Disability Insurance Lawyer Blog

Frankel & Newfield Partner Gives Presentation to the American Conference Institute

Frankel & Newfield partner Jason Newfield recently returned from giving a presentation to the American Conference Institute, Litigating Disability Insurance Claims. Mr. Newfield's topic was titled "Discovery, Scope and Limitations "360"; Key Strategies to Make Discovery Useful and Meaningful to your Case". This is one of the most controversial areas of ERISA disability insurance litigation, and Mr. Newfield was honored to once again be asked to present to such a prestigious organization, which gathers attorneys from both the plaintiff's and defense bar, along with disability claim personnel.

The presentation was a round table discussion with counsel for numerous insurers, including both in-house counsel and litigation counsel. Some of the key points of the presentation included a discussion about the various discovery devices to be utilized, the nature and scope of discovery across the country, with the lack of uniformity across circuit and district courts throughout the country, and key strategies to employ when pursuing discovery.

The presentation was well received, as it addressed a hot topic for ERISA disability insurance litigation, and a topic that is rapidly evolving.

Partner Justin C. Frankel Receives AV Preeminent Rating from Martindale

We are very pleased to report that Justin Frankel has attained the AV® Preeminent™ (4.5 out of 5) rating from Martindale-Hubbell for his legal ability and ethical standards. The AV® Preeminent™ rating is a significant accomplishment - a testament to the fact that a lawyer's peers rank him at the highest level of professional excellence and reflects the confidential opinions of members of the bar and the judiciary. To read his complete bio, click here.

If you'd like to speak with Justin about disability insurance issues at any stage or phase of a claim, please call us at 877-LTD-CLAIM (877-583-2524).

Long Term Disability Insurance Company Denies Benefits to Insurance Agency Owner; Frankel & Newfield Negotiates a Settlement

Our client was an insurance agency owner with a disability policy from a large national insurance company. He suffers from depression and was diagnosed as Bi-Polar with Sleep Apnea. After being paid long term disability insurance benefits for two years, the insurance company requested an Independent Medical Exam (IME).

Following the IME, the insurance company denied any further benefits, saying that he was no longer impaired from his occupation and able to return to work. Our client would have liked to be fine, and not to have suffered impairments in his functionality, but, unfortunately, his condition had not meaningfully improved.

He provided us with his medical records and all of the paperwork from the insurance company, and we developed strong arguments to counter both the IME findings and the conclusions of the insurer, and we thereafter represented him in negotiations which led to a settlement of his claim for a lump sum. The value of the settlement was greatly enhanced due to our work in collaborating with both the client and his medical providers to develop a powerful rebuttal to the biased conclusions of the insurer's hired gun.

The insurer knew that our firm was willing to aggressively litigate this claim in the absence of a resolution. This is an example of the value of engaging an aggressive, experienced law firm that practices exclusively on disability insurance matters.

If you have been denied long term disability insurance benefits and need help in negotiating a settlement, we encourage you to call our office today to learn how we can help you.

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.

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.

CIGNA Caves on Administrative Appeal

CIGNA had attempted to terminate our client's claim for long term disability benefits, a claim in which they had previously terminated, only to voluntarily reinstate benefits while in litigation, back in 2008. Two years later, CIGNA again made efforts to terminate the claim, on the purported basis that our client's treating physicians no longer supported her impairment.

In order to achieve this result, CIGNA intentionally miscast the doctors' opinions, and performed a cursory medical review, which on administrative appeal, we were able to destroy medically. We demonstrated that CIGNA's claim determination had no reliable evidence to support its position, and provided a wealth of additional claim support. Our client's claim is being re-opened and she will be paid all of the benefit appears.

This is a prime example of an insurer seeking to wear down a claimant's treating physicians, and why claimants need to remain vigilant in the claim process, even if their claim has been paid for a long period of time, or even where an insurer capitulates in litigation and agrees to pay the claim.

Our effective advocacy of this claim has helped ensure a happy holiday season to our client.

Successful Appeal of UnumProvident Termination of Long Term Disability Insurance Benefits for Surgeon

Our client is a vascular surgeon who suffers from numerous co-morbid conditions, including Chronic and Recurrent Alcoholism, Hepatitis C, Fatigue, Diabetes, Hemochromatosis, Hyperparathyroidism, Lumbosacral Disc Herniations, Degenerative Disc Disease, Facet Arthopathy, Forominal Stenosis, Chronic Pain, Depression, and Anxiety. He was unable to complete all the material and substantial duties of his job as a vascular surgeon within the course of a normal workday. He had filed for and was receiving residual disability benefits for several years when Unum terminated our client's benefits.

Unum relied upon selective portions of medical records and excluded more persuasive information and failed to undertake an appropriate investigation, relying upon biased and goal-oriented paper reviews of the evidence performed by well-known pro-insurer doctors. Making matters worse, Unum failed to appropriately consider our client's occupational requirements in evaluating his ability to be able to perform all of his work activities within the course of a normal work day, and failed to afford our client a "full and fair" review of his claim.

We fought back, and won. Our client is now back on claim as he struggles to cope with his many health issues. If you are facing challenges from many different illnesses at once and are having problems with your long term disability insurance claim, call our office today to learn how we can help.

ON A TECHNICALITY OF CARE AND TREATMENT

Despite our success in reversing a denied claim for a client suffering from alcoholism and anxiety, the insurance company balked at sending benefit checks. The appeal was granted in June, but up until early November, the insurance company had only paid a portion of our client's long overdue benefits.

After a long and contentious process, we are pleased to report that we have now finally gotten our client's benefits up to date. The insurance company has been trying to apply technical provisions concerning the frequency of care and treatment in an effort to find a way not to pay.

This was not an easy battle. Our client sees many health care providers, although not always in the exact order that the insurance company would like to see. We began working with his mental health provider to bridge the gap in treatment with the other providers that he had seen, thereby overcoming the insurer's technical objections to the claim.

He is currently back on claim with a regular monthly benefit as a result of our tenacity and unrelenting pursuit of his claim.

We don't give up on our clients and their rights to receive disability insurance benefits. Time after time, this persistence has been rewarded with success for our clients and our practice.

If your disability does not follow in the exact pattern that the insurance company would like and you have been denied or payments are being delayed, call our office. We don't give up without a fight - and this is one fight you don't have to go alone.

LUMP SUM BUYOUT OF A DISABILITY CLAIM

If you are worn out financially and emotionally from battling a long term disability insurance company, the offer of a lump sum buyout probably sounds like the light at the end of the tunnel. No more forms, examinations by insurance company doctors, fears of video surveillance and waiting for checks.

Frankel & Newfield has successfully represented hundreds of clients in negotiating lump sum settlement negotiations with their insurance companies. This is an area where our Firm's experience and knowledge gives our clients an advantage. All too often we hear from individuals who accepted a first offer from a disability insurance company and realize that they accepted a financial buyout that has made their situation worse, not better.

The insurance company has a very clear agenda on a lump sum buyout - minimizing its cost.

The disabled person has another agenda - maximizing the amount of money they receive and eliminating the challenges of dealing with an insurer.

The insurance company considers this type of information when making a decision:

Terms as stated in the policy
Age, income, mortality
Expected duration of the claim - to age 60? 65? Death?
COLA (cost of living) increases in the policy
Current market rates - interest rates, bond rates

But there's more to consider. What if inflation takes off for a wild ride? What is the value of the entire policy in terms of today's dollars? Will that truly be enough for you to care for yourself and your family?

Be especially cautious when discussing this matter with the agents and claims personnel from your insurance company. Misleading representation is not unusual - whether it is from a deliberate attempt to frighten claimants into accepting a poor offer or from an untrained representative does not matter. They are counting on your lack of knowledge and willingness to accept whatever they offer.

Their bottom line is at odds with yours - they want to minimize their cost and exposure. You want to maximize your buyout. Be prepared.

If you are receiving disability insurance benefits and have questions about a lump sum or one time buyout of your policy, call our office. If your insurance company has contacted you about a lump sum buyout, our attorneys will discuss your claim and explore whether your insurance company is making you an offer that is fair and reasonable, or if you need to consider another approach.

Frankel & Newfield is dedicated to ensuring that our clients receive the highest possible amount from their lump sum buyout. Call our office today and learn how we can help.

WE SUCCESSFULLY FIGHT DISABILITY INSURANCE COMPANY LINCOLN WHEN IT ATTEMPTS TO RECLASSIFY CLAIM FROM A PHYSICAL DISABILITY TO MENTAL NERVOUS DISABILITY CLAIM

Our client's claim was terminated after being paid for a period of time under his own occupation coverage, which he had secured through his employment. Lincoln Insurance terminated the claim despite the fact that he continued to suffer from intractable chronic pain and the impact of the heavy narcotics he was compelled to utilize to combat the pain.

Frankel & Newfield filed an appeal, providing the results of neurocognitive testing, which clearly revealed marked limitations in cognition. While this was sufficient to get the claim reversed, Lincoln next took the position that the claim was a mental or nervous claim, on the purported basis that the Issues were psychological and not due to the impact of his narcotic pain medications. Mental/nervous claims in most policies are subject to a 24 month benefit limitation, and many insurance companies try to get claims reclassified whenever this is a possibility.

We strategized that continuing payments was the goal and developed claim support for the physical impairment to be submitted toward the conclusion of the 24 month period for mental/nervous claims.

We then bombarded Lincoln with powerful support for the physical impairment, relying upon his Social Security award findings, his treating doctor's support, medical literature and a strong and direct attack of Lincoln's position. Ultimately, Lincoln yielded.

Our client is once again receiving his benefits under the physical disability clause in his policy.

If you have a physical disability and your long term disability insurance company attempts to re-classify your claim, you must take a very strong position and be prepared for a serious challenge. Call our office to learn how we can help you fight back.

FRANKEL & NEWFIELD WINS FOR PRINCIPAL LONG TERM DISABILITY POLICY HOLDER DENIED EVEN THOUGH IN-HOUSE DOCS SAY HE IS DISABLED

Our client has an orthopedic disability that exacerbated an existing psychiatric disability, which became so devastating that he was no longer able to work. His significant ankle problems (diagnosis of tarsal coalition and osteoarthritis of the foot) created a condition of intense chronic pain, which magnified a clinically diagnosed obsessive-compulsive disorder and major depression and anxiety.

He had a long term disability insurance policy with Principal, and after two years of being on claim, Principal cut off his benefits and declared that he could work in another occupation.

Our client had been the owner/operator of a convenience store. The specific tasks of his "job" included everything from forecasting sales, ordering products, managing employees, bookkeeping, stocking shelves, marketing, and all the tasks of a business owner, plus everything that his store employees did - from making coffee to cleaning the floors to selling lottery tickets.

He was compelled to undertake a psychiatric IME (Independent Medical Exam) despite the fact that Principal's own in-house psychiatrist said that a medical records review alone supported his claim of disability.

Usually the in-house physician is the first to agree with a claims manager that a disabled person is fit for work. It was not a cheap exam either -Principal paid more than $5,000 for the exam - and much of the report was supportive of his disability. Principal ignored that.

The psychiatric IME was followed by a vocational assessment, which we discovered had been done using many outdated resources, including the GOE - Guide for Occupational Exploration - a guide published in 1979 and based on research conducted in the 1960s that is used primarily by high school guidance teachers to help teenagers determine possible career paths.

After the psychiatric and vocational exams were done, the next tactic was the use of surveillance. The videotapes clearly showed that our client was disabled. Principal actually tried to redact all references to the surveillance in the claim file.

We worked closely with our client to obtain good supporting statements from family members and strong narrative reports from his treating psychologist and psychiatrist. Our client is back on claim and receiving benefits on a regular basis.

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.