No Professional Courtesy In Long Term Disability Insurance Conflict
Friday, July 22nd, 2011
When an insurance executive at one of the world’s biggest insurance companies filed a disability insurance claim, she expected that there would be some degree of professional courtesy. Our client, a 52 year old Business Continuity Manager at a global insurance company, never imagined that an insurance company would treat her badly, so she took on the task of filing for long term disability insurance by herself.
Despite her years of experience and her senior status in the insurance field, she was just another claimant to Hartford Insurance and more particularly, to MES Solutions, the company that Hartford uses to terminate client benefits. Whenever we hear of an IME being conducted by MES Solutions, we know that the claimant is about to be denied, and this was no exception. How do we know that MES Solutions is not exactly independent? Simple – MES Solutions received lots of money and repeat business for the “independent” medical examination and review of records.
Our client suffers from multiple disabilities, including Fibromyalgia, insomnia, chronic pain, myofascial pain syndrome, carpal tunnel syndrome, ulnar neuropathy, Addison’s disease, depression, anxiety, metal toxicity, degenerative disc disease of the lumbar and cervical spine, and failed back surgery syndrome.
Hartford terminated her claim on October 5, 2010, well before the two year own occupation period had expired, and in March of 2010, Hartford reviewed her file for a possible settlement. The medical review was paired with an occupational analysis that might have suited someone who sits at a desk all day long and plays online poker. But that’s not what our client did.
As a Business Continuity Manager for an international insurance company, our client’s responsibilities were challenging and demanding. She evaluated and certified business continuity and emergency/incident management programs for major companies. Her tasks involved complex audits, analysis, subject matter expert (SME) recommendations, and certifications for all available documentation for each critical company against a set of industry best practices and the insurance company’s own legal and fiscal standards.
That was just the start. She was also charged with project development support for emergency/incident response programs for the Middle East, Mediterranean and African regions with 17 countries across various, unrelated business lines, functions, and companies from insurance, financial services, to credit card and trading operations.
The cognitive demands of such a challenging position require an individual to have extremely high-level analytical abilities, reasoning and analysis which takes place on a level more like that of an extremely gifted scientist conducting complex research. Our client’s disabilities rendered her unable to think clearly, and she was no longer able to perform the duties of her occupation.
We were contacted when our client realized that while she might have had a chance in the battle when she was at the top of her game, her present condition made any success unlikely. Frankel & Newfield had to act quickly, as we came into the case when time was extremely short, and won the appeal. Our client is now being paid benefits of her own occupation policy and we continue to monitor her situation.