Disability Insurance Lawyer Blog

Appeals Court Reverses, Grants Retroactive Benefits

2010-03-08T15:06:22Z

The Ninth Circuit Court of Appeals seems to "get" it. The Court reversed a decision that was favorable to an insurer, granting the retroactive payment of benefits to a claimant who has had numerous hip revision surgeries, and was getting paid Social Security Disability benefits.

The Court found that the quantity and quality of the medical evidence supports the claim, where the Court rejected the insurer's argument that a lack of objective evidence existed, where the Court embraced the consistent use of strong paid medication, and where a Functional Capacity Evaluation ("FCE") supported a finding of impairment. The Court found that the insurer failed to credit reliable evidence. The complete disregard of the Social Security determination further informed the Court's decision.

LINCOLN NATIONAL DENIES DISABILITY CLAIM TO CLINICAL NEUROLOGIST; FRANKEL & NEWFIELD OVERTURNS DENIAL AND GETS BENEFITS REINSTATED

2010-03-05T14:21:51Z

Our client was a successful Clinical Neurologist, practicing in the area of movement disorders in a busy hospital with a focus on complex, advanced stages of Parkinson's disease and dementia. Her tasks required the ability to perform physical and labor intensive activities while working at an equally high level of analysis and cognitive abilities.

She developed a number of complex symptoms, including severe fatigue, weakness, muscle atrophy, shortness of breath, and painful muscle cramps and spasms. These were later diagnosed as early motor neuron disease, nueromitochondrial disorder, and pulmonary insufficiency.

Our client was no longer able to perform the tasks of her highly demanding occupation. She filed a claim for short term disability benefits with Lincoln and was denied, based on a paper review of the medical records conducted by a staff nurse.

In preparing her appeal, we worked closely with our client and her treating physicians to further develop the medical support in the record, clearly documenting the tasks that her job required, and the restrictions and limitations of her illness. We vigorously attacked the credibility of Lincoln's paper medical analysis, highlighting the many flaws in their medical review, and made it clear that they had failed to fully and properly review our client's medical records and to understand the tasks required for her to perform her profession.

We won the appeal, and Lincoln paid our client the short-term benefits that she deserved. This has set the stage for her making a claim for long term benefits. Without this positive outcome, she would not have been able to file for long term benefits, even with another disability insurance company.

The appeal was represented by Justin Frankel, a partner at Frankel & Newfield. He has helped many professionals who had demanding and complex careers when their disability insurance companies have resorted to a simplistic paper review of claims. If you would like a free consultation, call Frankel & Newfield at 877-LTD-CLAIM (877-583-2524).

FRANKEL & NEWFIELD WINS APPEAL AGAINST MET LIFE FOR EXECUTIVE WITH FIBROMYALGIA, CHRONIC FATIGUE SYNDROME

2010-03-03T15:31:11Z

A high level manager at an international consulting firm had applied for benefits under the disability insurance policy that she paid for through employee deductions. She filed a claim when Fibromyalgia, Chronic Fatigue Syndrome and multiple medical problems made it impossible for her to perform the tasks associated with her highly demanding position. As a proposal manager, she needed to be able to perform the tasks of her subordinates - analyze extremely complex business situations and make equally complex proposals - and manage a team of fast-paced brilliant business advisors.

Met Life denied her claim, based solely on a paper review of her medical records. Frankel & Newfield took a two-pronged approach. We worked with our client and her doctors to develop a strong vocational case that detailed the complex nature of the work that she and the subordinates she was responsible for were required to perform. This specific vocational approach made it clear that she was required to think at a very high level, think clearly, to make complex decisions and recommendations, and work through problems in the face of intense deadlines, working continuously until the problems were solved and the proposals were ready for clients. The second part of our tactic was to clearly prove that her medical conditions, Fibromyalgia and Chronic Fatigue Syndrome and other medical problems, had undermined her mental and physical ability to perform at high levels, in a demanding and fast paced atmosphere.

The appeal was filed in early November 2009 and within only several weeks, the appeal succeeded. This quick resolution was due to the hard work of disability insurance attorneys Justin Frankel and Jason Newfield, who have dedicated their practice and their careers to helping claimants.

We have represented many policyholders who have claims against Met Life and many who suffer from the debilitating effects of Fibromyalgia and Chronic Fatigue Syndrome (CFS). We represent clients nationwide, in appeals, litigation, settlement and policy buy-outs). If you are facing a problem with a disability policy, or are preparing to file a disability claim, please call us at 877-LTD-CLAIM (877-583-2524) or click here to send us an email.

New York Times' Article on the Disability Insurance Odds

2010-02-11T16:28:21Z

A recent article in The New York Times on Disability Insurance takes an amused look at the sources behind the numbers used to explain how important disability insurance is to the American worker. But hidden behind this lighthearted discussion are some very real facts - the average person who becomes disabled rarely has the resources to maintain their pre-injury or pre-illness lifestyle. And that's where disability insurance comes in.

Reporter Ron Lieber gets serious about how insurance companies attempt to limit your ability to make a claim. He touches on only one of the many strategies that we see on a regular basis: any occupation versus own occupation issue. "If you can afford it, you want what's known as "own occupation" coverage instead, which should pay claims if you can't do your old job." He's right. But even policyholders with "own occ" policies run into trouble, when insurance companies attempt to twist the language of the contracts and the tasks and responsibilities of occupations. We've seen CPAs being told by insurance companies that their skill sets apply to lower-earning freelance bookkeeping positions - with about a $200,000 a year in earnings difference.

If you are having trouble with a disability insurance claim and your bills are starting to pile up, don't wait to find out how to protect yourself, your family and your hard- earned way of life. Give our office a call. You don't have to do this alone.

UNUM REPORTS HEALTHY FINANCIAL NUMBERS - BUT WHAT ABOUT DISABILITY INSURANCE POLICYHOLDERS?

2010-02-03T18:35:54Z

Unum Group just released its quarterly earnings report for the end of 2009 that proudly trumpets the company's "favorable operating trends and solid capital position." President and CEO of Unum is quoted saying "the actions we have taken (sic) the past several years have positioned us well and provide us with significant operating and financial flexibility." While that may make the company's shareholders happy, it doesn't do much for the UNUM long term disability insurance policyholders whose claims are being delayed and denied. When an insurance company does not pay its policyholders, or instills a company-wide policy, unspoken or otherwise, of denying claims, it's considerably easier to show healthy profits.

For the formerly hard working employees whose employers purchased disability policies through Unum and are now fighting to get their benefits, the company's glowing press release is of little help. We work with many individuals who have had to fight to get their benefits from Unum. If you are having a problem with Unum, or any of the big name disability insurance companies, call our offices now at 1-877-LTD-CLAIM (877-583-2524) and learn how we can help.

Disability Surveillance Footage - When a Picture Really IS Worth A Thousand Words - and Dollars

2010-01-25T16:08:04Z

Anyone making a claim for disability insurance benefits needs to be aware that they can, and likely will at some point be under the careful and close scrutiny of a private investigator armed with video cameras. They may be parked outside your home in the classic low-budget spy thriller van, or they may be watching from a control room in a non-descript office building thousands of miles away. But if you've filed a claim, chances are good they are watching.

Video surveillance is a relatively inexpensive way for insurance companies to gather additional information about the life and daily patterns of a claimant. It's also a great tactic to intimidate policyholders. See our blog on a Good Morning America investigative news story concerning a Florida man suffering from Multiple Sclerosis. Hartford Insurance tried to scare him with a videotape, and then backed down when the powerful news show exposed this bullying practice.

Not everything that appears on video, however, is what it seems. If the videotape is being reviewed by the insurance company, chances are they will ignore the slight limp in a woman's gait. Or that the man only left the house once during an entire week - hardly "normal" behavior for a healthy person. Instead, the focus will be on the self-serving needs of the insurance company.

What should you do when an investigator shows up in your driveway with a tape? Ask for a copy. And call an experienced disability insurance attorney. There's a lot more to any picture than meets the eye. An experienced disability insurance attorney knows the strategies used by private investigators to build the insurance companies case as well as they know the law.

If you are being videotaped, call us. If you've been presented with a videotape and a surveillance log and the insurance company is delaying your benefit payments, call us. This is one battle you don't want to fight alone.

Who is Your Disability Advocate?

2010-01-18T17:17:58Z

Trying to advocate for yourself once you've been admitted to a hospital is practically impossible. If you are lucky enough to have a family member who knows the ins and outs of hospitals and health insurance, you can focus on getting better. If you don't, the hospital social worker will go toe-to-toe on your behalf with hospital staff, administration, insurance companies, etc. They are experienced and knowledgeable, and it's their job to help you at a time when you cannot help yourself.

The same holds true for a sick or injured person with a disability insurance claim who is not getting the right treatment from the disability insurance company. You need to focus on getting better and taking care of yourself. Your advocate should be an attorney who will fight for you, who has the experience, knowledge and the aggressiveness required to do battle with a large company that simply doesn't care.

If you read through our case studies on the blog and on our website, you will see how Frankel & Newfield fights for our clients. Our determination and relentless advocacy are well known by the insurance companies. If your disability insurance claim has been denied or is being delayed, if you are considering a settlement, call our office at 1-877-583-2524 to learn how we can help.

UNUM Policyholder - We Win on Appeal, Lifetime Benefits Are Reinstated

2010-01-05T21:53:12Z

A New Jersey doctor has been on residual disability with UNUM for over ten years as a result of a sickness that limited his ability to practice as an obstetrician/gynecologist. The language of his UNUM policy states that if he becomes totally disabled before age 65 because of an Injury, UNUM must pay benefits for the rest of his life.

Almost immediately prior to turning 65 the doctor became totally disabled based upon bi-lateral carpal tunnel syndrome. We immediately notified UNUM that the doctor was unable to perform any of the material and substantial duties of his occupation because he was totally disabled based upon an injury.

Not surprisingly, UNUM stopped paying benefits at age 65, stating that he was not totally disabled and furthermore, that carpel tunnel syndrome was not an injury.

Once again, a disability insurance company is trying to stop making payments. At over $20,000 a month, the doctor, has already received more than $2.4 million in benefits, based upon a sickness - not payable for lifetime benefits. Not hard to figure out why UNUM would want to cut him off.

Our firm was retained to represent him in an appeal, and with aggressive representation, we were successful. After performing extensive research, developing and attacking the underlying bases for UNUM's position, and submitting an Appeal to UNUM addressing these issues, we were able to convince UNUM that carpal tunnel was an injury and not a sickness warranting benefits for life.

Now the doctor will receive full payment - over $20,000 per month - for the rest of his life.

AGGRESSIVE REPRESENTATION BY FRANKEL & NEWFIELD GETS HARTFORD DISABILITY BENEFITS REINSTATED AND BACK BENEFITS PAID IN FULL

2009-12-30T18:18:07Z

Our client, a Global Product Manager with a large international bank, suffers from a painful orthopedic condition that makes it impossible for him to perform in his job. Hartford went after his disability insurance benefits on several fronts, and we fought back and won.

They started with a peer review, where an outside company hired by the insurance company engages one of its repeat offending paper reviewing doctors to perform a selective review our client's medical records. We had worked with our client's doctors to make sure that their files properly and specifically documented not just his condition, but the severe limitations that his condition created. Our doctors swiftly and thoroughly rebutted the insurance company doctors' claims.

We followed with an aggressive attack on the peer reviewing doctor's opinions, which was clearly falsifying his diagnosis and failing to accurately review medical records. The paper reviewing doctor's opinions were slanted by the peer review company in order to give the insurance company only what it wanted, and not the unbiased and honest review that they are allegedly hired to provide and which is legally required by ERISA, a federal law.

Our next level of attack involved a rebuttal of the insurance company's surveillance, which had videotaped our client in his yard, mowing the lawn for a few minutes. We forcefully attacked their surveillance, relying upon a recent Good Morning America broadcast and case law that revealed the treacherous use of surveillance on disability insurance claimants by Hartford and other insurers.

The results speak for themselves. Our client's claim has been reinstated, and he received full back benefits and reinstatement to his employer's other employee benefits.

Court Rejects "Result Driven" Functional Capacity Evaluation

2009-12-28T20:19:49Z

In the field of disability insurance, a trend that has seen a tremendous surge has been the insurance companies' utilization of Functional Capacity Evaluations ("FCE's"). This trend has caught a number of unsuspecting claimants in a web that has tangled their ability to continue receiving their disability payments.

Thankfully, some courts are beginning to see through these issues. One court recently rejected a claim termination that was based upon a "result driven" FCE. The FCE, which concluded that a claimant could perform greater than sedentary work over an eight hour day, was rejected, in large part because the examiner focused upon the puported self-limiting behavior, rather than relying upon the testing and observations for assessment of functional ability. Lowery v. UNUM Life Ins. Co.

Many insurers seek FCE's even where the policy does not specifically permit the right to conduct such an evaluation. In these instances, we typically aggressively challenge the insurers' right to the evaluation, based upon policy language, as well as legal challenges concerning the reliability of the test results, and medical challenges to the safety of such evaluations.

If your insurer is attempting to compel you to attend an FCE, we strongly urge you to engage counsel to protect your rights.

HOME FOR THE HOLIDAYS for all the wrong reasons?

2009-12-23T20:40:58Z

The holidays are a time of joy and celebration. But if an injury or illness has made it impossible for you to work, the holidays are an especially challenging time of year. If you are up against what seems like a Great Wall of Disability, where the long term disability insurance policy that you counted on has instead become an obstacle that you can neither go around, over or through, it may be time to consider retaining an attorney. If you are not sure what your next move should be, call our offices. You have enough to deal with. We can help.

Court Finds Decision Arbitrary and Capricious

2009-12-23T20:29:41Z

Despite acknowledging that the abuse of discretion standard of review is quite deferential to plan administrators, a court has determined that Harvard's termination of benefits was an abuse of discretion. The Court found the administrator improperly rejected the panoply of supporting physicians, and that the only medical opinions that were unfavorable to the claimant were those procured by the administrator. The Court also was troubled by the failure to consider both Social Security and Workers' Compensation awards.

In language that can be offered to other Courts throughout the country, the Judge stated that while "plaintiffs seldom if ever prevail when the standard [abuse of discretion] is applied. But seldom if ever cannot mean never at all, or the promise made to claimants that federal courts will review their benefits decisions for abuses of discretion would be a cruel and illusory exercise." McGahey v. Harvard University

MSNBC Reports: Job Losses Send Disability Claims Soaring

2009-12-18T14:37:54Z

The impact that the twin forces of a deep recession and an aging boomer population is having on increasing disability claims across the country is no news to Frankel & Newfield. The phone calls and emails received in our office over the last six months are from people between a rock and a hard place. In a kinder economic environment, the workplace might have been more flexible with doctor's appointments and more than usual sick days. Today there's little room for employees with problems, regardless of circumstances. And once a disabled person is out of work, there are fewer opportunities, and fewer options. A formerly healthy and hardworking person who is out of work and applying for disability because of illness or an accident should not be treated like a slacker.

Frankel & Newfield does not represent clients with Social Security claims. If you have a disability claim through a plan offered by your employer or a private disability insurance policy and you are concerned about protecting your benefits, call us.

Prudential Disability Insurance Policyholder - A Successful ERISA Appeal from Frankel & Newfield

2009-12-10T19:44:09Z

Despite bringing in one of the insurance industry's big guns for hire - a doctor whose practice is more focused on helping insurance companies keep a healthy bottom line than with patient care - Frankel & Newfield has won an ERISA appeal for yet another client.

The Prudential disability insurance policyholder was a Vice President with a global financial company, with a disability insurance policy commensurate with her income level. She suffers from several severe orthopedic conditions, including coccydydnia and lumbar radiculopathy. She is unable to sit in a car or at a desk, and the intense pain makes it impossible for her to perform at the high levels that got her to the senior position she held.

Prudential first delayed, then denied the claim. We knew that the high dollar value of the monthly benefit was the real reason the disability insurance company was trying to stop her claim. We also knew that she could not work, and deserved the benefits in her policy. Prudential brought in an insurance doctor whose presence always signifies a serious and expensive claim. We were ready.

Effectively utilizing our client's treating physician, we delivered a powerful rebuttal to the peer review and clearly demonstrated that our client was entitled to the benefits in her contract. Today, she is back on claim, receiving monthly checks, and we continue to manage her claim to make sure that her interests are protected.

If you are having trouble with a Prudential disability insurance claim, call our office toll-free at 1-877-LTD-CLAIM (1-877-583-2524).

Reality TV and Disability Insurance Claims

2009-12-03T22:17:55Z

Reality TV wanna-be's seem to be everywhere lately, taking their search for fame and fortune beyond the bounds of common sense. An interior designer from California appeared on a home improvement show while collecting disability insurance. Sadly for him, an employee for the insurance company was a big fan of the show. He was convicted for insurance fraud and tax fraud and had to pay the private insurance company more than $150,000.

Moral of the story - when you are disabled and on claim, everything you do can and will be used against you. Insurers are going to all lengths to terminate or deny claims. By putting yourself out in the public eye, whether through a television reality show, live radio call-in show, Twitter, FaceBook, MySpace, or any public forum, can and very likely will have a negative impact on your claim.