ERISA Appeals for Long Term Disability Insurance Policies

AENTA DENIAL FOR CHRONIC FATIGUE SYNDROME PATIENT IS REVERSED

After a diagnosis of Chronic Fatigue Syndrome (CFS) and fibromyalgia in his late 30's, our client spent more than fourteen years fighting to keep working. To us, that is a sign of determination and commitment.

Aetna denied his claim. Their attitude - what had changed that led him to file a claim now, when he had managed his conditions for so long?

The cumulative effects of his conditions over time had simply become too much. In addition to Chronic Fatigue Syndrome and Fibromyalgia, he suffered from muscle twitching and severe muscle spasms, sleep problems (insomnia, non-restorative sleep), headaches, and costochondritis (rib pain), chronic widespread pain from the Fibromyalgia, severe fatigue, and the cognitive side effects of his medications.

As Chief Financial Officer for a large retail furniture store, our client was responsible for directing and coordinating all financial affairs, negotiating contracts, preparing and analyzing budgets, and preparing complex reports. This position required strong cognitive skills and a high level of performance.

Aetna relied upon cognitive testing to claim he was malingering. We developed an aggressive attack that brought together reports from many health care providers, including therapists, who proved their observations of deteriorating cognitive and memory skills, paired with other doctors who supported this position.

We were successful in getting him the payments that he should have received when the claim was initially filed, and he is being paid on claim, as he originally should have.

Hartford Disability Benefits Reinstated

Our client was a Global Product Manager with a large international bank and suffers from a painful orthopedic condition that makes it impossible for him to keep up with a highly demanding job. Hartford started with a peer review, where an outside company hired by the insurance company engages paper reviewing doctors to perform a review our client's medical records – not the patient, just the records, and only parts of the medical records. We prepared the medical records to make sure the medical record reflected his condition and the severe limitations that his condition created. Our doctors swiftly and thoroughly rebutted the insurance company doctors' claims. The paper reviewing doctor's opinions were slanted to give the insurance company only what it wanted, and not the unbiased and honest review that they are allegedly hired to provide. Next, we forcefully attacked their surveillance, proving how Hartford and other insurers manipulate surveillance videos. Our client's claim has been reinstated, and he received full back benefits and reinstatement to his employer's other employee benefits.

Successful ERISA Appeal Against Prudential

A Vice President working in a global financial company had a disability insurance policy from Prudential was a policy that matched her high income level. Because of severe orthopedic conditions, including coccydydnia and lumbar radiculopathy, she is unable to sit in a car or at a desk, and intense pain makes it impossible for her to perform at the levels necessary in her position. Prudential first delayed, then denied her claim. We know that her disability was real – Prudential simply did not want to make such a high payout. When Prudential brought in an insurance doctor who we know is hired only when the claim is serious and expensive, Frankel & Newfield was ready. We fought back with a powerful rebuttal to the peer review that won the appeal. Today our client is receiving regular payments, and we continue to work with her to protect her interests.

Frankel & Newfield Reverses Insurer seeking to Apply Limited Pay Period to Claim

Issue:
Assurant sought to limit the period of coverage to our client on the purported basis that she suffered from a mental and nervous disorder, rather than from a severe auto-immune disorder, Undifferentiated Connective Tissue Disease (UCTD).

Result:
Working with the client and her doctors, we strongly rebutted the evidence Assurant had gathered and successfully navigated the IME process to demonstrate entitlement to benefits from a physical condition.  Now, the client will be paid benefits under her physical condition with no limitations for mental and nervous disorders.

Frankel & Newfield Secures Reinstatement of claim terminated for M&N

Issue:
Our client's claim had been terminated by Hartford based upon the limited pay period for mental and nervous conditions, despite suffering from a multitude of physical maladies.

Result:
In an administrative appeal, we were successful in having Hartford acknowledge the severity of the physical impairments and reinstate benefits and pay all benefit arrears.  Our client, a former attorney, is now back on claim receiving her monthly benefits.

Frankel & Newfield Succeeds on Liberty Mutual Appeal

Issue:
Liberty terminated our stock broker client's claim, despite continuing to suffer from severe co-morbid conditions.

Result:
F&N utilizes a vocational expert to soundly deflate the arguments raised by Liberty Mutual, and forced Liberty Mutual to recognize the scope and severity of our client's impairments.  Our client's claim was reinstated and he is back receiving his monthly benefit of over $12,000 a month.

Frankel & Newfield Secures Reinstatement for Insurance Sales Agent

Issue:
The Standard terminated our client's claim, determining that despite a myriad of health problems, she was not impaired from her own occupation.  Based largely upon a paper review of the medical records, the claim was terminated.

Result:
We developed strong support from the treating doctors, and articulated how and why the client could not succeed vocationally, and secured the reversal of the claim determination.  The client is now being paid all benefit arrears.

Frankel & Newfield Successfully Appeals Terminated Claim

Issue:
Our young client's disability claim for $ 26,000+ per month was terminated after being paid benefits due to suffering from degenerative disc disease.

Result:
On administrative appeal of the claim determination, we convinced Met Life that our client remained disabled, securing him the reinstatement of his benefits and the payment of benefit arrears of over $ 134,000.

Frankel & Newfield Secures Reinstatement of Benefits

Issue:
Our client's disability claim was terminated when Prudential determined that she no longer was disabled after 11 years of benefits while suffering from fibromyalgia and other ailments. Prudential relied upon the results of an FCE to support its claim decision, and rejected the prior appeal of our client's previous attorney.

Result:
We submitted a powerful appeal on her behalf, attacking the FCE findings and compelling Prudential to reinstate the claim and paid all back benefits to our client.

Frankel & Newfield Convinces Hartford to Reopen Process and Pay Benefits

Issue:
Our client came to our firm after his administrative process had been closed, and was advised that he had no recourse left but to commence litigation. He was suffering the effects of post-cancer limitations, and Hartford refused to accept his inability to perform his own occupation.

Result:
We successfully prevailed upon Hartford to accept additional support for the claim and convinced Hartford that our client was unable to perform his job or his occupation. Hartford issued benefit arrears and continues to pay our client.

Frankel & Newfield Proves that Disability is from Physical Condition

Issue:
Our client's disability claim was being wrongfully subjected to a limited pay period for a mental and nervous limitation, when she had strong evidence supporting her severe orthopedic problems. This required the firm to file an ERISA appeal of the claim determination, and develop further support for her claim.

Result:
We convinced Fortis that our client remained disabled from a physical condition, allowing her benefits to continue until she reaches the maximum benefit period under the policy.

Frankel & Newfield Secures Reinstatement of Benefits

Issue:
Our client's disability claim was terminated when Prudential determined that the severe heart disease of our young client (age 45) was not disabling him from his occupation as a broker. We needed to file an ERISA appeal of the claim determination and convince Prudential that his condition and the resulting restrictions and limitations prevented him from engaging in his own occupation.

Result:
Prudential reinstated the claim and paid all back benefits and is paying $ 8,625.00 monthly to our client.

Frankel & Newfield Succeeds in Reinstating Benefits for Bipolar Disorder

Issue:
CIGNA refused to acknowledge our client's bipolar disorder was disabling him from his job as a Investment Strategist earning over $ 500,000 per year.

Result:
Our appeal of the denied claim resulted in the acceptance of the claim with payments of benefit arrears.

Frankel & Newfield Succeeds in Reinstating Benefits

Issue:
CIGNA denied our client's claim that she was disabled from her occupation, despite her having severe orthopedic injuries and multiple surgeries.

Result:
By highlighting the numerous and profound claim handling mistakes, we were able to persuade CIGNA to reverse its claim decision and provide benefits.

Frankel & Newfield Succeeds in Reinstating Benefits

Issue:
Broadspire terminated our client's claim, despite the presence of multiple disabling conditions, after having paid our client for several years.

Result:
By working with our client and his treating physicians, we successfully appealed the denied claim, demonstrating that our client's conditions prevented him from performing the duties of any gainful occupation.

Frankel & Newfield Secures Reversal of Claim Termination

Issue:
Our client had been on claim for several years with Jefferson Pilot, under an own occupation definition of disability. Jefferson Pilot terminated the claim on the basis of an IME and a paper reviewing report.

Result:
Our attack on the validity of the findings utilized by Jefferson Pilot to terminate the claim and our attack on the processes employed resulted the reversal of the claim termination and the reinstatement of monthly benefits of $ 11,000 monthly.