Frankel & Newfield, P.C.

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

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March 2014 Archives

Disability Claimants Suffer When non-practising Physicians Start Practicing Medicine

We were dismayed to read a news article about guidelines on pain medication use by a company that we have seen in many of our litigated cases. Equally disturbing was the fact that this particular group is now owned by an insurance company that we actually respect. Yes, there are insurance companies who stand by their contracts and do the right thing for their claimants - we don't write about them here because frankly, we don't see them in our practice often.

Federal Judge Remands Claim to Met Life for Full and Fair Review

A Federal Court in Louisiana has determined that Met Life failed to provide a long term disability insurance claimant with a full and fair review, where it denied the claimant's appeal for a different reason that the one articulated in the initial claim decision. The Court determined that the failure to provide a second level of administrative review under these circumstances amounted to a failure to provide a "full and fair" review under ERISA. The Court thus sent the claim back to Met Life to permit the claimant to pursue an administrative appeal of Met Life's new decision.

Court Refuses to Permit Filing In Disability Litigation Under Seal

A Federal judge in Kansas has refused a request by an insurer (UNUM) to permit the filing of what it classifies as "confidential" information under seal. The Judge correctly noted that the decision whether to seal judicial records is a matter left to the sound discretion of the district court. The Court noted that "the public has a common-law right to judicial records", a right the Court noted derived from the public's interest in the fairness and honesty of its court, and in understanding disputes that are resolved in a public forum. But, the Court also noted that "the parties' privacy interest in some information may overcome the public's right."

NBA Referees Have Disability Issues too

In a decision from the United States Court of Appeals for the Second Circuit, the Court reversed a decision on a disability matter that is interesting for its fact pattern as well as result. An extreme simplification of the decision: because of specific tenants of law in Pennsylvania, if an insurance agent makes representation about a policy and says it provides certain types of coverage that is later found to be inconsistent with the policy, the insured is entitled to that coverage. It does not matter whether or not the insured's actually read the policies to ensure that the coverage was in place.

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