Disability Insurance Blog



Thursday, April 21st, 2011

Late night television commercials sell life insurance, boasting that no medical exam is required. How about a disability insurance company that doesn’t need a medical exam – in this case, to deny a claim? Maybe these companies need to get together….

Our client is a CPA whose conditions, which include Fibromyalgia, Chronic Fatigue Syndrome, chronic sinusitis, hypothyroidism, depression and anxiety, ovarian dysfunction, endometriosis, torn superior labrum, degenerative disc disease, migraine headaches, failed back surgery syndrome, facet arthritis, foraminal narrowing, and chronic pain, were too debilitating for her to perform in the duties of her job. Key issues driving this matter -lack of a proper medical review and a complete failure to accurately assess the tasks and duties of her occupation.

The doctor who did the peer review works for a company whose sole function is to review medical claims on behalf of insurance companies. Their reviews are supposed to be independent, but the company’s only clients are insurance companies. The physician was not well versed in any areas of the client’s numerous disabilities. Most outrageously, the doctor never examined the client in person, even though the policy gives the right for the insurance to do so.

Prudential relied on a generic classification of the client’s job as a desk job and totally ignored the strenuous cognitive demands of a CPA. We have seen this same tactic time and time again – an occupational review based on an outdated document – the DOT (Dictionary of Occupational Titles). The DOT is completely useless for a service-based economy, but the insurance companies continue to use it, as it works to their benefit in claim disputes.

Prudential failed to afford the client a full and fair review of her claim, failing to consider her credible subjective complaints, selectively reviewing the medical records, failing to conduct an appropriate vocational analysis, and failing to act as a neutral fiduciary. Rather, Prudential acted as an interested party influenced by its financial stake in the claim.

We fought back, with a vigorous appeal denouncing Prudential’s irresponsible medical review, occupational review and failure to act as a disinterested party. We won – and now our client is able to focus on taking care of her health challenges and not fighting with a massive insurance company that was determined to deny her claim.

If you are a professional who has become disabled, do not accept the denial based on an inaccurate evaluation of the tasks and duties of your career. Call our office today and learn how we can help you fight back.