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

Our client, an Engineer Manager specializing in Fluid Power Engineering, suffers from severe Coronary Artery Disease. Despite the fact multiple diagnostic tests performed indicated there were no abnormalities with his heart, he suffered two heart attacks in the span of six months. Following his second heart attack in July 2006, he applied for long-term disability benefits under his employer’s long term disability plan through Prudential. Prudential initially approved his claim for disability benefits, and following his elimination period he began receiving long term disability benefits in September 2006.

In July 2008, Prudential terminated his disability benefits, citing a lack of objective medical evidence to support his disability and resulting inability to perform his job. Upset and confused by Prudential’s denial of his disability benefits, he contacted Attorneys Dell & Schaefer to retain our services in the filing of his appeal. Review of the claim file by Attorneys Gregory Dell and Stephen Jessup revealed that Prudential was not properly classifying or recognizing the true nature of his pre-disability occupation with his employer. Therefore, Prudential was not reviewing his medical condition as it related to his ability to perform the duties of his occupation. Dell and Schaefer attacked Prudential on this fact, submitting an initial appeal in January of 2009 that detailed the duties of his occupation and how, in light of these duties, his coronary artery disease prevented him from being physically unable to perform those duties. Prudential reviewed the initial appeal and within three weeks sent a second denial letter.

Review of Prudential’s second denial letter clearly indicated that Prudential did not even take into consideration the information submitted in the first appeal regarding our client’s occupation and again cited no medical evidence to support disability. A second appeal was filed in late July 2009, which once again illustrated how Prudential was improperly reviewing our client’s claim for benefits in violation of ERISA. Attorneys Dell and Schaefer argued that although objective tests such as EKG’s indicated no abnormalities, the practice of medicine is not an exacting science, and that the only truth in our client’s medical history is that he repeatedly “passed” testing, and experienced a heart attack upon returning to work not once, but twice.

Following the submission of the second appeal, Prudential took the full 45 days to review his claim, and even requested an extension of an additional 45 days. During this period Prudential requested our client undergo an Independent Medical Examination, where once again diagnostic testing appeared normal, but his performance on other tests indicated the severity of his impairment. Faced with the reality of our client’s medical history, and the fact they had improperly reviewed his claim for benefits, Prudential reversed their decision to terminate our client’s benefits and paid all past due disability benefits. Fortunately our client was able to prevail without the need to file a lawsuit.

Attorneys Dell and Schaefer have represented hundreds of clients who have had benefits terminated or denied under Group Long Term Disability Policies. Attorney Stephen Jessup or Gregory Dell can be reached at 800-828-7583.
 

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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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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 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, who suffers from Parkinson’s, was a highly skilled engineer and operations manager for an international corporation before his illness rendered him unable to perform the duties of his occupation. Diagnosed with Parkinson’s years before filing for long term disability benefits under his company’s disability plan, he did everything in his power to work at a job he enjoyed and excelled at. However, the nature of his illness began to take a heavy toll, as symptoms relating to his cognitive functioning began to worsen. Left with little choice, he applied for disability benefits under his company’s short term disability policy in March of 2008. He was approved for short term benefits under the disability policy. However, in October of 2008, when the short term disability benefits were exhausted, MetLife denied his claim for long term disability benefits.

He then contacted Attorneys Dell and Schaefer to appeal MetLife’s denial. From the start, MetLife was uncooperative in requests for information made by Dell and Schaefer. Persistent in our representation we finally secured all of the documentation requested. Review of the MetLife claim file immediately identified how MetLife wrongfully denied our client’s claim. The most glaring injustice was that in denying his claim, MetLife relied upon the opinion of a licensed social worker and a registered nurse. MetLife had a duty to our client to give his claim for long term disability income benefits a full and fair review, and failed to do so when they decided to not hire appropriately qualified medical providers in the area of Parkinson’s to render opinions as to our client’s functional capabilities. In addition to this, the individual’s hired by MetLife to review our client’s medical records did not contact our client’s treating physicians to gain any insight into his condition, nor did they draft any reports documenting their findings and opinions. Moreover, MetLife relied on the report of a vocational rehabilitation specialist, who completely failed to identify the duties of our client’s occupation. Instead, the specialist concentrated on the most insignificant of job duties in rendering her opinion our client could perform his occupation.

Attorney’s Dell and Schaefer helped to guide our client to proper treating physicians for his condition, as well as tests to be performed that would counter MetLife’s reasons for denying his claims for long term disability benefits. To develop a better understanding of our client’s pre-disability occupational duties and his difficulty performing those duties, Dell and Schaefer contacted past co-workers for further insight, and to help present a complete picture of the battle our client endured with Parkinson’s. Armed with objective testing to prove cognitive dysfunctions and an understanding of the true nature of our client’s occupation, Dell and Schaefer filed an extensive appeal with MetLife to overturn the wrongful denial of long-term disability benefits. MetLife had 45 days under ERISA in which to review the appeal, however, presented with overwhelming evidence and arguments as to the mishandling of the claim, MetLife overturned its denial in less than one month.

This case was handled by attorneys Gregory Dell and Stephen Jessup.
 

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