Disability Insurance Lawyer Blog

Taking Disability Issues to the CEO - Does it Help?

An article in this week's Wall Street Journal explores the strategy of consumers who try to solve healthcare problems by going straight to the top - calling the company's Chief Executive Officer. A consumer who couldn't get bills paid sent an email to the CEO, a group of reporters and even Michael Moore, filmmaker of "Roger & Me" and other documentaries that skewer (deservedly so) various businesses. The insurance company paid up.

Earlier this year, we reported on a Florida man who was being delayed by Standard Insurance. He contacted Good Morning America and the day after a segment on his situation was broadcast, his claim was approved.

Can this strategy work for everyone? If it did, we'd be the first to tell our clients to make the phone call. But you don't have to go it alone. If your disability claim is being denied, or you are being strung along with a series of delays, call our offices to learn how we can help.

Frankel & Newfield Win Appeal for Floor Trader: Vocational and Medical Data Critical to Protect Claimaint in a High-Stakes Appeal

Our client had worked as a successful Floor Broker with the New York Board of Trade for more than eighteen years when severe orthopedic conditions and chronic lower back pain made it impossible for him to continue working. He was unable able to stand for long periods of time without suffering excruciating pain, preventing him from working in the hectic and demanding environment of a trading floor. Upon leaving his job, he was approved for long-term disability benefits by both Guardian Life Insurance Company and Mass Mutual Life Insurance Company.

After approving his claims and paying benefits without interruption for three years, both Guardian and Mass Mutual suddenly claimed that his conditions were no longer severe enough to prevent him from performing the duties of his regular occupation.

In preparing our client's appeal, Frankel & Newfield worked closely with his treating physician, gathering objective and subjective medical evidence to demonstrate that our client's condition had not improved and that he continued to suffer from severe impairments due to his degenerative orthopedic conditions.

We also conducted extensive vocational research, outlining the extensive physical and cognitive demands of our client's occupation as a Floor Broker. Through our efforts, the information submitted on appeal successfully demonstrated our client's continued disability, as both Guardian and Mass Mutual overturned their adverse decisions and reinstated disability benefits to our client.

The success of our appeal rested in strong preparation of both medical and vocational research. The physically demanding tasks of a floor trader needed to be made very clear to both Mass Mutual and Guardian.

If you have an occupation that does not seem physically demanding, but is, outlining the specific tasks that must be performed and the limitations that are created by the disability is critical to a successful appeal.

Surveillance Not Enough to Terminate Benefits

A recent case has offered excellent guidance to claimants with orthopedic disability claims, and is well transferable to other impairments. A claimant was being paid for several years, when CIGNA conducted surveillance, revealing activities which exceeded the levels that the claimant had advised he had capacity for.

After securing the surveillance, depicting the claimant active on each day, and engaging in some level of activity, CIGNA terminated the claim, finding the activity level inconsistent with the claimed impairment. The Court determined that while the surveillance raised some questions about functionality, there was an abundant amount of evidence showing that he was impaired, and that the activity did not translate into the ability to work full time. One component of the claimant's evidence was a diary showing typical daily activity and pain. The Court found this evidence compelling, along with the support from treating physicians.

The claimant take away point is that a diary or symptom log could well provide an additional level of claim support, to rebut an insurer's efforts to rely upon surveillance. Linck v. Arrow Electronics (D. Mary. 2009).

Liberty Life Admits that Surveillance is Aggressive Tactic

In a recently decided appeal in the Third Circuit (NJ, Pa, and Delaware), Liberty Life made an admission that the utilization of surveillance is an "aggressive tactic", one that might constitute a procedural irregularity demonstrating bias. Culley v. Liberty Life Assur. Co., 2009 U.S. App. LEXIS 16002 (3d Cir. 2009).

This case was presented to the Court of Appeals by Liberty Life, who lost at the District Court level. In seeking to argue that it was not under any obligation to conduct surveillance, it maintained this interesting position - one that certainly will be utilized against it in the future when Liberty Life does, in fact, conduct surveillance, a common claim handling technique.

The Court also determined that Liberty Life's claim process disfavored the claimant "at every crossroad". It is pleasant to see when judges appreciate the adversarial nature of the disability claim process engaged in by insurers.

Frankel on Long Term Disability Insurance Policies and Baby Boomers for Long Island Business News

The July 10 edition of Long Island Business News features an article by Justin Frankel on the fiduciary duty of employers re long term disability insurance policies. He tells employers to be sure that the companies behind the disability insurance policies they purchase for employees will be there when increasing claims from aging boomers begin to exert some strain on the insurance companies. Click here to read the article.

Frankel & Newfield Achieve A Significant Victory in Long Term Disability Insurance Case Against Met Life in Federal Court

The Court ruled that Met Life was arbitrary and capricious in its consideration of Plaintiff's claim, based upon a number of factors seen regularly in these cases. Plaintiff suffers from Chronic Fatigue Syndrome, an illness marked by a lack of true objective evidence.

The Court was troubled by Met Life's insistence upon objective evidence to support a disability from Chronic Fatigue Syndrome, which the Court noted was a condition that is marked by the absence of any such objective evidence, as well as Met Life's failure to provide Plaintiff with appropriate notice of what evidence it was seeking in order to approve the claim. The Court was also troubled by Met Life's reliance upon Dr. Maslow's "shoddy and incomplete" report and Dr. Payne's "flawed" report, and its failure to consider the findings from Plaintiff's Social Security disability claim, which had found Plaintiff to be credible and his complaints supported by objective evidence.

Many of these factors parallel the issues which appeared in Met Life v. Glenn, and thus, it appears that the Court's are becoming more sensitive to the claim handling bias and the resulted oriented processes of insurers.

Met Life Found to Have Abused Its Discretion

Another judge has found that Met Life abused its discretion in its consideration of a long term disability insurance claim. By relying upon physicians who derive substantial income from providing medical reports to insurance companies, Met Life failed to support its claim determination with "substantial evidence", and its determination was reversed.

Met Life utilized a cadre of paper reviewing doctors, eschewing its right to actually examine the claimant, and relied upon stale surveillance video obtained of the claimant. The Court also found that Met Life failed to provide the claimant with a full and fair review as it is obligated under ERISA. The Court noted that Met Life's financial conflict of interest was a significant factor in its determination. Solomon v. Met Life, (SDNY 2009).

Long Term Disability Insurance Company Claims Adjusters A Little Cranky?

If the next time you call to speak with a Long Term Disability Insurance Claims adjuster or a clerk and they sound cranky or on edge, don't be surprised. According to statistics from the U.S. Department of Labor reported in the June issue of Best's Review, an insurance industry trade publication, April marked the six consecutive month that the insurance industry's payrolls dropped. In April, no less than 4,000 jobs hit the chopping block. February saw 2,200 jobs cut, and 2,000 were let go in March. These numbers reflect the entire insurance industry, not just long term disability insurance companies. But the overall trend is not a good one.

So, if claim adjusters are on the chopping block, how do they best maintain their place within the company? By saving the company money - lots of money. Policy holders who have filed a claim or are thinking of filing a claim for disability insurance benefits need to keep this in mind. The person on the other end of the phone has two objectives in mind - to prevent their employer from having to pay out benefits on a claim, and two - to save their jobs. A difficult situation for them - and even worse for the policyholder.

Do not let your claim become a casualty of this difficult business environment. Stay vigilant and consider getting counsel involved. If you have questions, call us at 877-LTD-CLAIM (877-583-2524).

Jason Newfield Invited to Present at Prominent National Disability Insurance Conference

Jason Newfield returned to American Conference Institute, to speak before a national conference on the impact of the United States Supreme Court decision MetLife v. Glenn on disability insurance litigation in Federal courts. The American Conference Institute's 12th National Advanced Forum on Litigating Disability and ERISA Claims speakers are leaders in the field of disability litigation, and Mr. Newfield was honored to have been selected again to speak before the conference. His program, "A Circuit-by-Circuit Analysis of MetLife v. Glenn Interpretations and how to Adapt Your Litigation Strategies in Response," took place in Boston on June 15, 2009. It was an engaging round table discussion with counsel for insurance companies debating the impact of Met Life v. Glenn with Jason.

Hartford Policyowners - Take Note

If your Long Term Disability insurance policy is with Hartford, you need to know that the atmosphere in the home office is not good.

CEO Ramani Ayer has announced he is leaving by the end of December, and the man once most likely to succeed him, Thomas Marra, resigned earlier this year. Last year both the Chief Financial Officer and the Chief Investment Officer both left the company. With a large exposure in financial firms, including Lehman Brothers and AIG, the company has been struggling, and is taking as much as $3.4 billion in TARP funds. Compare that news with MetLife and Prudential, who are raising capital with stock sales and bond offerings, and Travelers Cos., which has been added to the Dow Jones Industrial Average.

Given these difficult financial times, it is likely that disability insurance claimants should expect renewed challenges to the status of their claims. if you have a long term disability insurance policy with Hartford and are concerned about what this news means to you, call our office at 877-LTD-CLAIM (877-538-2524) or click here to send an email.

The Next Supreme Court Justice? How will claimants fare?

As Judge Sotomayor's prior legal decisions, speeches and viewpoints are analyzed by the media and politicians, it is important for lawyers to appreciate her views and perspectives on issues that may impact our respective practices. So, what is Judge Sotomayor's perspective on disability insurance issues?

She has been involved in a number of decisions regarding disability insurance law, both when on the District Court bench, and on the Second Circuit Court of Appeals. She has been involved in decisions providing considerations of equitable principles to assist claimants, but she has also found in favor of insurance companies on several matters before her on the Court of Appeals. It appears that she will follow the law largely, and despite many protestations from the politicians, she is likely to refrain from too much judicial activism, at least as it pertains to the area of disability insurance law.

The attached article offers the opinion that Judge Sotomayor may in fact be pro-insurer.

JASON NEWFIELD IS FEATURED SPEAKER AT NATIONAL LEGAL CONFERENCE ON DISABILITY LITIGATION

On May 20, 2009, Jason Newfield, Esq., was a featured speaker at a legal conference, "Disability Claims in a Down Economy." It's a topic we've written about here and in our newsletter - and as the recession continues to take its toll, the quality of legal representation in disability insurance disputes has become even more important. Jason was a member of a distinguished panel of highly regarded lawyers in the disability insurance field, selected for his experience and knowledge in representing policyholders successfully in disability insurance matters. As a leading law firm in this area, we are proud of our professional reputation for excellence.

Jason Newfield Speaks at National Disability Insurance Law Conference

As a nationally recognized leader in disability insurance law, Jason Newfield, Esq., has been invited to speak at the American Conference Institute's 12th National Advanced Forum on Litigating Disability and ERISA Claims in Boston on June 15 and 16. There, he will present a Circuit by Circuit analysis of Met Life v. Glenn interpretations and advise lawyers on how to adapt their litigation responses to best represent their clients. Mr. Newfield's presentation will include a close look at Hogan-Cross v. MetLife, the first post-Met Life V. Glenn case, which was a Frankel & Newfield lawsuit and McCauley v. First Unum Life Ins. Co.

Mr. Newfield, who is a regular presenter at this conference, is pleased to continue to be invited to present at one of the disability insurance industry's most comprehensive events, which brings together attorneys and experts from all sides of the disability insurance field.

Frankel & Newfield's Spring Newsletter

Our Spring newsletter is in the mail and on our website. News in this issue features successful cases, including representation of a vascular surgeon, dentist and a Chief Financial Officer. All came to us at different stages of the claim process, and we were able to fight successfully to get them the long term disability benefits that were due them. The Spring issue also examines the case of the plaintiff who filed a claim for disability insurance benefits, but wasn't under a doctor's regular care. If you are disabled and cannot work, seek medical attention and make sure that you are cared for on a regular basis. Just as one doctor's visit is not enough to treat a serious illness, one doctor's visit is not enough to demonstrate a serious illness.

CDC Reports More Americans Reporting Disability - Frankel & Newfield is here to help

According to a study released on April 30 by the Centers for Disease Control and Prevention, the number of American adults reporting a disability took a significant leap upwards between 1999 and 2005.  As the recession continues to grind on and the baby boomer generation continues to age, expect to see more claims for long term disability insurance benefits.  And don't think for a moment that the LTD insurance companies aren't paying attention.  After all, the entire business of insurance is based on the model that while some people will file a claim, most will not. 

When the statistics become overwhelmingly out of favor for the insurance companies, the hardball of claims will get even tougher.  If you have been denied disability benefits, if you are on claim and payments are delayed, if you are about to file for long term disability claims, or if you have had enough of dealing with the insurance company and want to explore a settlement, visit our website, give us a call at 1-877-LTD-CLAIM (877-583-2524) or click here to send an email.   Speak with a partner and find out how we can help you.