Disability Insurance Lawyer Blog

JUSTIN FRANKEL TO ADDRESS DENTAL PROFESSIONALS AT GREATER LONG ISLAND DENTAL MEETING - DENTISTS FROM NASSAU, SUFFOLK, QUEENS, NEW YORK COUNTIES

As a result of years of repetitive movements and maintaining awkward positions, typically for long hours, dentists tend to have back, shoulder, arm, wrist, hand, head and neck problems. Many find themselves struggling to continue to practice, or completely unable to practice, and so dentists, orthodontists, periodondists and other dental professionals file disability insurance claims. Disability insurance companies love to sell policies to dentists - they can afford high premiums for these private policies - but they hate paying on claims.

Many of Frankel & Newfield's disability insurance clients are dentists, so we know the special challenges faced by members of this profession. We have seen a multitude of issues during the claim process, and have observed some interesting trends with regard to insurance company claim practices.

On Wednesday, April 21, 2010, Mr. Frankel will address the Greater Long Island Dental Meeting (GLIDM) with a program titled "What Your Insurance Company Doesn't Want you to Know About Long Term Disability Insurance." The program, from 6:00 PM - 9:00 PM will prepare attendees should they ever have to file a claim.

Hartford Insurance Terminates Fibromyalgia Claimant - We Win the Appeal

Our client was on claim with The Hartford for three years when they stopped paying her disability benefits, based on a paper review of her medical records and the results of an Employability Analysis. We represented her with an administrative appeal, and had her benefits reinstated.

Our client suffers from Fibromyalgia, degenerative disc disease, major depression, hyposomnia, hypothyroidism, and chronic headaches. She has been suffering from these conditions since 1998. She was employed with a major university as a top-level administrative assistant, responsible for maintaining a large portion of the University's website that is updated minute-by-minute, with news and information for events, activities, alerts, bulletins and news stories pertaining to students, parents, alumni, faculty, and staff. Her job required her to be available seven days a week, after hours and on weekends, to provide 24-hour monitoring and updating.

Approximately eight years ago, our client began having problems keeping up with deadlines because of the Fibromyalgia related severe fatigue and muscle pain, along with the symptoms of other conditions, and the side effects of the numerous medications she needed daily. When she was no longer able to perform the tasks required of the position, she applied for her long-term disability benefits and was approved.

Our client received long-term disability benefits until June 2009, when The Hartford determined that she was no longer disabled and could go back to work full time. The Hartford paid for an extremely selective review of her medical records by an outside vendor, who could not possibly be neutral, since The Hartford was signing his check! The vocational analysis reported that our client had recovered and was able to perform her own occupation as administrative assistant, even though there had been no change in her medical condition since the time that The Hartford itself had determined that she was disabled.

In the administrative appeal, we attacked the selective review of our client's medical records by the third-party vendor, the credentials of the reviewing doctor (or lack thereof), and highlighted all of the errors in the vocational analysis that The Hartford conducted.

By aggressively attacking each step in The Hartford's process of terminating our client's benefits and including more objective medical evidence and test findings that continue to support our client's disability, we were successful in having The Hartford overturn their termination on appeal, and our client's benefits have been reinstated.

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

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

A claimant 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, which required her to be able to analyze extremely complex business situations, manage a team of fast-paced brilliant business advisors and prepare highly analytical reports.

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 reports were prepared.

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 Jersey Chronic Fatigue Syndrome Association Presentation

I had the honor of being invited to provide a presentation to the New Jersey Chronic Fatigue Syndrome Association on October 18, 2009. The conference was held at the Sheraton Eatontown, and was well attended. The presentation was entitled "Professional Advocacy by Objective Documentation and Active Intervention on Behalf of the CFS Patient."

It was a great opportunity to share insight about the disability claim process to the patient community suffering from this somewhat amorphous, misunderstood medical condition, and to offer support to the claimants who all too often struggle to find medical practitioners willing to be their providers and advocates for disability claims.

The presentation was well received, and afterwards I was able to spend additional time in various one on one sessions with individual claimants to discuss their specific claim concerns. These types of forums are always rewarding since there are so many claimants who are unable to access legal advocates during these difficult and challenging times.

The conference presentation can be accessed here.

If you or someone you love suffers from CFS and you are having problems with a disability claim or wish to be well prepared before making a disability claim, call our offices at 1-877-LTD-CLAIM (877-583-2524) to learn how we might help.

Met Life Denies Long-Term Disability Benefits and Frankel & Newfield Overturns On Appeal

Our client had worked as a Payroll Manager for a large advertising firm for over 17 years, when, as a result of a motor vehicle accident, she sustained a severe injury to her left foot, fracturing her left calcaneus. Despite undergoing surgery on her foot a few weeks after the accident, our client soon developed a number of other difficulties, including post traumatic subtalar joint arthritis in her left foot, which continued to cause her severe pain and discomfort. The motor vehicle accident had also aggravated an old back injury, which resulted in increased pain throughout her back. In addition, our client became severely depressed, due to the pain she was suffering and the dramatic changes in her lifestyle that had resulted from the accident.

Although our client had attempted to continue working from home following the accident, the combination of her physical and mental limitations soon overcame her ability to function in that capacity. In fact, the stress of keeping up with her job requirements was hindering her recovery. Thus, based on the recommendations of her treating physicians, our client stopped working and subsequently filed a claim for long term disability benefits with MetLife.

At that point, she came to Frankel & Newfield. We assisted in preparing an appeal of MetLife's determination. Working closely with our client and her treating physicians, we gathered additional support for her disability from both her physical and mental conditions. The final appeal included both objective and subjective evidence of our client's impairments, as well as medical literature describing the nature of her severe injuries. In addition, our client was approved for Social Security Disability benefits during this time, further evidence of her disability which was also incorporated into the appeal.

Based on the extensive medical, legal, and factual support provided in the appeal by Frankel & Newfield, MetLife subsequently overturned its denial, determining that our client was disabled from both her physical and mental condition and thus entitled to her long term disability benefits.

Prudential Terminates Benefits and Frankel & Newfield Overturn on Appeal

Our client, a 37-year old graphic designer and creative manager for one of the world's largest luxury goods corporations, was diagnosed with a tumor of the spinal cord that extended into the brainstem, accompanied by two cysts, one below the tumor and one above the tumor.  Our client underwent surgery to remove the tumor. After the surgery, our client went for intensive inpatient physical and occupational therapy. 

She continued to experience dizziness, vertigo, poor mobility, generalized weakness, lack of fine motor skills, and paralysis of both the upper and lower extremities after the surgery and continues to experience these neurological deficits today.  These neurological deficits prevent our client from being able to use her hands to do simple everyday things, like eat a cup of soup with a spoon, hold a cup of coffee, or park where there is a parking meter because she does not have the fine motor skills to pick up a quarter and put it in the meter.  Our client has the continuing support of her doctor, a highly respected and renowned board-certified neurologist whose medical specialties span over 20 years and include neurology, clinical neurophysiology and electromyography.   

Our client was on claim with Prudential for four and a half years when they terminated her claim on the basis that she was no longer disabled.  Before terminating her claim, Prudential did a paper review of our client's medical records, sent our client to an "independent" medical examination and a functional capacity examination, conducted an Employability Assessment, and eventually conducted surveillance on our client. In the administrative appeal, we attacked the selective review of our client's medical records by Prudential's Medical Director, the credentials of the doctor who conducted the "independent" medical examination and her results, the fact that Prudential distorted the findings of the Functional Capacity Examination that actually supported our client's disability, the flawed results of the Employability Assessment, and the surveillance. 

By aggressively attacking each step in Prudential's process of terminating our client's benefits and including more objective medical evidence and test findings that continue to support our client's disability, we were successful in having Prudential overturn their termination on appeal, and our client's benefits have been reinstated.

Long Term Disability Insurance and the Physician Practice

Jason Newfield and Justin Frankel spoke with publisher Nancy Collins for a SoundPractice Podcast that followed their article in the January/February issue of The Journal of Medical Practice Management.   Frankel & Newfield  discussed the meaning of "dual occupation" in the claims process, the importance of specialty language, common misconceptions about the specialty letter, the definition of residual claims and why they matter, opportunities and pitfalls to backdating of claims, and the major misconceptions surrounding group disability policies, private policies and association policies. 

Frankel & Newfield is Featured in The Journal of Medical Practice Management

Justin C. Frankel and Jason Newfield have authored an article entitled "Strategies For Navigating Disability Insurance Claims" which appears in the January/February 2009 issue of The Journal of Medical Practice Management.  The article provides fundamental information about filing a long term disability claim, the issues that often arise in the claims process, and the potential problems that must be avoided to successfully maintain a claim for disability benefits.

To read the entire article,click here. For more articles published by the firm regarding the disability insurance claim process, please see our Disability Articles.

Jason Newfield Has Again Been Asked to Present At the ACI National Disability Conference

Jason Newfield is honored to have once again been invited to present to his colleagues at the June 2009 American Conference Institute's 12th National Advanced Forum on Litigating Disability Insurance Claims.  His presentation is entitled "A Circuit-by-Circuit Analysis of Met Life v. Glenn Interpretations and How to Adapt Your Litigation Strategies in Response."  He is well suited to provide this presentation, as the firm's nationwide practice finds them litigating cases throughout the country.  Since Glenn was decided in June 2008, there have been a multitude of decisions on both discovery and dispositive issues which Mr. Newfield will be addressing, and providing insight as to the most effective strategies to consider in choosing a forum for litigation and for the litigation process.

Frankel & Newfield Warns and Informs: Disability Insurance Claimants

As the economy grinds slower and the only increasing numbers are jobs lost, disability insurance companies have begun circling the wagons into a tight, self-protective circle that claimants will find increasingly harder to break through, according to Jason Newfield and Justin Frankel, nationally recognized disability insurance lawyers.  Click here to visit Frankel & Newfield's web site.

"Disability insurance companies are fighting to protect their cash reserves and the claims area is the first place to shore up cash reserves.  There is no downside for these companies when they delay or deny a claim, and long term disability policyholders must keep that in mind," warns Jason Newfield, Esq.

When disability insurance companies deny or delay claims, the worst that happens to the insurance company is that a court forces them to pay the original amount to a date certain (and not into the future).  For policyholders, claim delays and denials can lead to a ruined credit rating, loss of their home, bankruptcy and worse.    

Disability insurance lawyers Frankel and Newfield warn claimants that understanding the claims process and the strategies used by insurance companies is critical to filing a successful disability claim. 
 
What should policyholders do?  

• Do you have the original policy?  Don't rely on the HR office or your broker. 
• Read the policy and the directions for filing a claim and follow every step.
• Make a copy of everything you send, and send everything with return receipt to prove that it was sent.
• Document every telephone conversation carefully.  Enlist a trustworthy friend or family member to help.
• If you have a high value policy, disability insurance companies may hire an investigator to videotape your activities.  Be prepared for surveillance.
• Help is available from consultants who assist claimants through the application process and attorneys who work with claimants before, during and after claims have been filed. 
• Disability insurance companies review files on an on-going basis. If you were being paid and then checks slow down or stop, your claim may be in jeopardy.

Presentation at National Disability Conference

Jason Newfield had the privilege of presenting at the annual American Conference Institute, Litigating Disability Insurance Claims, where he was an invited speaker to industry leaders.  His topic was Advocating A CFS/FMS Case, Administrative Appeals and Litigation Issues, Case Summaries and Strategies.  In this presentation, consideration of important strategy issues were addressed, both for bolstering the administrative record on ERISA appeals, and for success in the litigation posture where necessary. For a copy of the presentation, click
ADVOCATING CFS CASES.pdf.

The firm has had great success in advocating for claimants with Chronic Fatigue Syndrome and Fibromyalgia.  To see some of our success stories, click here.