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First Reliance Standard Denies Doctor, We Fight Back and Overturn Denial

Tuesday, October 26th, 2021

A 60-year-old internist for a large well-known New York-based hospital suffered from multiple degenerative spinal conditions. Her conditions became progressively worse, and it became increasingly difficult for her to hide her daily pain and discomfort from patients. For her own safety and the well-being of her patients, her doctors recommended she stop working.

She owned several disability policies, including individual disability policies with Northwestern Mutual and Unum, along with a group disability policy through her employer with First Reliance Standard.

She understood the risk of trying to file a claim on her own and began researching disability law firms. Following a consultation with partner Justin Frankel, she retained Frankel & Newfield to file her disability claims and protect her interests.

The team at Frankel & Newfield got to work in developing the medical and vocational support needed, tailored to her specific disabling conditions, and addressing the details of the occupational requirements as a physician.

Shortly after filing each of her applications for long term disability, Northwestern Mutual, Unum and First Reliance Standard approved her claims, finding her totally disabled and unable to practice as a physician and began paying her long term disability benefits.

Two years later, her claim transitioned to the “any occupation” phase. There were no changes to her claims with Northwestern Mutual and Unum, both unilaterally opined she was incapable of returning to work.

But First Reliance Standard claimed she was no longer eligible for disability benefits and her benefits were terminated. The team at Frankel & Newfield worked diligently in developing a plan to aggressively attack the insurer for their adverse benefit determination.

On appeal, our client obtained the necessary testing to refute First Reliance Standard’s wrongful determination. We worked closely with her physicians in developing narrative reports outlining the degenerative nature of her conditions and specifically delineated her restrictions and limitations and inability to work in any occupation. After receiving the necessary medical support, we engaged a vocational expert to conduct an interview and assessment of her claim which objectively demonstrated her inability to perform any occupation.

Following the submission of her appeal, First Reliance Standard requested that she undergo a purported independent medical evaluation (IME).

The firm only agreed to the IME after securing specific requirements from the insurer that allowed us to provide information to the IME doctor, the ability to respond to any reports drafted by the IME doctor and allowed our client to have a witness present during the examination.

Following the IME, we received an unfavorable report of our client. Upon cross-checking the IME doctors report with the findings of the witness present during the examination, the findings of the IME doctor were polar opposite and wholly inaccurate.

Because we reserved our right to review and respond to any reports drafted by the IME doctor, we undercut each of his findings with an affidavit prepared by the witness.

Our strategy proved successful when we received a letter from First Reliance Standard reinstating our client’s claim.

To this day our client remains on claim with First Reliance Standard, Northwestern Mutual and Unum, receiving benefit checks each month. Our client now has the peace of mind she deserves and can focus on her health.

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Frankel & Newfield does not currently handle any Social Security Disability Insurance claims.

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This is about a Social Security Disability claim.

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