsibilities, and further medical support.

Upon review of the remanded claim, the Court determined that Reliance Standard abused its discretion, on the basis of a number of factors. This included the selective review of medical evidence by Reliance Standard's hired paper only reviewing doctors, the failure to perform an examination of the claimant, instead relying solely upon paper only medical reviews the rejection of all subjective and self reported information from the claimant, and the flawed vocational review performed by Reliance Standard.

This combination of factors led the Court to conclude that Reliance Standard's rejection of the claim for long term disability insurance benefits was an abuse of discretion, and awarded the claimant back benefits, and the ability to seek attorneys fees.

Kelly v. Reliance Standard

Company Files for Bankruptcy and New Disability Insurance Company Terminates the Claim - Frankel & Newfield Files Federal Lawsuit and Wins Back Benefits

Our client, a 57 year old Senior Vice President of distribution and manufacturing for a large company located in Illinois, became disabled due to brachial plexopathy, non union of humeral fracture, cervical radiculopathy and carpal tunnel syndrome.

The long-term disability plan was managed by Trustmark Insurance, and the company was self-insured. After the company filed a claim for bankruptcy protection, Met Life became financially responsible for the claim, responsible for handling the claim and the payment of benefits.

After several years of qualifying for benefits under both the original company plan and under Met Life, a paper review was conducted by Met Life. It was determined that she continued to be totally disabled from any occupation and benefits continued to be paid.

Several months later, another paper review of her file was conducted, this time by Reliable Review Services (RSS), a company that does paper reviews for many disability insurance companies. The review from RSS determined that our client was now able to perform full time sedentary work based upon a labor market survey. Her administrative appeal was reviewed by Met Life and subsequently denied.

Frankel & Newfield was retained to represent her claim, and we filed a lawsuit in the United States District Court. We demonstrated that this review was completely inaccurate and that our client was no more able to work in any occupation at the time of the RSS review as she was when she was first found to be disabled.

Met Life reinstated her benefits and paid her the claims that had been denied.

In a time when companies file for bankruptcy with increasing frequency, employees are right to be concerned about changes in disability insurance coverage. However, when mistakes are made, an aggressive approach to litigation is necessary to fight for benefits.

If your disability insurance claim has been terminated after a review, call us today to learn how we can help.

Court Finds Lincoln Life to Have Abused its Discretion

A Federal Court in Michigan has recently determined that Lincoln Life abused its discretion when it terminated a claim, finding that Lincoln's decision making process was lacking in terms of analysis of the evidence. The claimant had provided extensive evidence documenting a history of back pain, along with objective testing which supported the impairments in functionality.

The Court also took issue with Lincoln's reliance upon a file review which was conclusory and lacked meaningful consideration of the evidence, holding that "conclusory and unsupported statements that the documentation was insufficient to support a finding of disability" did not demonstrate a deliberate and principled decision-making process.

The Court thus awarded the claimant his back benefits.

All too often, insurers rely upon file only reviewing doctors, who are regularly used by them to support the denial or termination of claims. These opinions are often lacking meaningful analysis of the medical evidence, and are often simply an outright rejection of the medical evidence.

Peshke v. Lincoln Life

Met Life Denies Disability Insurance Benefits for Project Manager Based on Paper Medical Records Review, We Fight Back and Win

Our client, a 57 year old man, was a project manager in building maintenance. In October 2008, he could no longer perform the duties of his job. He was suffering from a long list of painful disabilities: herniated discs, degenerative disc disease, lumbar spondylosis, radiculopathy, chronic back pain, cervical and lumbar spine stenosis, lumbar facet arthropathy, radiculopathy, fatigue, carpal tunnel syndrome, and headaches.

Met Life had originally accepted his claim, and he received full disability benefits from October 2008 until late April 2011, when suddenly MetLife terminated his claim based solely on a paper review of his file.

A paper review means exactly what it says: a review of the paper file. There was no medical exam, no one met him or saw him at his home or in a doctor's office. They simply looked at some of his medical records and determined that he was no longer disabled. We are familiar with their process and the reviewer.

On December 14, 2010, our client's claim file was reviewed by Dr. Marc Sloan, a paid consultant for Met Life who conducts many Physician File Reviews (PFRs) for Met Life short and long term disability claimants. From our research and experience, we know that every claim reviewed by Dr. Sloan that involves a spine or back condition is found not disabled, reportedly based on a lack of objective findings supporting functional limitations. Met Life had the right to have our client examined in person, but never exercised that right.

To add insult to injury, Met Life failed to conduct a proper vocational assessment. They asserted that our client would be capable of functioning in any capacity, relying on generic physical categories of occupations, rather than considering the mental and intellectual demands of the various occupations it believes our client was capable of doing.

Our client can neither sit nor stand comfortably, nor can he walk, carry anything, or do much of anything physical without a tremendous amount of pain and discomfort. We'd love Met Life to find an occupation that would be suitable for him.

On April 25, 2011, Met Life terminated the client's long term disability claim. We prepared an appeal, with aggressive documentation of his condition and of Met Life's complete failure to conduct an appropriate vocational assessment.

Met Life overturned its decision on December 2, 2011.

Early Intervention Can Cut Disability Costs - Smart Business is also Good Business

Sun Financial Life and Integrated Benefits Institute (a purported non-profit benefits research organization) have "discovered" that employers who take a pro-active approach and get involved with their employees soon after they are initially disabled can be effective in helping them return to work faster and happier - and, no surprise, this approach cuts disability-related costs.

IBI did a study of Steelcase, a Michigan office furniture manufacturer. After the company introduced a disability management program which integrated worker's compensation, short and long-term disability and the federal Family Medical Leave Act, worker satisfaction allegedly rose by 48 percent.

Steelcase implemented the program because employees were confused by disjointed employee benefits. They took the proverbial bull by the horns and made significant changes. The IBI study looked at nearly 1,000 non-maternity short term claims. Those in the study who received services like coaching about back-to-work expectations, information on light-duty positions, job site modifications, medical intervention to ensure appropriate care, and communication between the employee, employer and physician did far better in returning to work.

Apparently, kindness in the workplace pays big dividends. Especially when it saves the employer big money.

If your employer isn't Steelcase and doesn't understand the value of this sort of program, and no one is responding to your requests for help with the disability insurance company's delay or denial of claims, call our office to learn how we can help.

Chiropractic Economics Includes Frankel & Newfield in Resource Guide

We were very proud to learn that our firm was included in a resource guide published in the November edition of Chiropractic Economics.

Over the years, we have published several articles in Chiropractic Economics about disability insurance and they have always been well received. Many of our clients are chiropractors, who unfortunately suffer from the long-term effects of a very physical job.

It's ironic that the chiropractor, whose career is dedicated to keeping their patients healthy and well, often faces long term health challenges from the techniques of their profession. Bending and twisting, while applying force, often at awkward angles, can lead to neck, shoulder, back and arm problems.

When it becomes too painful to practice, many professionals transition into other related fields, like office management or teaching. However, their disability insurance policies should be paying benefits, partial or total, as the policies insure the chiropractor's ability to function as a chiropractor. It's not just semantics- its dollars and cents.

If you are a chiropractor and have been trying to keep working despite suffering pain or injury, call our office. We have represented many chiropractors in filing disability insurance claims, and would be happy to speak with you about your particular situation.

Does It Matter Which Disability Insurance Company Has Your Policy?

We wish we could say that there was one particular company that always came through for their disability insurance claimants. There would be little need for us as disability insurance attorneys, so we would become insurance salesmen, and make sure that everyone bought policies from that one good disability insurance company.

Unfortunately, this is not the case.

Our clients are insured by many different disability insurance companies. Some have private insurance with the highest rated disability insurance company, while others have the least expensive policies that they receive as a benefit from their employers. They are doctors and lawyers and business owners with huge incomes, and working people with moderate incomes. They come from all backgrounds, work in all fields, and live in a variety of states.

Regardless of the insurance company, they all share the same challenge: they are ill or injured and have been denied the benefits that they thought would help them, or the process has been unreasonably delayed with countless demands for more information, or they have been intimidated by the insurance company and required to undergo testing or examinations without being made aware of their rights.

When you are facing a problem with an insurance company, it's common to feel like you must have made a mistake. Did you pick the wrong company to provide disability benefits for you? Was there another level of coverage that might have been more likely to be accepted and paid?

If you have been denied disability insurance, it is not a reflection of who you are or anything you have done wrong. Don't let the insurance company intimidate you - you have rights. Call our office to learn about our practice and what we do to help our clients.