FRANKEL & NEWFIELD WINS FOR PRINCIPAL LONG TERM DISABILITY POLICY HOLDER DENIED EVEN THOUGH IN-HOUSE DOCS SAY HE IS DISABLED
Thursday, August 5th, 2010
Our client has an orthopedic disability that exacerbated an existing psychiatric disability, which became so devastating that he was no longer able to work. His significant ankle problems (diagnosis of tarsal coalition and osteoarthritis of the foot) created a condition of intense chronic pain, which magnified a clinically diagnosed obsessive-compulsive disorder and major depression and anxiety.
He had a long term disability insurance policy with Principal, and after two years of being on claim, Principal cut off his benefits and declared that he could work in another occupation.
Our client had been the owner/operator of a convenience store. The specific tasks of his “job” included everything from forecasting sales, ordering products, managing employees, bookkeeping, stocking shelves, marketing, and all the tasks of a business owner, plus everything that his store employees did – from making coffee to cleaning the floors to selling lottery tickets.
He was compelled to undertake a psychiatric IME (Independent Medical Exam) despite the fact that Principal’s own in-house psychiatrist said that a medical records review alone supported his claim of disability.
Usually the in-house physician is the first to agree with a claims manager that a disabled person is fit for work. It was not a cheap exam either -Principal paid more than $5,000 for the exam – and much of the report was supportive of his disability. Principal ignored that.
The psychiatric IME was followed by a vocational assessment, which we discovered had been done using many outdated resources, including the GOE – Guide for Occupational Exploration – a guide published in 1979 and based on research conducted in the 1960s that is used primarily by high school guidance teachers to help teenagers determine possible career paths.
After the psychiatric and vocational exams were done, the next tactic was the use of surveillance. The videotapes clearly showed that our client was disabled. Principal actually tried to redact all references to the surveillance in the claim file.
We worked closely with our client to obtain good supporting statements from family members and strong narrative reports from his treating psychologist and psychiatrist. Our client is back on claim and receiving benefits on a regular basis.