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Disability Insurance Blog

Pogue v. Northwestern Mutual Life Insurance Company - Licensed Professionals Be Warned

A recent case heard in the appellate court of Tennessee sends a chilling message to physicians or any licensed professionals who need to file a claim on their disability policies and have licensing issues which may impact their continued ability to practice.

Dr. Pogue, a physician who practiced in Nashville, Tennessee, owned three private disability insurance policies with Northwestern Mutual Life Insurance (Northwestern). He submitted a claim to Northwestern, stating that he suffered from a severe anxiety disorder, had experienced a total nervous breakdown and could no longer think clearly enough to practice medicine. He said that he had surrendered his medical license.

The importance of disability insurance for physicians

Here at Frankel & Newfield, PC, we represent doctors across the country when their disability insurers deny their claims or prematurely terminate their disability payments. The practice of medicine is both physically and mentally demanding, with long hours, stressful situations, life-and-death decision making and potential exposure to radiation and chemicals. For these reasons, unexpected disability and an interruption of salary is not unexpected. 

Doctors can be financially vulnerable 

Unfairness inherent in disability-insurer use of doctor rosters

When someone buys disability insurance or joins a group disability policy at work, he or she deserves to be financially protected should injury or illness interrupt the ability to work and earn a living. Accordingly, when it becomes necessary to file a claim under his or her disability insurance policy for benefits, it should be enough proof for the insurer look at the claimant’s medical records from treating physicians as well as other objective medical evidence like lab tests, X-rays or other kinds of scans, depending on the condition. 

Unfortunately, disability insurers regularly pay doctors who do not treat claimants to either conduct independent medical examinations, called IMEs, or to conduct paper reviews of the medical and other evidence in the file and express an opinion on disability. (Whether an insurer may force a claimant to attend an IME usually depends on the terms of the insurance contract.)

Part 2: More about disability-insurer claimant surveillance

Today we continue our discussion of insurance company use of physical and online surveillance of disability-insurance claimants in an effort to find evidence that might discredit claims of injury and illness. If a picture, video or social media post suggests that a claimant can do something in his or her personal life that is inconsistent with his or her impairments, the insurer may use it as a basis to deny a claim, sometimes even when the person's treating doctors and objective medical evidence say otherwise.

Not only is it disconcerting to have surveillance evidence used against you out of context, but also being tailed by a vehicle wherever you go or having a surveillance van sit outside of your house for hours can be frightening.

Part 1: Questionable disability-insurer surveillance of claimants

We recently told you the story of a Canadian writer whose disability insurance provider reportedly denied his claim for benefits based on depression. In that post, we described a Toronto Star article about an allegation that the insurer in that case had used as evidence pictures posted on social media that showed the claimant looking happy. We have had a client had this happen to them in the past on a claim for depression, where the claimant was seen "smiling" on surveillance.

Even a layperson knows that having clinical depression does not mean that a patient never smiles or does not spend time with loved ones such as at family gatherings. In fact, many medical professionals who treat depression are likely to tell patients to try to participate in life when they can because it is good therapy for their disease.

Senators Target Aetna's Review of Health Insurance Claims

Frankel & Newfield have battled Aetna and other disability insurance companies when claims have been denied with no apparent regard for the support provided in the claimants' medical records for years. Now it seems that two Senators, Ron Wyden, (Oregon-D) Ranking Member Senate Committee on Finance and Patty Murray (Washington-D) Ranking Member, Senate Committee on Health, Education, Labor and Pensions, are taking up the issue.

The role of social-media evidence in disability insurance claims

Canadian media has exploded with a story that broke a couple of weeks ago about a well-known Canadian writer and professor whose disability insurance claim for depression was denied after he took a leave of absence. According to the Toronto Star, the author’s physician informed him that the disability insurer had denied the claim after viewing pictures on social media in which he looked happy and active. 

Treating physician opinions important 

Study shows link between TBI and long-term disability, dementia

People can suffer a traumatic brain injury (TBI) for a variety of reasons, including car crashes, sporting accidents, falls from heights and more. In fact, TBIs are a leading cause of long-term disability in our country. In fact, in 2013, over 2.5 million people in the U.S. sought emergency room care or were hospitalized for a TBI.

TBIs can be disabling for a number of reasons. A TBI can impair one's thought processes, making it difficult to remember things. It could also affect a person's ability to function emotionally. Even more concerning is a recent study that suggests TBIs could also increase the chance that the victim might one day develop dementia.

Exploring the basics of disability insurance

People have health insurance to cover their medical expenses when they are injured or ill. However, what happens when a person becomes disabled and cannot earn an income for a significant period of time? It won't take long for a person to burn through their paid sick leave and vacation time. Health insurance covers medical expenses, but it does not reimburse a person for the income lost when a medical condition keeps a person from working for an extended period of time. That is when having another type of insurance is important: disability insurance.

Disability insurance plans fall under two categories when it comes to covering a person's lost income: "own occupation" and "any occupation." An "own occupation" plan will provide benefits to those who are unable to continue working under their specific job. Therefore, a person may receive benefits if they can't perform their current job, even if it is possible for them to do a different type of job. An "any occupation" plan, on the other hand, only provides benefits if the policyholder is unable to perform any type of work whatsoever. Therefore, if a person is able to perform a different type of job, he or she may not get benefits.


In a stunning admission, a former medical director for Aetna admitted, under oath, that he never looked at patients' records when deciding whether to approve or deny care, according to an exclusive news report from CNN. Dr. Jay Ken Iinuma, who was medical director for Aetna from March 2012 - February 2015, made this admission during a deposition in an insurance coverage lawsuit.

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