Disability Benefit Claims Law Blog : Disability Benefits Lawyer & Attorney : Dell & Schaefer : Disability Insurance Claims Law Blog

The Prudential Insurance Company of America (PRU), one of the world’s largest long term disability insurance companies, recently issued a press release regarding their return to work strategies. In my opinion, when Prudential or any long term disability insurance company discuss “return to work strategy”, this is tantamount to saying how quick can we stop paying a long term disability income claim. It’s no secret that Prudential can make a lot more money if less people are paid long term disability. No employer wants to see their employee miss work due to a disabling condition, but it is is scary when a long term disability company thinks they are qualified to make decisions about when a disabled person can return to work. Unfortunately, many long term disability insurance companies rely on computer programs to tell them how long a person should be out of work based upon a specific medical condition. Prudential and many other long term disability insurance carriers attended a national conference to discuss “effective return to work strategies”.

For more information about the meeting check out dmec.org.

Prudential’s August 26, 2010 Press Release states as follows:

NEWARK, N.J., Aug 26, 2010 (BUSINESS WIRE) — Kimberly Mashburn, vice president of Strategic Partnerships for Prudential’s Group Insurance business, a unit of Prudential discussed the critical role of managers and effective return to work strategies at the annual Disability Management Employer Coalition (DMEC) conference, August 1- 4, 2010 in San Diego, Calif.

Workplace absence can be very expensive. Costs and consequences of absence can include direct costs like disability premiums, benefits paid to disabled employees, continuing employee benefits, and wages to replacement workers. Also, indirect costs like reduced productivity, increased overtime, increased supervisory time, increased stress & pressure, recruitment and training of replacement workers, increased medical costs, and administrative cost all add up. While many disability absences are out of a manager’s control, some may not be.

“Some disability absences are driven by subjective feelings about work, so managers should make sure they are building an environment that breeds commitment,” said Mashburn. During her August 1 workshop, she provided the following actionable steps that managers can take to enhance prompt return to work and boost productivity:

• Create a positive work environment that employees want to come back to;
• Prepare for planned absences by discussing how to cover the work with the employee going on leave;
• Keep personal and professional connections when employees are out of work;
• Plan for the return to work using all the options available at your company; and
• Monitor the return to work to help ensure additional absence is mitigated.

“New laws, escalating costs, fewer employees, and health and productivity issues are the challenges of the post-recession economy,” said Joe Wozniak, Certified Professional in Disability Management and Chief Financial Officer of DMEC. “This year’s conference allowed attendees to learn best practices and proven solutions that help employers return workers to productive employment from peers and thought leaders like Prudential.”

If you have questions about a long term disability claim please call 800-828-7583 for a free consultation or use our contact page.

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Certain Underwriters at Lloyd's London insurance company took almost two years to make a decision regarding a doctor's disability application for benefits. When he sued, the Court stayed the suit until an arbitration panel could review his claim. This article discusses the how the final disability benefit award was finally settled.

Most people don't think of cardiologists developing heart conditions. It is far more common than most people realize.

Dr. Zev Lagstein held a disability policy with Certain Underwriters at Lloyd's, London. The policy required Lloyd's to pay him $15,000 per month for up to 60 months if he lost his ability to practice medicine due to a disability.

When he developed complications from heart disease, including severe migraine headaches and other neurological problems he applied for benefits. He supported his claim with the opinions of several physicians who concluded after examination that he was permanently disabled from practicing not only as a cardiologist but as a physician.

Months passed without Lloyd's reaching a decision. Lagstein went back to work against his doctor's advice, which only complicated matters. Finally after almost two years had passed since he filed his long term disability claim, Lagstein sued. The policy mandated binding arbitration, so Lloyd's moved that the case be stayed until a three - member arbitration panel issued its decision. A arbitration panel found Lloyd's in the wrong and awarded Lagstein more than $6 million to cover policy benefits, emotional distress damages and punitive damages. Lloyd's responded to this decision by filing a motion to vacate the arbitration award.

The motion was heard before the U.S. District Court, District of Nevada. The judge sitting on the bench was shocked by the size of the award and used this as his primary reason for vacating the decision of the arbitration panel. He also vacated the punitive damages the arbitrators entered as being outside its jurisdiction. Lagstein appealed.

The Ninth Circuit Court of Appeals found that the District Court did not have the authority to vacate an arbitration award just because it disagreed with the size of the award. See Collins v. D.R. Horton, Inc. Rather proof that the arbitration panel had exceeded its powers, was necessary. The Court found that § 10 of the Federal Arbitration Act does not sanction judicial review of the merits behind an arbitration award. The District Court had stepped outside the scope the law gives the Court in these matters.

Lloyds argued that the arbitration board had manifestly disregarded the law, yet could produce no evidence to demonstrate this. In Kyocera, the Court had found that an award is completely irrational "only where the arbitration decision fails to draw its essence from the agreement." Lloyd's claimed the issue was the fact that Lagstein was not disabled because he had returned to work. Thus the panel's findings were irrational.

The Court of Appeals did not find the arbitration panel's findings irrational. The majority of the panel had found that Lloyd's violated the policy's "referee provision" by hiring a physician of its own choosing while failing to inform him of the import of this action. The majority also found that he was disabled thus Lanstein was entitled to benefits, whether Lloyd's agreed with these conclusions or not.

The Court of Appeals also found fault with the District Court's finding vacating the punitive damages which were awarded by the panel after they had issued their initial arbitration award. The panel had requested an extension of an additional 15 days in which to submit its initial award. Both parties agreed. The filing occurred before the deadline with punitive damages set to be determined at a later date. Nothing in Lagstein's policy expressly withdrew determination of procedural issues from the panel, so the panel was within its rights to set another hearing for determining what punitive damages, if any, would be awarded.

Both rulings by the District Court were vacated and Lloyd was ordered to pay over 6 million dollars to Dr. Lagstein.

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There seems to be a trend recently in which the Hartford disability insurance company is closely scrutinizing long term disability claims regardless of how long a claimant has been on claim. In the past 7 days I have been contacted by two separate claimants that have been on claim with Hartford for over 20 years and are having issues with Hartford. We usually see problems develop with long term disability claims when a new claims adjuster is assigned to a disability benefit claim. In my opinion, Hartford is one of the most difficult and unreasonable long-term disability insurance companies to deal with. I based my opinions on long-term disability claims my firm has handled and the numerous lawsuits around the country that discuss the conduct of Hartford.

A woman recently contacted me and she asked that I share her experience with Hartford so that other disability claimants can be aware of Hartford's claim handling tactics. This woman stated the following:

"The Hartford sent us a letter demanding that we sign a bunch of papers allowing them access to ALL doctors previously seen, All bank accounts, several questionnaires or they would cut off all benefits (which they did). I spoke to a paralegal at a local law firm that told me to sign all papers unless I had something to hide. We reluctantly signed the papers (I didn't feel that they needed our bank account info amongst other info not pertaining to this claim). My wife has been on disability with Hartford for 13 years and she has seen many doctors. Her primary doctor has recently filled out a letter stating that there was no time table for her return to work ( she just had an epidural in her spine last week). The Hartford has just sent us a letter stating that they have basically annoyed several other doctors that my wife has seen recently (she has renal issues also) trying to get them to give information but they are blackmailing us as they did at the beginning by saying you MUST tell your doctors to send them the information within 21 days or we will shut off your benefits. They have continually tried every angle to cut off my wife's benefits with these harassment techniques. We didn't want to sign any of these papers but we did. We think we should tell them that we are revoking their right to contact everyone. (My wife also gets social security because of this injury and we fear The Hartford will destroy that also leaving us in ruins). Now the doctors that my wife sees are being tormented which will have an effect on the care my wife receives AND now they are resorting to another type of blackmail as they expect us to do their work contacting these doctors to force them to give in to their demands or they will cut us off. I don't believe we signed up for that duty. I originally thought that they were going to negotiate a payoff settlement but instead it appears that they are trying the bullying tactic so they can stop paying."

This woman's experience and frustration with Hartford is consistent with the hundreds of Hartford disability claim emails we receive each year. In this scenario, a claimant should never revoke Hartford's ability to contact a treating doctor, however Hartford does not have a right to receive whatever information they feel like asking for. If you have questions regarding a long-term disability claim, contact us for a free consultation.

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Disability Insurance Attorneys Gregory Michael Dell and Rachel Alters of Dell and Schaefer have filed a lawsuit in the United States District Court for the Southern District of Florida against Liberty Life Assurance Company of Boston "Liberty Mutual" for failure to pay long-term disability benefits owed to a disability claimant in violation of The Employee Retirement Income Security Act of 1974 (ERISA). The Plaintiff suffers from Fibromyalgia Syndrome which causes her unrelenting pain in her arms, legs, wrists, neck, shoulders and feet. Additionally, she suffers from severe fatigue and cognitive impairment as a result of her Fibromyalgia Syndrome. All of which prevents her from being able to perform the material and substantial duties of her occupation as a Benefits Coordinator, for Bridgestone Americas, Inc., an occupation that requires her to sit at a desk and type on a computer 6-8 hours a day.

The Plaintiff's treating physicians all concur that she is disabled and unable to work due to severe pain, fatigue and cognitive impairment. She underwent a functional capacity examination which revealed that she was only able to sit or stand for a maximum of 2-4 hours in an 8 hour day. Her pain was so severe on the first day of testing she was unable to complete the exam. A neuropsychological examination revealed that she was impaired in her high order thinking which was likely due to her fibromyalgia syndrome.

Liberty failed to provide a "full and fair review" of the Plaintiff's claim in violation of ERISA. Liberty ignored her treating physicians' opinions, with whom she has treated with for over 15 years, who opined that she was clearly disabled and unable to work. Liberty disregarded the neuropsychological test results as well as the functional capacity exam results. Instead Liberty determined that the Plaintiff was not disabled, could work 40 hours a week in her regular occupation and should not limit her activity when she is in severe pain, but should be as active as possible in order to prevent her joints from stiffening. According to Liberty and the physician they paid to review our client's medical records, working 40 hours a week would actually be beneficial to her condition. Liberty provided these opinions without ever examining the Plaintiff. They based their denial solely on a paper review of her medical records ignoring the medical opinions given by her treating physicians that she should not and could not work.

In our opinion, Liberty has really bent over backwards to wrongfully deny this claim. It is shocking that Liberty has relied on the opinion of a doctor that says 40 hours of work each week will make our client recover from her 15 years of suffering from fibromyalgia.

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