Disability Insurance Claims Law Blog https://www. Keeping Disability Insurance Companies Honest and Helping Claimants Collect LTD or STD Benefits Fri, 28 Feb 安徽福彩网app官方下载 16:50:41 +0000 en-US hourly 1 https://wordpress.org/?v=5.3.2 Strategies to Appeal a Denied Lincoln Financial Disability Insurance Claim https://www./安徽福彩网app官方下载/02/articles/disability-insurance-cases-nationwide/appeal-denied-lincoln-financial-disability-insurance-claim/ https://www./安徽福彩网app官方下载/02/articles/disability-insurance-cases-nationwide/appeal-denied-lincoln-financial-disability-insurance-claim/#respond Fri, 28 Feb 安徽福彩网app官方下载 16:50:41 +0000 https://www./?p=3255

Learn what to do and what needs to be included in a disability insurance appeal if your claim has been denied by Lincoln Financial.

GREGORY DELL: Hi, I am attorney Gregory Dell. I’m here today with Victor Pena. And Victor, let’s talk today about strategies and things that somebody who’s been denied a long-term disability appeal or claim, I should say, by Lincoln Financial.

Lincoln Financial – company been around for a long time. They’re one of the largest group disability insurers in the entire country安徽福彩网app官方下载. We know that they recently, in 2018, acquired the long-term disability division of Liberty Mutual, which was big.

So the two of them now are a top five largest disability group insurer in the country安徽福彩网app官方下载. But let’s get into person who’s watching this video recently had their claim denied by Lincoln Financial. They need to file an appeal. What is the most important thing that needs to be done in that appeal.

VICTOR PENA: Medical evidence, medical support – in an appeal, what your entire claim is based on. It’s what the insurance company looks at. They always fall back on those medical records to make sure that they’re consistent with what the claimant’s telling them – what they’re filling out on their claim forms. So as medical records are the most important thing.

GREGORY DELL: OK, so person has been denied already. They may or may not have requested their claim file. Obviously, the insurance company got the medical records.

Insurance companies, especially like Lincoln, often claim rep will be trying to say, hey, go ahead and submit an appeal. A new person is going to look at it, not me, because that’s the way it goes. Just get us some additional records and go ahead and send it in.

Now we know that’s basically a trap. That’s not the right way to do it because there’s so much more you can do to put in a great appeal. What is unique about what we do as lawyers helping a claimant with their appeal versus what a person would be able to do on their own?

VICTOR PENA: Well, one big problem with medical records in general is often, depending on the nature of the condition and depending on the doctor that you’re working with, doctors aren’t always the best at documenting medical records for purposes of a disability claim. So simply submitting medical records from a doctor isn’t always enough. Oftentimes, doctors have to be told how they have to document things, and certain insurance companies look for very specific things in those medical records.

So when we handle an appeal, we look for those deficiencies. We look at the medical records and how the doctors documented things over time, whether or not they actually reflect what the claimant – how they describe their condition to be affecting them on a daily basis. And wherever those deficiencies are, we work on kind of filling those gaps during the appeals process.

GREGORY DELL: So more specifically, I mean, the insurance companies like Lincoln has a two-page attending physician statement, which they request to be turned in. From us having handled thousands of disability appeals with every company, not just with Lincoln and what was Liberty Mutual, we have custom attending physician statements that are specific to a person’s medical condition and specific to the occupation, whether if it’s a definition of an occupation or any occupation. Is it a sedentary, a light duty, a medium duty? Is it a doctor? Is it an accountant? Is it a bookkeeper? Is it someone who has a desk job?

And based upon that, we consider every single one to be unique. So I find it impossible that the disability insurance company asks you for here’s our attending physician statement – the same one they use for every single claim. So there’s no way a claimant is going to be able to do that on their own versus what we customize for the doctors.

The other thing that we keep in mind is we know no matter what we send in is going to be looked at by their hired doctor, whether it’s in-house or outside. Very important that we’re considering how’s that other doctor that they’re going to hire going to look at what our doctor turned in. So we have to become like quasi doctors, which we’re not doctors. We’re never going to treat a claim, but we know enough to say, this is what the doctor is going to look for for medical support in the physician’s statement that we’re submitting.

And if we present it in the right manner, no reasonable doctor could disagree with that. So I think that’s huge in obtaining the medical records when trying to get physician support that a claim and just can’t go into the doctor and say, I need all of these things. And when we do that, the doctor is more responsive to the lawyer. Do you find they’re more responsive to you or to the claimant?

VICTOR PENA: Right, well, when you know what questions to ask, they tend to be more responsive. So oftentimes, a claimant will go in and try to describe to the doctor what you told them over the phone, and they don’t always relay that information exactly the same way. But yeah, generally, I find that the doctors that are supportive of the claimant tend to be pretty responsive, and they tend to work with lawyers pretty well.

GREGORY DELL: OK, so the other thing I want to talk about the importance of – look, it’s the inability to do your occupation or any gainful occupation. So in order to not do an occupation, you have to have some kind of restrictions or limitations. That’s one element of an appeal that you have to prove. The other element is, well, what is that occupation or what does any occupation mean? How do we present that to the insurance company in a light most favorable to our client?

VICTOR PENA: Well, one of the things that we also find insurance companies tend to do, they tend to simplify things. They oversimplify things, like your occupation, for example. They’ll just look at The Dictionary of Occupational Titles and the intended kind of group and occupation into either whatever physical characteristics if it’s sedentary or light duty, heavy duty occupation.

So often, they just focus on those physical requirements of an occupation. So when we do an appeal, we obviously break it down. We point out what those material and substantial duties actually are. And doing a vocational assessment is just that– presenting it in a way that paints a picture of what this claimant’s occupation actually consists of.

GREGORY DELL: And then we also have the resources throughout the whole country安徽福彩网app官方下载 of what’s called a vocational consultant to work with an expert who will take all of the medical records, do a market labor analysis, look at jobs that are available, look at the skills required of a job, and write a pretty intensive report comparing the responsibilities for a particular job or any occupation and then comparing the restrictions and limitations that the doctor has proffered forward and the medical evidence that we’ve helped to gather and then render an opinion as to whether or not there’s any job that the claimant can do. So I think that’s unique because those reports cost a couple thousand dollars, and most claimants who are filing an appeal don’t want to put out money to hire, don’t even really know who to hire to submit one of these reports.

Since we handle these claims on a contingency fee basis, claimants don’t have to worry about putting out thousands of dollars we may spend on appeal because they won’t be responsible for that unless we win their appeal. So that’s a very big advantage for someone who’s considering to file an appeal. And they don’t get stuck at a disadvantage of not having that because the insurance companies have vocational experts. I mean, you’ve never looked at an appeal that wasn’t reviewed by their own in-house vocational consultant.

VICTOR PENA: Right and sometimes they make mistakes. We’ve seen cases where they misclassified. Even if you look at The Dictionary of Occupational Titles, and they’ve completely miscalculated the occupations. So it’s really important to look at and not ignore that aspect of the claim.

GREGORY DELL: Right, we’ve only talked about the medical and the occupational. There’s many other things that are super important in a Lincoln appeal. But what about this requirement from Lincoln for a second appeal? Do you have to do that?

VICTOR PENA: Yeah, so one of the things with Lincoln, there’s multiple carriers that offer two levels of appeal. Usually, the first one’s required. Second one is voluntary. So you can either go ahead and file a lawsuit and not be penalized for not submitting that second appeal.

But Lincoln, they have two levels, required levels of appeal. So you have to go through both appeals. If they deny the first, you have to submit the second appeal in order to preserve your right to any legal remedies.

GREGORY DELL: And those second appeals also have to be very strategically organized, and you really don’t know the strategy on that until you see how they reviewed the first appeal. And they’re very strategic, the second ones because maybe in the first one, they screwed something up so badly that you may be very limited in what you want to put in the second one because you don’t want to bring their attention to what they did wrong because of the fact of then when it gets to a lawsuit that the court will say, well, you told them what they did wrong. And now they reviewed it. And so you have to always do that balance because of the standard of review, which we’ve talked about in many other cases about the standard review in these ERISSA lawsuits.

So if you have a claim with Lincoln or what was formerly Liberty Mutual that’s been denied, we’re able to assist you anywhere in the country安徽福彩网app官方下载. We’ve handled thousands of these disability appeals, and we always offer you a free initial consultation. So we welcome you to give Victor call or any of our other disability lawyers, and we’ll let you know right away whether or not we can help you.

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Tips for Appealing a Disability Insurance Denial by The Hartford https://www./安徽福彩网app官方下载/02/articles/disability-insurance-cases-nationwide/tips-for-appealing-a-disability-insurance-denial-by-the-hartford/ https://www./安徽福彩网app官方下载/02/articles/disability-insurance-cases-nationwide/tips-for-appealing-a-disability-insurance-denial-by-the-hartford/#respond Wed, 19 Feb 安徽福彩网app官方下载 18:44:27 +0000 https://www./?p=3246

How Do I Appeal a Disability Insurance Denial from The Hartford?

When it comes to filing Hartford disability appeals, there are some crucial things to know. The appeal process begins just after receiving a disability insurance claim denial in which The Hartford company has rejected your claim. But then what?

Before rushing in and making your own response to the denial, disability insurance attorneys Gregory Dell and Rachel Alters have some important details to help you choose the proper path forward. They’ve handled hundreds of ERISA appeals involving Hartford, with continuing increases due to the company’s 2018 acquisition of the long-term disability division of Aetna.

What to Expect

Once you receive a denied disability claim from Hartford, a strong appeal response is essential. Knowing what to expect can equip you to launch an effective appeal from the very beginning, which is crucial for this reason: You only get one shot. Disability lawyer Rachel Alters explains that if your appeal is denied and it goes to court, that appeal is basically your only trial in front of the judge.

“All the judge sees is the administrative record,” says Alters. “They don’t get any new testimony; you can’t file anything new. They don’t get to meet the claimant. So everything you want to show the judge as to whether the insurance company was “arbitrary and capricious” needs to be in that appeal. If it’s not, you’re out of luck.”

Attorney Gregory Dell notes that a good number of people do call them after they’ve filed their own appeals, without the aid of a disability insurance law firm. “We’re still able to help them,” he says. “But those people are at a significant disadvantage compared to the ones that contact an attorney beforehand to do the appeal.” There is no second chance for getting the vital information into the record.

Even if a related new event occurs that impacts your case in a significant way, the law still prohibits new details being added after an ERISA denial and ERISA appeal. Gregory Dell gives an example that someone could turn in their appeal, get a decision, and then lose their leg in a catastrophic accident. But the court cannot consider that new evidence because the appeal record is closed. That’s why it is very important to submit a phenomenal appeal, he stresses.

Most Important Element in a Hartford Disability Appeal

Most experts, such as those at disability insurance law firm Dell & Schaefer, agree that one of the most important elements of an ERISA appeal is doctor support. A very good written statement of doctor support must contain his conclusion that you have an inability to work. This can be the inability to work in your “own occupation” or in “any occupation,” according to Rachel Alters. It needs to specifically support your restrictions and limitations, and it could also add a vocational rehab expert to corroborate your physician’s statement.

A disability insurance lawyer knows what insurance companies are looking for because they do these types of appeals each and every day. They know the specific language that Hartford is looking for, and they can ensure that medical records coincide with what the attending physicians are writing in their statements. It’s also important that the medical record contains consistent documentation over a period of time, ideally six months.

Disability claimants have 180 days to file an appeal. So if they begin working with an attorney right away, the chances are much greater that the appeal files will contain sufficient and continually progressive medical records and documentation. Doctors are often given a standard “physician’s statement” form to fill out, but if any mistakes are made or the form is filled out improperly, it will be too late to amend them after filing.

Disability lawyer Rachel Alters explains that she can help a doctor document the disability in ongoing medical records prior to filling out the official statement, and then review it all before the appeal goes to The Hartford. As she notes, doctors are trained to treat patients, not fill out forms. That’s part of the role of a disability insurance law firm. Attorney Gregory Dell adds that 95 percent of the time, the doctors appreciate the fact that their patients have a professional helping them with the intricacies of an ERISA appeal.

What Is a Vocational Report?

Almost as important as having solid medical support for an ERISA appeal is including a vocational report. The insurance company will first be looking at whether you can do your “own job” and then it turns into whether you are capable of performing “any job.” A vocational expert examines the claimant’s job description and medical records in order to produce a detailed report stating what you are realistically capable of doing as an occupation.

The vocational expert uses the ONET (Dictionary of Occupational Titles) to pinpoint the duties involved in the claimant’s job and then compares it with the MRI reports or any other medical proof that documents the disability. Rachel Alters notes that the ONET is also what insurance carriers use to establish job criteria, so it’s vital to get a detailed report.

These vocational reports can take 60 to 90 days and cost a few thousand dollars, explains Gregory Dell. This means that a person fighting a disability insurance claim denial on their own may not have the ability to pay that type of expense. Claimants are often already in a financial bind because their claim has been denied. But a disability insurance law firm such as Dell & Schaefer takes cases on a contingency basis, so the claimant pays nothing unless they win.

Personal Statements

Another crucial item to include in an appeal is a solid personal statement. A comprehensive statement from the disabled claimant basically serves as his or her “day in court.” It’s the closest thing to taking the stand and explaining how you feel, why you can’t work, and what your day is really like. The claimant who is living that every day is the best possible witness.

As attorney Gregor Dell points out, it’s not a machine reading that appeal – it’s a human being. If they feel for you or have an understanding of what you’re really doing, that strengthens your appeal and the chance to receive your deserved disability insurance benefit. The lawyers will also collect statements from family members, former co-workers and others in your sphere, which helps bolster your claim and your LTD (long-term disability).

These important tips for appealing an insurance disability denial can apply to just about any company. However, Hartford is very specific and detailed, and they have certain requirements that trained attorneys know about. So, if you have an appeal with Hartford anywhere in the United States, the attorneys at disability insurance law firm Dell & Schaefer are available any time for a free initial consultation.

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Denied by Metlife? Tips for Disability ERISA Appeal https://www./安徽福彩网app官方下载/02/articles/disability-insurance-cases-nationwide/denied-metlife-disability-erisa-appeal-tips/ https://www./安徽福彩网app官方下载/02/articles/disability-insurance-cases-nationwide/denied-metlife-disability-erisa-appeal-tips/#respond Wed, 12 Feb 安徽福彩网app官方下载 16:36:19 +0000 https://www./?p=3240

When MetLife Insurance 安徽福彩网app官方下载 dishes out a denied disability claim, it’s crucial that your initial appeal is comprehensive and convincing. That’s because you only get one shot at it. Disability insurance lawyers Greg Dell and Alex Palamara, who have handled more than 1,000 of these MetLife claims, explain what’s involved in the process and what it takes for a successful ERISA appeal.

Though individual MetLife disability policies do exist, resulting in an occasional private disability denial, the vast majority of MetLife disability coverage (about 95 percent) comes through group policies. Once you’ve received a disability insurance claim denial from MetLife on one of these policies, the burden falls on you to file an appeal. Whether you choose to go it alone or let a seasoned expert from a disability law firm handle it for you, there are some absolutely essential things that must be in that appeal.

Disability insurance attorney Alex Palamara explains that ERISA laws governing group disabilities are very tough laws, and they “pretty much favor the insurance company.” But most importantly, your appeal after a denial is the one and only chance you have to get documentation into your claim file. Even if other proof of your disability comes up later, you will not have the ability to add that information into your claim file

Goals of an ERISA Appeal

When filing an ERISA appeal, you basically have two goals, according to Alex Palamara. One purpose of the appeal to get back on claim by having MetLife reevaluate the information and reinstate your claim. The next goal when appealing the denial is to strengthen your case for a lawsuit down the road. Remember that when disputing the ERISA denial in a court of law, the claim file from your original appeal is still closed for new documentary evidence.

“Once the final denial is issued, that claim file is closed and no more information can be submitted to the judge,” Alex Palamara stresses. That’s why it’s so important to get it right in your initial appeal of the denial.

How Does the Appeals Process Move Forward?

If you choose to have a disability insurance law firm handle the claim denial and appeal it on your behalf, your attorneys will first send a letter requesting the claim file, which legally has to be released in a timely manner. That file contains all information that MetLife used to deny your claim, and it can be 500 pages long or even many thousands of pages. Your lawyers will be looking for the proverbial “needle in a haystack” – or in this case, several needles. Somewhere buried in that thick imposing file, which will likely be cryptically disorganized, are the following crucial pieces of information.

  • An “independent” physician consultation. They could easily have ordered a consultant review in which they sent your medical records to a doctor or nurse of their own choosing. They are seeking to obtain an evaluation that is inconsistent with your own treating physician’s diagnosis. This part of the claim file could be up to six or seven pages long out of a 5,000-page file.
  • Independent medical evaluation. MetLife may have required you to submit to a new medical evaluation, resulting in a “functional capacity evaluation” by their own chosen professionals.
  • Surveillance. It’s entirely possible that MetLife will have conducted surveillance of you that is recorded on video. A CD or similar type of recording will be in the claim file, and your attorney will review it to look for discrepancies or exaggerations in the written account they’ve inserted into your file.

After a thorough review of the documentary evidence used to deny your claim, the seasoned and skillful disability insurance attorneys at Dell & Schaefer will be able to identify what the insurance company used to deny your claim. And that’s when the real work begins.

Physician Collaboration

Your own personal treating physician throughout your period of disability is a critical link in the appeals process. Your new attorney will reach out to the doctor and other treating medical professionals to get their input on what is in the claim file and to make sure they understand the criteria for a legitimate disability. Creating a new physician statement to accurately reflect your true condition is the ultimate goal here.

The new customized attending physician statement, which will be drafted by the law firm, contains pertinent and detailed information that’s particular to the client’s claims, including the identification of physical restrictions and limitations, and an opinion of the ability to do either their job or any job.

“We draft attending physician statements for each of our clients,” states Alex Palamara, “because every single client’s condition is a bit different… Anyone could be suffering from fibromyalgia, but there’s always different variances for each client.”

It’s also important to get objective evidence rather than just medical opinions, adds attorney Greg Dell. For example, if someone has a neck or back problem and is complaining of radiating pain, the objective evidence of functional limitations could include an updated MRI, C.T. scan, EMG test or nerve conduction study. A claimant without a representative attorney who knows what the insurance company is looking for would not likely get this often-pivotal and irrefutable evidence.

The Vocational Component

Finally, the last thing to include in an effective ERISA appeal is the vocational/occupational component. With group disability polices such as ones by MetLife, the definition of disability generally changes after a certain period of time. During the first 24 months, the focus is on the ability to perform “your own” occupation. But after 24 months, explains Alex Palamara, it gets a bit more complicated. At that point, you must prove that you are unable to perform “any occupation.”

In the first phase, insurance companies will often take great liberties in interpreting a claimant’s occupation. They’ll look at a dictionary of standard occupational titles and make their own assumption of whether your medical issues preclude you from performing “your own” occupation.

In the next “any occupation” stage, companies such as MetLife will strive to prove that you are capable of performing other occupations, especially ones deemed “sedentary.” However – and this is important to know – there is an income component that comes into play when determining what kind of work you are capable of performing. The insurance company must be able to show that any job they claim you are capable of doing compensates you at 60 percent or 80 percent of your prior monthly earnings.

A vocation expert, hired by your disability insurance attorneys, can provide invaluable input on explaining the job requirement and duties of the claimant’s “own occupation.” They can also apply it to any occupation stage and then pinpoint jobs that the disabled person could or should be able to perform based on his or her restrictions and limitations.

Other vocational components of the ERISA appeal include a market labor analysis for available jobs, as well as a collection of statements from past coworkers and family members. These all go into the appeal as collective proof that your disability claim denial should be overturned.

Where to Go from Here

Now that you are familiar with how the process works, it’s time to move forward in a positive way toward final resolution. A disability insurance lawyer at Dell & Schaefer can put you in the best position to win your claim in any part of the country安徽福彩网app官方下载. They always offer a free consultation, so just click the free consultation button on the Dell & Schaefer website, or call for a direct conversation. They’ll review your denial letter right away and let you know how they can help.

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This Week on DIAttorney.com (02/07/安徽福彩网app官方下载) https://www./安徽福彩网app官方下载/02/articles/disability-insurance-industry-news/this-week-on-diattorney-com-02-07-安徽福彩网app官方下载/ https://www./安徽福彩网app官方下载/02/articles/disability-insurance-industry-news/this-week-on-diattorney-com-02-07-安徽福彩网app官方下载/#respond Fri, 07 Feb 安徽福彩网app官方下载 18:25:27 +0000 https://www./?p=3238 FAQ: Appeals & Lawsuits
This case can be instructive to those who are impatient with their insurance company that seems to be taking too long to decide on their administrative appeal.

Disability Insurance News:
This case can be instructive to those whose claims for LTD benefits have been terminated without an explanation of why from their insurance company.

Disability Insurance News:
This case can be instructive to those who have had their benefits under their disability policy reduced due to “other income benefits.”

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Strategies and Tips for a Cigna Disability Benefit Lawsuit https://www./安徽福彩网app官方下载/02/articles/disability-insurance-cases-nationwide/strategies-tips-cigna-disability-benefit-lawsuit/ https://www./安徽福彩网app官方下载/02/articles/disability-insurance-cases-nationwide/strategies-tips-cigna-disability-benefit-lawsuit/#respond Wed, 05 Feb 安徽福彩网app官方下载 18:01:42 +0000 https://www./?p=3231

As experts in long-term disability insurance claims, attorneys Greg Dell and Stephen Jessup explain the intricate layers involved in disability benefit denials and related lawsuits. Assuming that an individual by Cigna has completed all possible appeals and is now faced with filing a lawsuit, here’s a look the roadmap for filing that suit. From filing timelines to realistic expectations and possible remedies, these Dell & Schaefer disability insurance attorneys dig from a deep well of experience handling hundreds of Cigna claims, appeals and lawsuits across the country安徽福彩网app官方下载.

From Denial Letter to Lawsuit Filing

So, you’re holding a denial letter in your hand and have no idea what your options are – or even if any hopes of reprisal exist. The letter states that you have exhausted all remedies and the matter is closed. But that’s far from reality because that’s the point at which ERISA allows you to file a lawsuit to reassert your rights and claim legitimate disabled status.

According to disability insurance lawyer Stephen Jessup, the first and foremost step is to obtain the final claim file. That file holds all the medical reviews, the associated information you provided, and all the details of the appeal process. By law, Cigna has a duty to release that file after you file a lawsuit – but that release could come much later down the road. So, it’s extremely useful and more convenient to get the file prior to filing a lawsuit.

With that file in hand, your attorney will be better equipped to assess the chances of success. After analyzing the information and breaking it down for a rational approach, it’s then possible to establish realistic expectations for time frames and possible outcomes.

It’s now time to file the lawsuit, which is where knowledge and expertise are crucial. Greg Dell explains that a disability lawsuit governed by ERISA must be filed in federal court, and it can be any federal court in the country安徽福彩网app官方下载 that holds the best chance of success for the client.

“A lot of inexperienced lawyers try to put it in state court,” says Dell. “But that should be your first clue that you’re talking to a lawyer who doesn’t know what he’s doing… You can’t go into state court, period. End of story.”

What is the Timeframe After Filing?

Attorney Stephen Jessup, whose practice is comprised solely of representing long term disability insurance claimants through the entire process of a disability insurance claim denial, including ERISA appeals and resulting litigation, reveals what happens once the lawsuit is filed in federal court. The judge must issue a scheduling order, then it potentially goes to summary judgment and on to a final verdict from the judge.

Depending on the federal court and the assigned judge, the timeframe could be anywhere from six months to two years – but realistically, the entire trial process could take up to 18 months. This starts with Cigna being served with the lawsuit papers, at which point they have 21 days to respond. Considering potential extensions, the initial resulting answer back from Cigna should arrive within a month. This is typically a formal document from them that basically denies everything in the complaint.

That’s when the wheels are set in motion for the scheduling order from the judge, which generally happens within 45 to 60 days. This sets the time periods for mediation, the filing of motions, whether the judge will allow a hearing on the motions, and an actual trial period.

What’s The Difference: Negotiated Settlement Versus Trial?

The reality, according to disability attorney Greg Dell, is that only about 98 percent of these cases go through a trial and get an opinion from a judge. Why? The reasons can be complex, but a major driving force behind a client’s decision to settle is financial considerations. It’s already been a long road from initial claim filing to a Cigna denial, the ERISA appeal, and then the final denied disability claim. It could have already been nine months to a year since the client has been paid.

“There’s no money coming in. It’s a huge financial problem,” says Dell. “Our job when we get retained is, how quickly can we get the benefits reinstated or how quickly can we get to some kind of negotiated settlement to get this matter resolved?”

There’s also the possibility that the insurance company will prevail in a lawsuit and that the disabled client will end up with nothing. This reality is more serious than most people realize, primarily because the existing material in the client’s original claim file and appeal is the only evidence that the judge will ever see.

“You don’t testify. Doctors don’t testify. You’re not going to have a jury,” explains attorney Stephen Jessup. “The federal judge is going to review the information that’s in that claim file only. So, if you had new information that came about after that final denial, that’s not allowed for a judge to consider.”

As unfair as it sounds, that judge is going to determine only two things. One, does he or she think you’re disabled? And two, did Cigna have a reasonable basis to deny the claim? Based on what’s in that claim file, the odds are stacked in favor of the insurance company.

As dire as that may sound, Cigna does have something to gain from settling. They already know what happens when they go toe-to-toe with a Dell & Schaefer disability insurance attorney and that it won’t be an easy win, based on the firm’s vast experience fighting denied disability claims. Cigna also realizes that they’ll end up paying their own lawyers thousands of dollars to defend a lawsuit if they choose to go that route. By law, they are required to place a certain amount of monetary assets in reserve during an ERISA lawsuit, which ties up funds that can be released and reinvested after a successfully negotiated settlement.

What If You Win the Lawsuit?

Finally, the potential of winning a much larger amount of money in a trial verdict warrants consideration. But here’s the reality and the risks in an ERISA lawsuit, which disability insurance attorneys Dell & Schaefer help you evaluate. What most people don’t realize is that if you win that lawsuit, what you’re actually winning is your back benefits. You don’t automatically win the next 10 years that you’re owed in benefits, according to Greg Dell. Cigna can re-evaluate you any time after the lawsuit and send you to a doctor who determines that you’re better now and that you can return to work. Cigna could also appeal the judge’s ruling in your favor, which means you have to start the entire dispute all over again. By contrast, a negotiated settlement is a done deal and money in your pocket.

How to Move Forward Now

Now that you’re fully informed on how the process works and on the risks and potential rewards of an ERISA lawsuit, it’s time to move forward and get the entire ordeal moving toward final resolution. Just click the free consultation button on the or call for a direct conversation. The firm never charges fees or costs to represent you if a review determines that they can help you get a recovery in your claim. As claim partners, everyone wins from a successful resolution – and you can move on with your life in a positive way.

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This Week on DIAttorney.com (01/31/安徽福彩网app官方下载) https://www./安徽福彩网app官方下载/01/articles/disability-insurance-industry-news/this-week-on-diattorney-com-01-31-安徽福彩网app官方下载/ https://www./安徽福彩网app官方下载/01/articles/disability-insurance-industry-news/this-week-on-diattorney-com-01-31-安徽福彩网app官方下载/#respond Fri, 31 Jan 安徽福彩网app官方下载 18:38:23 +0000 https://www./?p=3227 Disability Insurance News:
Many employer welfare benefit plans offer employees who quit their employment the option of converting their disability insurance plan to a private plan. When a claim for disability benefits is filed, there may be a dispute over whether the conversion plan is governed by ERISA.

Frequently Asked Questions:
When the review of a registered nurse consultant complies with the mandate of ERISA and when it does not.

Disability Insurance News:
The Arizona Court held that U.S. Life had a reasonable basis for denying ABA Policy Holder’s total disability claim so did not breach its contract nor act in bad faith.

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Court Discusses Employer-Specific Positions Reliance LTD Decision https://www./安徽福彩网app官方下载/01/articles/disability-insurance-cases-nationwide/court-discusses-employer-specific-positions-reliance-ltd-decision/ https://www./安徽福彩网app官方下载/01/articles/disability-insurance-cases-nationwide/court-discusses-employer-specific-positions-reliance-ltd-decision/#respond Wed, 29 Jan 安徽福彩网app官方下载 16:37:46 +0000 https://www./?p=3224 Juanita Nichols worked as a Hazard Analysis Critical Control Point (HACCP) Coordinator at Peco Foods, Inc, a chicken processing plant in Sebastopol, Mississippi. As part of her job, she was regularly exposed to cold temperatures as chicken processing plants are required by federal law to operate much of their facilities under a certain temperature for food safety reasons.

In late 2015 and early 2016, Nichols was diagnosed with Raynaud’s phenomenon, a circulatory disorder. The condition meant that Nichols could develop gangrene if she continued to work in colder temperatures. On January 28, 2016, Nichols stopped working due to her limitations with working in the cold.

She applied for long term disability benefits through Reliance Standard Life Insurance 安徽福彩网app官方下载 (Reliance), the company that provided her employer’s ERISA plan. However, her application was denied, and she appealed that decision by filing a lawsuit with the Federal District Court in Mississppi.

Defining Total Disability and Regular Occupation in the Reliance Plan

The ERISA plan through Reliance required that she be considered “Totally Disabled” to get benefits. That means that she “cannot perform the material duties of [her] Regular Occupation” as of the date that the total disability began. The claimant’s “Regular Occupation” under the disability insurance policy is the way that the applicant’s job is “normally performed in the national economy.” The definition also specifically states that the occupation is not the way that the job is “performed for a specific employer or in a specific locale.” In this case, Nichols’ limitation exclusively dealt with her ability to work in the cold. She was not limited in any other way. As a result, the question became whether working the cold was a requirement based on her “Regular Occupation.”

Reliance’s Initial Evaluation and Denial

In their evaluation of the claim, Reliance obtained a copy of the job description for Nichols’ role as HACCP Coordinator. The information they obtained also include Sanitation Standard Operating Procedures and Good Manufacturing Practices Procedures for the plant. The job list and description did not include any indication that Nichols was required to work in the cold.

When Reliance compared Nichols’ duties to the Department of Labor’s Dictionary of Occupational Titles (DOT), it concluded that her regular occupation matched that of “Sanitarian.” The material duties of a Sanitarian did not include working in a poultry processing facility or exposure to the cold, however.

Reliance denied Nichols’ required for LTD because it concluded that she “retain[ed] the ability to perform the material duties of [her] occupation.” However, they also acknowledged that she could be exposed to cold temperatures and that her job required her to work in cold areas. Nonetheless, Reliance noted that working in the cold was specific to her particular job and employer but was not required in a Sanitarian position based on the “national economy.”

Nichols’ Appeal Focuses on the Reality of Her Position

Nichols appealed Reliance’s initial determination, noting that her condition prohibited her from working in cold environments and that any poultry plant across the United States was going to be below a certain temperature. Federal law required these lower temperatures, which meant that if she wanted to work in the poultry industry, she would have to be exposed to that type of environment.

The lower court agreed with Nichols, noting that her meat inspection and meat packaging duties would require her to work in the cold no matter where she worked. The Court stated that Reliance used the wrong DOT classification, concluding that it should have used “Cooler Room Worker (Meat Products)” rather than “Sanitarian.” The court also went on to note that Reliance has a history of denying reasonable claims and that the court should carefully scrutinize claims that are denied.

The United States Court of Appeals for the Fifth Circuit Reverses the Lower Court

Although Nichols won at the lower court, the U.S. Court of Appeals for the Fifth Circuit reversed the lower court’s decision and denied LTD benefits for Nichols in May 2019. In reaching its conclusion, the Court of Appeals focused on the environmental factors at a particular employer and compared them to working in the industry in general.

Specifically, the Court of Appeals noted that there was no way that Reliance could possibly guess what every person in every occupation does to determine what their material job duties are. They rely heavily on job descriptions from employers, vocational reports, and experts to determine what tasks a worker must actually complete in their particular industry, job, and position. The Court also emphasized the deference that it should give to the insurance company as part of its initial review of the claim.

The Court of Appeals took issue with the lower court’s decision, in part, because it classified Nichols under a different definition in the DOT on its own. Nichols did not argue that she should be considered a “Cooler Room Worker,” when she appealed Reliance’s denial. If she had made that type of argument, there is a real possibility that the Court of Appeals’ decision would have been very different.

This case highlights the importance of having the right information and arguments, even at the very first level of your long-term disability application. If Nichols has provided further explanation of what she did in her role as HACCP Coordinator, specifically the fact that she was required to work in the cold, the Court may have reached a different conclusion at the last level of appeal.

Dell & Schaefer did not handle this case, but the lessons that it teaches us are very important to virtually every disability benefits claim. If you need assistance with your long term disability application or appeal, contact the attorneys in our office to learn how we can help.

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United of Omaha Denial of Disability Benefits for Senior Manager Remanded by Appeals Court https://www./2019/07/articles/disability-insurance-cases-nationwide/united-of-omaha-denial-disability-senior-manager-remanded-appeals-court/ https://www./2019/07/articles/disability-insurance-cases-nationwide/united-of-omaha-denial-disability-senior-manager-remanded-appeals-court/#respond Tue, 16 Jul 2019 12:46:40 +0000 https://www./?p=3223 For approximately 16 years, Shirley Lacko was employed by BKD, Inc., an accounting firm. When her health issues forced her to quit her job, she applied for both short-term disability (STD) and long-term disability (LTD) benefits due to her numerous documented medical problems. At the time she stopped working on September 25, 2015, her position was that of Senior Manager in the Audit Department with an annual salary of $93,250.04.

The disability insurance group policies her employer provided to her were issued by United of Omaha Life Insurance 安徽福彩网app官方下载 (United). United initially approved her claim for STD from October 12, 2015, through November 22, 2015.

United informed her she would receive no benefits after November 22, 2015. United seemed to accept that Lacko had a plethora of medical problems, but it concluded that she failed to prove that these problems prevented her from performing a material duty of her regular occupation.

In making that decision, as it was allowed to do under the terms of the policy, United chose a job classification from the U.S. Labor Department Dictionary of Occupational Titles (DOT) to determine her “regular occupation.” The job classification it chose was “Manager, Department” with a generic job description suitable for an unskilled worker.

Meanwhile, the Social Security Administration (SSA) approved her claim for disability benefits. The SSA also chose a job classification from DOT after it conducted an in depth comparison of her actual job duties. It determined her regular occupation was that which required a skilled worker.

After United denied her claim, Lacko filed an administrative appeal which United denied. She then filed an ERISA lawsuit in the U.S. District Court for the Northern District of Illinois, Eastern Division. The District Court upheld United’s decision that Plaintiff had not proved she was disabled from working in her regular occupation. Plaintiff then appealed to the United States Court of Appeals for the Seventh Circuit.

In Shirley Lacko v. United of Omaha Life Insurance Co., the Appellate Court held that United did not properly consider Plaintiff’s job description or duties when classifying her job according to the U.S. Labor Department Dictionary of Occupational Titles (DOT). The Court remanded with instructions to United to reevaluate Plaintiff’s regular occupation classification, and to specifically consider the job classification used by the SSA in approving her disability claim.

United Erred When It Chose the Wrong Job Classification and Ignored Plaintiff’s Actual Job Description and Duties

The Appellate Court noted that Plaintiff based her claims for disability benefits on the combination of several impairments, “including but not limited to gastroparesis, diabetes, rheumatoid arthritis, congestive heart failure, breathing difficulties, anxiety, musculoskeletal impairments, and cognitive difficulties related in part to the medication needed to manage the other conditions.”

Plaintiff’s medical conditions were documented with physician statements and lab reports, X-rays, and MRIs. There was really no dispute over her actual ailments and United acknowledged her medical problems.

Plaintiff’s psychiatrist submitted a report based on medications Plaintiff was required to take and said that they interfered with her cognitive functioning. They psychiatrist stated that Lacko was incapable of performing an occupation that requires more than unskilled work. “Unskilled work for SSA purposes is work that ‘requires little or no judgment to do simple duties that can be learned on the job in a short period of time (30 days or less).’”

The record contained no mental or psychological evaluation that contradicted the psychiatrist’s report, and United never “challenged or questioned those findings.” The district court had agreed that United accepted the findings of Dr. Fritz, but that court failed to note that by accepting the findings of Dr. Frizt, this meant that the Plaintiff “possessed mental limitations that rendered her incapable of work other than unskilled work.”

On Remand, United is Required to Consider the SSA’s Job Classification in Order to Determine if Plaintiff Could Not Perform a Material Task of Her Regular Occupation

According to the United disability plans for both STD and LTD benefits, the Plaintiff was required to prove, among other things, that she was “prevented from performing at least one of the Material Duties of Your Regular Occupation on a part-time or full-time basis.”

When the SSA considered Plaintiff’s actual job duties of her regular occupation, it also used the DOT and considered the Plaintiff’s actual job description and job duties in order to determine the DOT classification that best fit Plaintiff’s regular occupation.

The SSA classified her position as “Accountants, auditors, and Related Occupations.” This classification recognized the job required “specialized administrative and managerial functions.”

The Seventh Circuit found that the SSA classification applied “to the audit and accounting managerial functions common to many organizations. Those appear more directly related to the Senior Manager position at issue here. They also more closely align with the job description for the position of Senior Manager in the Audit Department.”

This was an occupation requiring specialized skill. Since Plaintiff’s medical condition allowed her only to perform unskilled work, the SSA found that under its job classification, she was unable to perform a material task of her regular occupation which required skilled work.

The Seventh Circuit held that “because United failed to recognize and address the cognitive limitations set forth in the SSA decision, there is no reasoned basis in the decision to support the determination that Lacko was ineligible for disability benefits. The district court failed to address that deficiency in United’s analysis.”

The Appellate Court expressed some frustration with United, stating “on appeal, United continues in its selective characterization of the SSA’s decision.” In its brief, United argued that the SSA found that Plaintiff’s limitations “had not arisen to such level as to prevent her from participating in work related activities.” United left out the part that the SSA found she could participate in “work” only if the work was “unskilled work.” But, the SSA determined that she “lacked the ability to perform her past relevant work because it was skilled work.”

The Seventh Circuit reversed the district court finding that Plaintiff was not entitled to benefits since the district court, like United failed to recognize the significant distinction between skilled and unskilled work “which is controlling for the purposes here of determining her ability to perform the job of Senior Manager.”

If your disability insurance company is improperly classifying your regular occupation, or if you are having any other problem with your disability claim, contact one of our disability attorneys at Dell & Schaefer. We offer a free consultation and serve clients in all parts of the United States.

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Principal Life Insurance Denial of Disability Benefits for Lawyer with Migraines Upheld by Court of Appeals https://www./2019/05/articles/disability-insurance-cases-nationwide/principal/principal-life-insurance-denial-of-disability-benefits-for-lawyer-with-migraines-upheld-by-court-of-appeals/ https://www./2019/05/articles/disability-insurance-cases-nationwide/principal/principal-life-insurance-denial-of-disability-benefits-for-lawyer-with-migraines-upheld-by-court-of-appeals/#respond Tue, 21 May 2019 12:39:27 +0000 https://www./?p=3220 After working for a law firm as a healthcare attorney for more than seven years, Amanda Foster began having intractable migraine headaches, so she stopped working. She received long term disability (LTD) benefits from Principal Life Insurance 安徽福彩网app官方下载 (Principal) from September 4, 2013, until they were terminated effective December 9, 2014.

Foster filed two administrative appeals and submitted additional medical records. After Principal paid numerous physician reviewers, it denied her claim and found she was not disabled according to the meaning of her disability insurance policy. She then filed an ERISA lawsuit. That was decided in favor of Principal, so she appealed that denial to the Fifth Circuit Court of Appeals.

In Amanda Foster v. Principal Life Insurance 安徽福彩网app官方下载, the Fifth Circuit upheld the District Court’s denial of LTD benefits to Foster. It found substantial evidence supported Principal’s denial. Final Fifth Circuit decision: Appeal Denied.

Relevant Facts

In support of Foster’s claim that she was unable to work in her own occupation due to her migraines, she provided Principal her medical records as well as an attached report from her neurologist that said he advised her to “stop working” due to her headaches.

Principal hired four physicians to review Foster’s medical records. The first two doctors agreed that her daily migraines would keep her from working on a full-time basis, so Principal hired two more reviewers. The new reviewers both reported that her medical records did not support a finding of disability.

One reviewing physician stated that there was “no clinical evidence that demonstrates that Ms. Foster is functionally impaired.” He concluded that she could perform her sedentary job full-time.

Foster’s Administrative Mandatory Appeal

Foster filed a mandatory appeal with Principal. She submitted new medical records, test results for an MRI and EEG that were normal, report of an independent medical exam (IME), and a new letter from her neurologist who repeated his earlier assessment that “she was advised to stop working.”

Again, there was conflict with Foster’s treating physicians and Principal’s reviewing physicians. In addition, Principal’s surveillance on her showed her doing routine activities like grocery shopping and picking up her children. She also maintained a monthly online blog which showed her to have an “undiminished ability to write, focus, and concentrate as would also be required in her occupation.” Based on this evidence, her appeal was denied.

Foster’s Administrative Voluntary Appeal

A voluntary appeal followed the denial of her mandatory appeal. Foster submitted essentially the same evidence, with the independent medical examiner giving his opinion that she could not fulfill her duties as an attorney.
Principal again hired reviewing physicians and ordered an independent neurological exam (INE). That examiner found she had psychological problems, but determined there should be no impairment in her ability to carry out her tasks.

Since she had exhausted her administrative remedies, she filed an ERISA lawsuit alleging that Principal had abused its discretion by denying her LTD benefits. The lawsuit was decided in Principal’s favor by the U.S. District Court for the Eastern District of Louisiana. Foster appealed that decision to the U.S. Court of Appeals for the Fifth Circuit.

Court of Appeals Standard of Review

The Court of Appeals conducted de novo review of the district court’s decision which means it reviewed “the plan administrator’s decision from the same perspective as the district court” which was to determine if Principal had abused its discretion in denying Foster’s claim.

The Court explained that “Under the abuse of discretion standard, if the plan fiduciary’s decision is supported by substantial evidence and is not arbitrary and capricious, it must prevail.” It added that this is true “Even if an ERISA Plaintiff supports his claim with substantial evidence, or even with a preponderance, he will not prevail for that reason… rather, it is the plan administrator’s decision which must be supported by substantial evidence, and, if it is, the administrator’s decision ‘must prevail.'”

The abuse of discretion standard of review is an example of why it is so difficult for claimants to win their case against disability insurance companies in the courts. The deck is stacked against the claimant from the beginning. At Dell & Schaefer, we always do whatever we can do legally to convince the court to apply a de novo standard, which means the courts do not have to give deference to the decision of the plan administrator.

Appeals Court Finds Substantial Evidence Supported Principal’s Finding that Foster Was Not Disabled from Performing the Duties of Her Own Occupation

There were conflicting medical reports; however, all reviewing physicians were given a list of Foster’s specific duties as a healthcare lawyer. The Appeals Court acknowledged that Principal had a “light burden,” but concluded it met that burden.
Evidence given by the psychologist who conducted the INE was substantial. He did assess a range of skills Foster needed to use in her own occupation and opined she was not disabled from performing them. That was substantial enough evidence for the Court of Appeals to uphold that ruling.

Substantial Evidence Supported That Her Migraines Did Not Interfere with Her Ability to Work

Foster claimed that Principal abused its discretion by requiring objective evidence that she suffered from migraines. The Court disagreed. It said that it wasn’t objective evidence of the migraines Principal requested, but instead, for evidence that whether and to what extent those migraines functionally impaired her and interfered with her ability to perform the duties of her own occupation. Since there was substantial evidence that the migraines did not interfere with her ability to perform her job duties, Principal did not abuse its discretion by its LTD denial.

This case was not handled by our office, but if you have any questions about issues raised in this appeal, or any other aspect of your disability claim, contact one of our disability attorneys at Dell & Schaefer. We offer a free consultation.

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AIG Disability Insurance Claim, Denial, Appeal and Lawsuit Information https://www./2019/04/articles/disability-insurance-cases-nationwide/aig-disability-insurance-claim-denial-appeal-and-lawsuit-information/ https://www./2019/04/articles/disability-insurance-cases-nationwide/aig-disability-insurance-claim-denial-appeal-and-lawsuit-information/#respond Thu, 18 Apr 2019 20:21:47 +0000 https://www./?p=3217 Disability insurance claims attorney Gregory Dell discusses American International Group (AIG) short term and long term disability benefit claims and denials.

Mr. Dell discusses some specifics about his disability law firm’s experience in handling AIG disability benefit claims and information about disability policies offered by AIG. Mr. Dell covers the importance of “being prepared” when dealing with AIG and any other disability insurance company.

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