Frankel & Newfield, P.C.

We Have Recovered Over $100 Million In Claims For Our Clients

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December 2010 Archives

Long Term Care Policy Challenges

Long term care insurance policies, marketed heavily in recent years as a way to protect older persons and provide financial benefits where they are no longer able to care for themselves, have seen a poor claims history, and insurers are reacting aggressively.

2010 Group Disability Market Survey Results

The 2010 mid-year summary of Group Disability Market results offers some interesting insight into the marketplace for LTD benefits. This survey is published by JHA - a division of Gen Re, a Berkshire Hathaway company. This report is largely published for the insurance industry, but the information is significant to those on the front lines of battle, representing claimants on a daily basis.

Critical Illness Insurance - Cause for Concern?

It has been suggested by industry insiders that the demand for critical illness insurance will be a major growth opportunity in 2011. This type of insurance typically pays a lump sum benefit following diagnosis. It is marketed as a supplement to typical disability insurance, to help cover medical bills and other needs.

LONG TERM DISABILITY INSURANCE IS NEVER A DO-IT-YOURSELF PROJECT

If you spend any time on the Disability Insurance Forums, you'll learn first-hand how badly the disability insurance companies treat their claimants, and read heartbreaking stories about women and men who simply want to be treated with honesty and decency. There are a handful of challenges that are repeated year in and year out. Let's address some of them:

CIGNA Caves on Administrative Appeal

CIGNA had attempted to terminate our client's claim for long term disability benefits, a claim in which they had previously terminated, only to voluntarily reinstate benefits while in litigation, back in 2008. Two years later, CIGNA again made efforts to terminate the claim, on the purported basis that our client's treating physicians no longer supported her impairment.

Insurer Acted Improperly In Rejecting Claimant's Medical Support

Another court has offered insight into how to determine when a claim administrator acts in an arbitrary and capricious manner. A Federal Judge in Michigan determined that Sedgwisk, a third party administrator of claims for General Motors, abused its discretion, by adopting the opinions of a hired medical reviewer, over the well supported opinions of the claimant's treating providers. The Court found the hired doctor's opinions to be conclusory, failed to properly consider the objective support for the claimant's impairment, and lacked substantial support. Another factor noted by the Court was the fact that the hired doctor submitted an addendum at the urging of Sedgwick, deciding that such supplemental report was entitled to very little weight, as it was clear that the second report was issued to satisfy the requests of the insurer.

A DIRE WARNING .... AND NOT UNEXPECTED..... ABOUT DISABILITY INSURANCE

Peter Orszag, director of the White House Office of Management and Budget from 2009 to July 2010, a distinguished visiting fellow at the Council on Foreign Relations and a contributing columnist for The New York Times has shared his thoughts on what he considers one of the key challenges facing our weakened economy - the long-term unemployed workers who give up looking for work, in some cases, permanently, and who apply for disability insurance where, in a robust economy, they might have continued to stay in the work force.

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