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

Our client, a general dentist, purchased a long-term disability policy from Berkshire Life Insurance Company of America. The policy defined “disability” as the inability to perform the substantial and material duties of his regular occupation. Our client maintained a solo dental practice since 1995. After several years of practice, Dr. Q began experiencing back pain which made it difficult for him to bend over patients for long periods of time and perform most of his dental procedures. The pain continued to worsen as time went on. Dr. Q’s treating neurologist diagnosed Dr. Q with lumbar degenerative disk disease and associated radiculopathy. Eventually, the pain forced Dr. Q to put his practice up for sale and discontinue the practice of dentistry.

Knowing that the application process for long-term disability benefits could be complicated, Dr. Q contacted Dell and Schaefer to assist him in submitting his claim for long-term disability benefits. Attorneys Gregory Dell and Cesar Gavidia gathered all of the medical, financial, and occupational information necessary to submit Dr. Q’s claim for long-term disability benefits. Berkshire delayed payment of Dr. Q’s disability claim as Dr. Q. had began working in a new occupation as a dental professor. After field interviews with Berkshire and our client, Attorneys Dell & Schaefer were able to prove that the material duties necessary to be a professor are not similar to the material duties required to work as a solo general dentist. Once Berkshire accepted that Dr. Q could no longer practice dentistry on patients, they agreed to pay long-term disability to our clients. Berkshire agreed to pay benefits just prior to Attorneys Dell & Schaefer filing a lawsuit for their failure to pay. Attorneys Dell & Schaefer continue to maintain Dr. Q’s long-term disability claim with Berkshire 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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