Disability Insurance Lawyer Blog

Reality TV and Disability Insurance Claims

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.

FRANKEL & NEWFIELD WINS APPEAL FOR HIGH INCOME MET LIFE POLICY OWNER WITH "RED FLAG" CONDITIONS

Our client suffers from Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome and Post-Traumatic Stress Disorder. Claims based on these particular illnesses always send up a red flag to a disability insurance company's claims department. Add to that her position as a high-earning employee at a leading national consulting company with a high monthly benefit and the result is almost always a denied claim. A Met Life nurse reviewed the file and claimed that there was no evidence of impairment or cognitive deficits. We worked closely with our client's treating doctors to prepare a strong appeal, with solid arguments, and we won. She is now on claim.

Certain impairments set off red flags, as do high monthly benefits. If you are in this situation, call our office today and learn how we can help.

The New Insurance Paradigm - Blame the Insured

As experienced disability attorneys, we at Frankel & Newfield have seen the worst from third party administrators, claim adjusters, doctors for hire and investigators.

But a recent article in a leading insurance industry publication featured a subtitle that even we found infuriating. "As bankruptcies soar, some claimants eye insurers for their personal bailouts." No individual we know would choose to suffer from a chronic illness or injury that prevents them from leading a fulfilling life, having a regular job and good health.

Employees of companies that have closed their doors as the result of the current economic climate are not slackers seeking a handout. And if their illness or injury coincides with a company's shutting down, we don't think that should be a punishable offense. If you are disabled but fear what might happen if you stopped working, call our office at 1-877-LTD-CLAIM (877-583-2524). You don't have to go it alone.

Good Morning America Continues to Report on Outrageous Acts of Disability Insurance Companies

Frankel & Newfield applauds Good Morning America as one of the few news outlets reporting on the outrageous actions of disability insurance companies.

Earlier this year, GMA reported on a Florida man with Multiple Sclerosis who was told he wasn't sick enough to collect disability benefits. The same team has revealed a case where The Hartford is trying to cut off payments to a man whose broken neck makes it impossible for him to work. Three doctors and the Social Security Administration have declared Mr. Whitten disabled. After paying a monthly benefit for five years, The Hartford hired an investigator to videotape the man and then showed the tape to Mr. and Mrs. Whitten in an attempt to intimidate them. Then, his benefits were cut off. Eight days after reporters from GMA called the company to ask about the case, his $2100 monthly payments were reinstated, and sent him a check for $45,675 for past benefits.

Frankel & Newfield has represented many policyholders who are put through the same torturous pattern: the disabled person receives benefits for a number of years, and then the insurance company seeks to shut down the claim, using a variety of techniques similar to those The Hartford used against Mr. Whitten.

Hartford is just one of many companies that utilize surveillance and other techniques to terminate claims. Claimants need to be vigilant while on claim and should consider engaging attorneys to manage the claim process to prepare for possible challenges. If you are on claim and have concerns, call our office at 1-877-LTD-CLAIM (877-583-2524).

Disability Insurance Forums - A Helpful Source

A helpful forum where policyholders and disability insurance sources meet online is www.disabilityinsuranceforums.com. We are not affiliated with the forum, but we do occasionally participate in the discussions. One common thread that we see is surprise at the callous attitude and uncaring responses of disability insurance companies and their representatives. We have been fighting insurance companies for so long that we don't expect the insurance companies to be kind or respectful to policyholders.

Another common question concerns the amount of claims payments. Policy holders are usually content to accept whatever the insurance company decides to pay, without checking whether it is the correct amount. In some instances, the insurance companies discover an overpayment error, and the policyholders are in dire straits when they must return the funds. Other times, policyholders are stunned when they learn that the disability insurance company offsets their payments - deducts the amount that Social Security Disability pays.

Long term disability insurance claims is a complex legal insurance matter, where big companies bring all of their resources to bear on individuals struggling to manage a life-changing illness. If you are having a problem with a disability insurance claim, or are interested in negotiating a settlement, call Frankel & Newfield at 1-877-LTD-CLAIM (877-583-2524). You don't have to go it alone.

Suffolk Dental Bulletin Features Article on Dentists and Long Term Disability Insurance Challenges

The October issue of the Suffolk Dental Bulletin features an article by Justin Frankel and Jason Newfield on the special challenges facing dental professionals concerning Long Term Disability Insurance policies. No matter how up to date and ergonomically correct dental equipment may be, dentists tend to have back, shoulder, arm, wrist, hand, head and neck problems as a result of years of repetitive movements and maintaining an awkward position while caring for patients.

Disability insurance companies in the past considered dentists one of their prime markets for personal disability policies. Dentists could afford the high premiums of private policies, and the statistics indicated lower claim rates than other professionals. But when it comes time to file a claim, dentists are subject to the same treatment as other policy holders - delays and denials.

Frankel & Newfield has a tremendous amount of experience working with dentists who are surprised when their LTD insurance company balks at paying a claim. If you are about to file a claim, or if you are having a problem with your disability policy, call our office at 977-LTD-CLAIM ( 877-583-2524). We can help.

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.

Liberty Life's Decision was Abuse of Discretion

A recent case from the Federal Court in New York has demonstrated that it is an abuse of discretion to terminate a claimant where liability had been accepted for a lengthy period of time, with no change in the claimant's condition. Smith v. Liberty Life Assurance Co. of Boston (N.D.N.Y. 2009).

The decision serves to re-affirm the vitality of arguments that have been successfully lodged by claimants that where a claim has been approved due to the severity of a condition, absent a marked change in the condition in terms of improvement, it is improper for an insurer to alter its prior claim determination, or as stated by the Court "decisions to terminate benefits in the absence of a change in condition....are arbitrary and capricious." The Court also chastised the insurer for crediting the opinion of a "newly hired" physician to review records, which appeared as "physician shopping".

We have unfortunately seen this type of conduct as a recent trend, with insurers going after older files with renewed vigor, hoping to find files to terminate benefits. If your insurer is engaging in similar conduct, please contact our offices to discuss how we can assist you in fighting back against such improper conduct.

The Importance of Limiting the Insurance Company's Contact with Your Treating Physician

Often, when reviewing a claimant's eligibility for benefits, an insurance company will attempt to contact the claimant's treating physician via a "peer-to-peer" telephone call. In these instances, an in-house physician or nurse reviewer will contact a treating physician in order to "clarify" a claimant's functionality. However, more times than not, these calls will end up harming a claim.

This happened to one of our clients, who retained our firm after her claim had been terminated by CIGNA. When reviewing her eligibility for benefits, CIGNA contacted one of our client's health care providers to ask his opinion as to her disability. However, this doctor was not our client's primary physician, was not treating her for her disabling conditions, and in fact, had not evaluated her in over a year. As a result, this doctor claimed that our client was not disabled and was more than capable of returning to work, and even suggested that CIGNA refer her claim for special investigation. Needless to say, within a few months of this conversation, our client's disability claim was terminated.

For this reason, we act as a mediator to closely monitor all contact the insurance company has with our clients' treating providers. Even if your treating physician is supportive of your disability, their statements are often twisted or taken out of context by the insurance company in order to support an adverse benefit determination. Thus, we highly recommend limiting all correspondence with your treating providers to written requests, as well as limiting which providers the insurance company is authorized to contact.

If you have concerns about your long term disability insurance claim, at any stage of the claims process, call our office and learn how we can help. Call us at 1-877-LTD-CLAIM (1-877-583-2524).

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

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).

California Insurance Commissioner Announces Settlement with Life Insurance Company of North America - LINA

California's insurance commissioner Poinzer announced that the California Department of Insurance has reached a $600,000 settlement agreement with LINA - Life Insurance Company of North America (an insuring subsidiary of CIGNA) - to resolve allegations of disability insurance claims handling violations from February 2005 - June 2006. In addition to the settlement, LINA is to implement changes in its policies, procedures and practices and is going to review any claims that were denied between January 2005 through December 2007.

An on-site examination of claims handling practices conducted by the California Department of Insurance exposed business practices that are best described as outrageous. Decisions were made before medical records were even requested. There were many examples of LINA adjusters ignoring substantial new information after claims had been denied.

We know that this is business as usual for many disability insurance companies, but we congratulate the California Department of Insurance for recognizing that these practices are against the law and doing something about it.

A disability insurance battle is not something a policyholder can easily fight. It took the legal and political muscle of a state insurance commissioner to force LINA to make changes. If you are having a problem with your disability insurance claim, or are about to file a claim and don't want to go it alone, call our office at 877-LTD-CLAIM (877-583-2524). Leverage our experience in fighting these fights. You are not in this alone.

Chiropractic Economics Magazine Features Article by Frankel and Newfield

The September issue of Chiropractic Economics features an article by Attorneys Jason Newfield and Justin Frankel on navigating the minefields of long term disability insurance claims. Several recent cases indicate that courts are finally starting to understand that when the same company who pays a claim also decides the merits of the claim, the insurer cannot be truly fair and impartial.

While these judicial decisions are encouraging, too many other courts have remained ignorant on this critical issue, and thus it is still necessary to be proactive, cynical and informed before filing a claim.

We work with many chiropractors who originally felt that their experience dealing with the paperwork of health insurance claims meant they could easily manage the disability insurance claims process. They were surprised when they learned how different, and difficult, disability claims can be. For testimonials from other professionals who have engaged the firm, please visit our website.

Claim Decision Reversed; Not the Result of Deliberative, Principled Reasoning Process

A Court in Michigan has reversed the denial of a disability claim under ERISA, where the administrator failed to engage in a full and fair review, largely because it based its decision upon the conclusory evaluations of its hired doctors. These hired doctors simply rejected the opinions of the treating physicians, and the administrator simply adopted those conclusions, despite extensive evidence in the record supporting impairment.

The Court reconciled the Supreme Court's holding in Black and Decker v. Nord, and found that the administrator simply failed to fully address any contrary evidence without meaningful explanation. The selective review of records furthered the Court's concerns about the lack of a full and fair review. Unfortunately, the Court remanded the claim to the administrator for further consideration.

Dockery v. USG Corp. Retirement Plan (E.D. Mich. 2009)

CIGNA Disability Insurance Pays a Claim - But Only After Lawsuit Begins

Our client was an Equity floor trade on the New York Stock Exchange, working in a highly competitive and demanding job that requires total concentration, critical thinking and peak performance at all times. The ability to take action quickly and confidently was central to his daily work as he made split second decisions to trade, buy or sell millions of dollars in equities.

When he developed Tinnitus, a ringing or noise in the ears, resulting from an Acoustic Neuroma, he was unable to hear, and his ability to sleep and concentrate began to degrade. An Acoustic Neuroma is a benign brain tumor that occurs near the eighth cranial nerve that connects the brain to the inner near. Like a surgeon who loses the ability to see, our client no longer had the physical capacity to perform the tasks of his job.

The treating and evaluating doctors include some of the most distinguished and outstanding physicians in the field. They include a) the Director of Otology-Neurotology and Associate Professor of Otolaryngology at Mount Sinai School of Medicine, b) the Chairman of the Department of Neurosurgery at Mount Sinai, c) the Vice-Chairman of the Department of Otolaryngology- Head & Neck Surgery, Director of the Center for Facial Reconstruction, and Co-Director of the Center for Cranial Base Surgery at St. Luke's-Roosevelt Hospital, who is also the Director of Cranial Base Surgery and an Associate Professor of Clinical Otolaryngology at Columbia University College of Physicians & Surgeons and d) the Chairman of the Department of Neurosurgery at St. Luke's-Roosevelt Hospital and Co-Director of the Center for Cranial Base Surgery, a world leader in the complex neurosurgical treatment of cranial base tumors.

CIGNA denied his claim based on a paper review of his records by a Registered Nurse and a Medical Director. However, the poor quality of the review became glaringly apparent upon an analysis of the evidence. These two CIGNA employees never actually reviewed all of the evidence, but, rather, reviewed only selective materials, and the review contained an overwhelming number of discrepancies, inconsistencies and omissions. CIGNA kept delaying our appeal, to a degree even more outrageous than usual.

Based upon CIGNA's violation of the time requirements, we filed a lawsuit charging CIGNA with failing to issue a timely decision on our appeal, and while the lawsuit was in process, CIGNA woke up and reversed its decision. Our client is now being paid his past due benefits and is back on claim. He will never be able to function as a floor trader again, and it is likely that his daily life will continue to be a difficult struggle, but at least he is being paid according to the terms of the contract he signed with CIGNA.

You don't have to be a high-income trader with world-class doctors to fight for your disability insurance policy benefits. Call our office at 877-LTD-CLAIM (877-583-2524). You are not in this alone.

Social media and disability insurance - a word to the wise

It's just a matter of time before a policyholder's Tweets or Facebook posts become part of an insurance company's evidence against them. We advise our clients to keep their personal lives private and limit the information that they share online. Every disability claim is subject to traditional investigation, from field representatives who show up unannounced at your home, interview your neighbors or conduct video surveillance.

If you participate on Facebook, Twitter, LinkedIn, or any of social media websites, be prepared to have this information viewed by more than just friends and family. If you post on forums and any of those postings can be linked back to you, those too are likely to be examined. An individual who is out on claim for a disability needs to be mindful of the public nature of the internet.

If you have questions about your disability insurance claim, call our office at 877-LTD-CLAIM (1-877-583-2524). Our practice is exclusively dedicated to representing policyholders in disability disputes. Call today to learn how we can help.