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

Attorneys Dell & Schaefer were retained by a former chiropractor who was receiving long-term disability benefits from one of her two disability policies. Despite one company paying her long-term disability benefits, Lincoln National refused to pay disability benefits, claiming she could perform the substantial and material duties of her occupation as a chiropractor. Following her initial consultation with attorneys, Gregory Dell and Robert Kerr, she retained the firm to pursue the disability benefits owed to her under the Lincoln National policy.

Our client was unable to continue working as a chiropractor as a result of back pain and arthritis in her shoulders and hands. Before moving to south Florida, she owned a successful practice in Colorado, and treated with a physical medicine and rehabilitation doctor in Denver. Because of her illnesses, she was forced to stop working and sell her practice. She subsequently moved to south Florida in the hope that the milder climate would ease the pain that makes her unable to work.

Despite her treating physician’s clear support of her disability, Lincoln National denied our client benefits based on their independent medical exam (IME) and surveillance of her riding a bike. Dell & Schaefer worked with our client and her physicians to develop the medical support necessary to properly document and support her claim. After several months of treatment by the appropriate physicians, Attorney Robert Kerr submitted an appeal to Lincoln National outlining the documentation and clear support for our client’s right to long-term benefits. Within a reasonable timeframe of receiving the appeal, Lincoln National approved our client’s long-term disability benefits and paid all past due benefits.

Attorneys Dell & Schaefer will continue to handle our client’s claim moving forward to ensure that she continues to receive her long-term disability benefits on a monthly basis.
 

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Our client, a chiropractor, was involved in motor vehicle accidents in 2005 and 2007, which resulted in him suffering from lumbar radiculopathy and cervical discogenic disease. As a solo practitioner and business owner he attempted to continue to work through the pain by working in a reduced fashion. He modified the techniques he employed for certain chiropractic procedures, and had to eliminate others all together. By the middle of 2008 the worsening pain became such that he realized he would no longer be able to work as a chiropractor. By the end of 2008 he closed his chiropractic office and filed for long term disability benefits under his AXA Equitable Policy.

Shortly after filing for long-term disability benefits, Attorneys Dell & Schaefer was retained to assist with the approval of long-term disability benefits. Attorneys Gregory Dell and Stephen Jessup took over the handling of the long-term disability claim, and advised Disability Management Services (DMS) that they shall not contact our client. DMS administers the AXA Equitable policy and began making numerous and lengthy requests for documentation from our client. DMS is a third party disability benefit administrator, which means that they are a 3rd party company that has been retained by AXA Equitable to review and handle all aspects of our client’s disability claim. DMS administers claims for multiple long-term disability insurance companies and Dell & Schaefer has handled numerous claims against DMS.

Throughout the application process, Attorneys Dell & Schaefer responded to multiple request for information and assisted our client with the preparation of all claim forms. DMS requested a field interview with our client which Dell & Schaefer attended and prepared the client. All requests for information and questions were promptly answered by Attorneys Dell and Jessup. Despite answering all of DMS’s requests for information, DMS failed to make a timely determination as to our client’s eligibility for benefits under his long-term disability policy. As a result of this attorneys Dell and Jessup demanded DMS provide our client with benefits or a lawsuit would be filed. In response to the demand DMS forwarded a check to our client representing five months of disability benefits, which were not made under reservation of rights, while they continue to evaluate the disability claim on a monthly basis. Attorneys Dell & Jessup will continue to handle all aspects our client’s long-term disability claim on a monthly basis.
 

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Our client, a chiropractor, fractured his arm and tore his rotator cuff as a result of a skiing accident in March 2008. Despite his injuries our client attempted to return to full-time chiropractic performing manual spinal adjustments. His treating physicians advised him that he should cut back on the number of patients he was treating pre-accident and see if he can handle a limited patient load. This client came to Dell & Schaefer for guidance and help in filing his disability claim.

After reviewing the client’s long-term disability policy he had purchased from National Life of Vermont and now administered by UNUM, Attorneys Gregory Dell and Robert Kerr advised him of his options moving forward. The client retained Dell & Schaefer to advise him of his contractual rights and to guide him through the process of applying for long-term disability benefits. During the application process, UNUM requested several years of tax returns, profit and loss statements, CPT annual and monthly production reports and medical records from all of his treating physicians. Despite overwhelming and repeated documentation from the client’s treating physicians that our client was unable to perform his job as he once did, Unum continued to refuse to pay our client, claiming they did not have sufficient evidence of his inability to perform his job as a chiropractor.

We performed an extensive analysis of our client’s activities for the time periods before and after his accident. Based on our client’s billing, it was clear that the time he was spending performing manual manipulation – the basis of his practice – was significantly decreased following his accident. This information was presented to Unum as further evidence of his inability to do his job as a chiropractor, along with the numerous doctors’ reports where his doctors repeatedly told him that he should not be performing manual manipulations. It was our opinion that the client was clearly eligible for partial disability benefits as a result of his loss of income caused by his injuries.

After several months of providing sufficient evidence of disability and Unum refusing to pay our client, Dell & Schaefer filed a complaint with the Florida Department of Financial Services in anticipation of litigation. Shortly thereafter, Unum made the decision to pay our client, finally agreeing that our client is partially disabled pursuant to the terms of his disability contract.

Since originally reducing his hours, our client has had to stop working, and as a result sold his practice. He is now totally disabled from his former occupation as a chiropractor specializing in spinal adjustments. Dell & Schaefer is handling his transition from partial disability to total disability and will monitor our client’s claim moving forward.

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