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

Our client, a dentist working in the capacity of a director of clinical technology for a well known company, began experiencing problems with his balance in March of 2009. In his role as director of clinical technology he was required to give lengthy presentations and speaking engagements, as well as be on the cutting edge in dental procedures. His initial balance problem quickly progressed leading to the cancelation of scheduled presentations, and our client seeing his doctors for testing. Test results indicated that he had a life-threatening brain tumor. Within a month and a half of first being seeing for the brain tumor he was undergoing brain surgery to remove the cancerous mass. The surgery was successful in removing the majority of the tumor, but resulted in loss of hearing in his left ear, cognitive dysfunction, and the exacerbation of a cervical neck condition brought on by years of dentistry. In the aftermath of the surgery his balance and equilibrium problems worsened, he began to experience severe headaches when working at the computer, and the surgery exacerbated his cervical neck condition. Hopes of returning to work after a short rest period from the surgery quickly vanished and he contacted Dell and Schaefer to assist in the filing of his disability claims.

Attorneys Gregory Dell and Stephen Jessup gathered all of the medical, financial and occupational information necessary to submit our client’s claim for disability benefits. Attorneys Dell & Jessup obtained supporting documentation from our client’s treating physicians and assisted our client with his application for disability benefits. Our client was further advised of the importance to have his doctors continue to document his restrictions and limitations. Within a week of filing for benefits, our client was approved for disability benefits. Attorneys Dell & Schaefer continue to handle our client’s disability claim on a monthly basis.
 

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The case of Mary Midgett v. Washington Group International Long Term Disability Plan, 561 F.3d 887 (8th Cir. 2009) is a reminder that there are discrepancies in how Federal courts apply the law with regard to the weight of credibility to give to an insured’s treating physicians versus the opinions of doctors hired by the insurance carrier to conduct reviews of medical records only.

Mary Midgett was a contract manager for Washington Group International, and was insured under Washington’s group short term and long term disability policies. The policies were originally administered by Broadspire, and then by Aetna. Ms. Midgett filed for benefits under Washington’s short term disability policy due to a myriad of conditions including degenerative arthritis, fibromyalgia and cervical degenerative disc disease, and osteoporosis.

Ms. Midgett treated with various doctors for her conditions. However, as the Court would point to as grounds to uphold the denial of benefits, many of the medical records from her treating physicians were silent as to an opinion on disability, and Ms. Midgett’s primary treating physician’s records suggested he was uncomfortable classifying her as disabled. Based upon results from nerve conduction studies, MRIs, and peer reviews, Aetna denied her claim for short term disability benefits. Ms. Midgett appealed the denial of benefits and added additional medical records from further physicians. Ms. Midgett’s appeal was once again denied, in part upon the review of the medical records from four more insurance company doctors. Between the initial application, and the final determination, Aetna relied upon no less than eight doctors who reviewed the available medical files, and never physically examined Ms. Midgett.

Following Aetna’s denial of benefits, Ms. Midgett filed a lawsuit for the short term disability benefits. The Court, taking into account Ms. Midgett’s medical records from her treating physicians and the opinions of eight insurance company doctors who only reviewed medical records that Ms. Midgett was not totally disabled, the Court sided in favor of the Insurance carrier. In rendering its opinion, the Court pointed to the Supreme Court decision of Black & Decker Disability Plan v. Nord, which stated an insured’s treating physician’s are not automatically entitled to special weight in disability determinations under ERISA. Ultimately the Court determined denial of Ms. Midgett’s short term disability benefits was supported by substantial evidence, as the opinions of all eight of the reviewing physicians accurately represented her medical records and addressed all the evidence supporting her claim for disability.

COMMENT: Without strong medical support from a claimant’s treat physician(s), it is almost impossible for a claimant to get approved for long-term disability benefits. A claimant must always be aware of the medical records documented by their treating physician and any documentation that the treating physician sends to the disability carrier. The attending physician statements that disability insurance companies send to claimant’s treating doctors contain open ended questions that allow the disability companies to manipulate the answers in support of claim denial. A claimant should always review the attending physician prior to returning the form to the disability carrier.
 

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Our client, an obstetrician/gynecologist, suffered from rheumatoid arthritis and could no longer perform his occupation. He approached Dell & Schaefer seeking assistance with his long-term disability applications. After completion of his applications for private long-term disability insurance benefits and approval by two different insurance companies, the doctor disclosed that he had recently been denied short-term disability benefits by Aetna.

The short-term disability benefits were provided as an employee benefit by his employer, meaning his claim for benefits was governed by a federal law known as ERISA. Because of the ERISA statutes, this client’s short-term disability claim posed more challenges than the individual long-term disability benefit policies that he purchased on his own from other disability insurance companies such as Unum and Mass Mutual.

Robert Kerr, an associate with Attorneys Dell & Schaefer, wrote the appeal of Aetna’s denial of short-term disability benefits. After performing their review of the appeal, Aetna agreed that the denial of benefits was incorrect, and reversed the original decision. Aetna also transferred our client’s claim to the long-term disability division, since the short-term disability benefits period had expired, and full benefits had been paid under the terms of the policy. Attorneys Dell & Schaefer will know begin the process of helping our client obtain long-term disability benefits from Aetna.

Dell & Schaefer continues to monitor all of this client’s disability claims on a monthly basis, ensuring that he will meet the terms of his policies and receive disability benefits for as long as he is unable to work.

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