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

Our client, a professional video cameraman retained Attorneys Dell & Schaefer to secure disability payments under the terms of two policies he had purchased from The Mutual Life Insurance Company of New York (“MONY”). Prior to retaining Attorneys Dell & Schaefer, MONY was paying benefits under a reservation of rights and disputing whether our client was either total or residually disabled. After extensive work with our client, his accountant, and treating physicians, we were able to appropriately present our client’s claim to MONY. MONY accepted liability for the claim and removed the reservation of rights.

Prior to hiring Attorneys Dell & Schaefer, MONY had proposed settling his disputed claim for a low lump-sum buyout. At that time, accepting a lump-sum buyout was not in our client’s best interests because it was unclear how much he would receive under the disability policy, since he was then only residually disabled. After clarifying the status of the claim, Attorneys Dell & Schaefer was able to secure a lump-sum buyout nearly three times that of the original offer prior to hiring our law firm.

Because of Dell & Schaefer’s involvement and handling of the claim, we were able to maximize disability benefits for the client. This claim was handled by Attorneys Gregory Dell and Robert Kerr. Attorneys Dell & Schaefer have represented thousands of long term disability insurance claimants and can be reached for a free consultation at 800-828-7583.

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After several month of attempting to handle his long-term disability claims on his own, our client contacted Attorneys Dell & Schaefer. Mutual of New York Life Insurance Company claimed to be conducting an evaluation of his claim, but had not yet paid any benefits. Disability Management Services (“DMS”), a third party administrator, was retained by Mutual Life to administer and process our client’s claim for disability benefits.

Our client’s disability policy contained a residual disability definition which provided benefits if he had a 25% loss of income and unable to perform one or more of his material duties. As a professional cameraman and business owner, he had to carry heavy cameras when on photo shoots and move around with these cameras constantly. Having suffered a knee injury, he now had to hire outside cameramen to perform the filming. Thus, he was unable to perform all the substantial and material duties of his occupation, and was suffering a loss of income due to his increased cameraman expenses.

After retaining Dell & Schaefer, Attorneys Gregory Dell and Robert Kerr worked diligently with the client, his personal attorney, and his accountants to properly document the client’s financial losses as a result of his disabling condition. This work involved months of careful documentation of the client’s earnings and repeated contact with the insurance company to ensure they had everything needed to evaluate the disability claim.

After providing the requested documentation on multiple occasions, Mutual Life appeared unable to make a decision, despite a clear loss of income in the years following his knee injury. Just prior to the filing of a lawsuit, Mutual Life approved our client’s claim for long-term disability benefits.

Dell & Schaefer continues to monitor our client’s claim to ensure Mutual Life has all the documentation it needs and that the proper amount of benefits are paid to the client every month.
 

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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 pharmaceutical sales representative, was recently denied benefits by her carrier, Cigna, despite clear medical documentation of several severe medical problems that prevent her from performing the duties of her occupation.

Once Attorneys Dell & Schaefer had been retained, we discovered that Cigna had based its denial of disability benefits on three pieces of paper from only one of her three treating doctors. Cigna determined that our client’s vasculitis, idiopathic peripheral neuropathy, fibromyalgia, and chronic fatigue were not severe enough to support her claim for disability benefits.

Attorneys Robert Kerr and Gregory Dell at Dell & Schaefer submitted an Appeal to Cigna containing all of our client’s medical records in an effort to secure our client’s benefits without having to pursue a lawsuit. This information included notes from her primary care physician, the hospital where she received chemotherapy, and her rheumatologist. The rheumatologist was and continues to be the specialist primarily responsible for her care and treatment of the disabling conditions.

Despite the clear evidence of disability in the medical records and clear statements by her doctors in support of her claim for short-term disability benefits, Cigna denied the Appeal and determined that our client is not entitled to disability benefits. As a result of this disability denial, Attorneys Dell & Schaefer filed a lawsuit against Cigna within 2 days of the final short-term disability denial. Additionally, Attorneys Dell & Schaefer continues to work with the client in order to submit her application for long-term disability benefits.
 

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Our client was diagnosed with renal cell carcinoma of his left kidney in June of 2007. Under the provisions of his catastrophic illness policy, he was paid the lump sum benefit of $50,000 under the policy shortly thereafter. The terms of his policy stated that if he received no treatment for this cancer for at least a year, he could receive additional lump sum benefits if he developed another critical illness, such as a different type of cancer, a heart attack, or a stroke.

Over a year later, in September 2008, our client was diagnosed with renal cell carcinoma of his right kidney. His doctor stated that this diagnosis was a new, separate, primary cancer unrelated to his previous diagnosis of cancer in his left kidney. Accordingly, our client filed for benefits under his critical illness policy due to his new cancer diagnosis.

The insurance company denied coverage for the new diagnosis of cancer in his right kidney. The insurer argued that because our client attended follow-up visits and underwent scans to make sure his left kidney cancer had not recurred following surgery, he was ineligible for additional benefits for renal cell carcinoma under the policy.

Attorneys Dell & Schaefer obtained a copy of the insurance company’s claim file and all of our client’s medical records. An extensive Appeal letter was prepared and the insurance company was given 30 days to reverse their previous denial or a lawsuit would be filed.

After reviewing the Appeal letter prepared by Attorneys Gregory Dell and Robert Kerr, the insurance company reversed their prior denial and agreed to pay the $50,000 policy benefit to our client under a confidential settlement. Additionally, the insurance company agreed to keep the policy in force for any future additional catastrophic illnesses except renal cell carcinoma of the kidneys.

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Our client, a trial attorney representing parents and children in dependency, delinquency, and guardianship cases contacted Attorneys Dell & Schaefer to see if she would be eligible for long-term disability benefits under her individual disability income and business overhead expense policies purchased from Unum. Upon consultation with attorney Robert Kerr, the client retained the law firm of Attorneys Dell & Schaefer to assist with the filing of her application for disability benefits under both types of policies based on paresthesias in her hands and feet. Additionally, her diabetic neuropathy was causing increased difficulty with walking, numbness and tingling in her feet and hands, and intense pain when sitting, standing, and walking.

Attorney Kerr guided the client through the process of preparing her long-term disability claim, instructing her as to the best approach to obtaining appropriate medical support. Once her claim was properly documented, based on Dell & Schaefer’s extensive experience in filing applications, Mr. Kerr worked closely with the client to complete the necessary paperwork. He then submitted it to Unum on her behalf and advised Unum to direct all correspondence to the office of Attorneys Dell & Schaefer only.

Attorneys Dell & Schaefer then responded to all inquiries made by Unum during the application process. Mr. Kerr followed up repeatedly with Unum to make sure that a decision was made in a timely manner. Within 60 days of submitting our client’s application for long-term disability benefits, Unum approved both the individual and business overhead expense long-term disability claims.

Mr. Kerr and the team at Dell & Schaefer will continue to handle our client’s claim on a monthly basis and document her ongoing disability to ensure that she remains eligible for benefits as long as she is disabled.
 

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