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

As an attorney for clients who go up against disability insurance companies all over the country, I can tell you that the insurance contracts are often full of legalese and gibberish that most individuals don’t understand. Unfortunately, most individuals don’t understand even the communication they receive from the disability insurance companies, such as why their claim has been denied. According to the outcome of the case below, even a judge may find communication from the insurance company difficult to understand.

Nancy Love vs. National City Corporation Welfare Benefits Plan

Nancy Love worked for National City Corporation for two decades before she was forced to stop working. When Mrs. Love began experiencing dizziness, fatigue and blurred vision, she visited the doctor and was diagnosed with multiple sclerosis. Mrs. Love applied for and received short term benefits from the National City Corporation Welfare Benefits Plan, underwritten by Liberty Mutual. Short term disability benefits were for 18 months, and when Mrs. Love benefits expired, she applied for and received long-term disability benefits.

Mrs. Love received the disability benefits for three years before Liberty Mutual determined that she was no longer what the plan considered to be ‘disabled.’ According to the policy, an individual is considered disabled for the first two years if he or she is unable to perform their job but after the first two years, they’re only considered disabled if they’re unable to perform any job, including a job they could take classes and qualify for, etc.

Liberty Mutual Hired Physicians to Discredit Several of Love’s Attending Physicians

To first deny Love for any more disability benefits, Liberty Mutual relied on Doctor Jonathan Sands. Dr. Sands reviewed Love’s medical file and determined that although she most likely did have multiple sclerosis, there was no clinical attack noted, and that “no objective limitations in functional ability or capacity were noted.”

This report was sent to Love’s physician, who did not respond. Soon after, Mrs. Love’s benefits were terminated due to Dr. Sands’ assessment and Mrs. Love’s inability to provide information which supported her assertions that she was unable to perform any job due to her disability. Mrs. Love appealed Liberty Mutual’s denial, turning over more medical records, including a functional capacity evaluation, a vocational evaluation and a physical therapy evaluation. The next physician Liberty Mutual had to examine the case was Dr. Gerald Winkler. Dr. Winkler stated, after reviewing the files, that Mrs. Love was not totally disabled and could perform certain tasks, such as answering telephones, working at computers or dealing with the general public. Love’s appeal was denied.

Failure to Explain Sufficiently

Love filed a lawsuit in the Illinois Federal District Court against the insurance company, citing ERISA law and claiming:

- That the insurance company did not consider all medical evidence provided to them by Love, and;

- The insurance company did not fully explain why they had denied Mrs. Love her benefits.

The Illinois District Court ruled in favor of Liberty Mutual, pushing Love to appeal their decision to the Seventh Circuit Court of Appeals. Since ERISA requires all insurance companies who deny policyholders to “set forth the specific reasons for such denial, written in a manner calculated to be understood by the participant,” the appeal court felt that Liberty Mutual had not done so. The court found that neither the termination of benefits letter nor the appeal denial letter properly explained to Love why she would no longer be receiving disability benefits.

Another thing Dr’s Sands or Dr. Winkler did not address was the contradiction they held with Mrs. Love’s attending physicians. Every physician that personally examined Mrs. Love felt that she was not able to work at any job, and that she was unable to perform even small tasks for more than a few hours at a time. Dr. Sands and Dr. Winkler did not address those issues. They did not go over the statements or medical tests and explain why they weren’t credible or able to be used as proof of Mrs. Love’s disabilities. Therefore, the court found that there was insufficient explanation on this part as well.

The case was remanded to Liberty Mutual with requirements to fully review the case of Mrs. Love and determine her eligibility for disability benefits in the fairest of ways. While this is a victory for Mrs. Love, the truth is that she should not have had to fight so long in order to get what she deserved in the first place. With as many physicians’s reports as Mrs. Love had all stating her disability made it unable for her to work  she should not have had to fight so hard for what she deserved, but she did. Perhaps, the ruling in this case will make future cases easier for Liberty Mutual policyholders who are unable to work and have credible medical support.

*About the Author: Gregory Michael Dell is an attorney and managing partner of the disability income division of the firm Dell and Schaefer (www.diattorney.com). He has assisted thousands of claimants with their claims for long-term disability benefits.. He can be reached at 888-SAY-Dell or gdell@diattorney.com

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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 was a successful, independent financial advisor who owned her own business. On December 21, 2008, while stopped at a red light, her car was struck from the rear by a cement mixer. Within days of the accident she was beginning to experience pain in her neck and lower back. MRI reports indicated multiple herniations of her cervical and lumbar spine. Unable to return to her office for little more than an hour at a time, her fear of losing all she had worked for became an unfortunate reality. Due to her inability to continue working, she decided to make a claim for disability benefits under her long term disability policy. Three months after her accident, she contacted Dell and Schaefer to assist her in the preparation of her claim for long-term disability benefits.

Attorneys Gregory Dell and Stephen Jessup worked closely with our client to ensure that her doctors appropriately documented her restrictions and limitations. After a thorough review of her medical records and obtaining a firm understanding of her occupation as a financial analyst and business owner, Dell and Schaefer filed her application for benefits in early May of 2009. Dell and Schaefer argued that despite the fact she attempted to return to work during the four months following her auto accident, that she was totally disabled from performing the material and substantial duties of her occupation as of date of her accident. Lincoln National made additional requests for information and further inquiries from our client, which were anticipated by Dell and Schaefer, and met with prompt and consistent responses. In response to the application for disability benefits and additional information in support of disability submitted by Dell and Schaefer, Lincoln National approved our client’s claim for long term disability benefits back to the date of the car accident. The claim for long-term disability benefits was approved within 30 days.

Attorneys Dell and Schaefer continues to handle our client’s claim with Lincoln National on a monthly basis. All communications from Lincoln National are sent directly to our office and Lincoln National is prohibited from having any direct communication with our client. Attorneys Dell & Schaefer represents claimants nationwide in all aspects of a long-term disability claim, which includes everything from the application process through litigation of any disability claim denials.
 

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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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