Disability Insurance Lawyer Blog

How to choose a disability insurance lawyer

Fri, 11 May 2012 08:57:57 -0500

Choosing a disability insurance lawyer to represent your claim when it has been denied or delayed or when you want to find out about a lump sum settlement is not always easy.

Justin Frankel and Jason Newfield have been representing disability insurance claimants for decades and have seen many lawyers enter the field in recent years. Here's what you need to know to make a smart selection of someone who is going to represent your legal needs:

• How long have they been practicing in the area of disability insurance law?

• Do they represent ONLY plaintiffs, or do they represent insurance companies also?

• How many lump sum settlements have they succeeded in obtaining for clients?

• What's their track record against the big companies, like CIGNA, MetLife and
Hartford?

• If you have a UNUM policy, do they know the company's history or have some involvement with the class action lawsuit that took place in the late 1990s?

• Do they do the actual work, or will you be passed along to another law firm or to a junior associate?

• Do they speak before professional groups, including other lawyers?

• Are they rated by Martindale-Hubble®, and what is their rating?

• Are they a Super Lawyer?

• Have they been singled out as leaders by any local organizations?

Disability insurance law is complex and challenging, even to other lawyers. If you have any questions about how to choose a disability insurance lawyer, call our office. We have practiced in the disability insurance law arena for many years, and believe that our insight can help you make the right decision.

Social Media and Investigations

Mon, 07 May 2012 20:00:12 -0500

We are big believers of the adage "keep your friends close and your enemies closer." So when we found a law blog, or "blawg" about insurance coverage, we were all ears. Like our own blog, this one has been named a Best Insurance Law Blog by NexisLexis, and like also us, they see the value in using blogging to share updates and news in their practice area.

For years we have advised clients and our blog readers that if you are on claim or if you are considering filing a long term disability insurance claim, be extremely careful about their FaceBook, Twitter, YouTube, Pinterest and any other social media activities. The blogger, New York Insurance Coverage lawyer Roy A. Mura, Esq., wrote an article that appeared in Claims Magazine/Property Casualty 360° and we think this paragraph says it all:

Search engine result pages are now replete with numerous examples of insurers having successfully utilized social media content in insurance claims decisions. From the denial of further long-term disability insurance benefits to the recovery of a paid but fraudulent auto physical damage claim, insurers have found that social media content can in some cases provide the means of determining whether a claim is legitimate or not. The potential usefulness of social media content can extend beyond the point in time when the claim decision is made, as such useful content sometimes appears after payment is made and well within the applicable statute of limitations for an action to recover such payment. (Emphasis added)

To read the entire article, click here.

If you have questions about your social media life and how it may impact your claim, call our office to learn how we can help.

CIGNA Denies Fibromyalgia Claim, We Win It Back

Wed, 02 May 2012 12:14:33 -0500

Our client suffers from Fibromyalgia, Chronic Fatigue Syndrome (CFS), and Lyme disease, among other co-morbid illnesses. She is 34 years old and had previously worked for a Native American organization as a Career Development Assistant. Even though her title was an 'assistant,' she worked hard and took great pride in knowing that her efforts made a difference in the lives of the people she worked with.

When she could no longer perform the tasks required by her occupation because of the chronic pain, debilitating fatigue, lack of energy and the overall cognitive impairment that now lives with on a daily basis, she filed a claim for disability coverage.

Unfortunately, CIGNA did not share her dedication and her medical review was seriously lacking. CIGNA assigned her claim to a nurse, who reviewed her medical records on paper only. The nurse never met with her in person or spoke with her on the telephone. The nurse also never spoke with any of her many medical providers.

Her occupational review wasn't much better. CIGNA took a limited look at the duties and tasks of her job. According to CIGNA, she had a desk job that required very little physical or mental exertion.

CIGNA denied her disability claim. She retained Frankel & Newfield to help her fight for her disability insurance benefits.

We tackled her appeal with a vigorous approach. We worked closely with her medical providers to present a very clear and accurate report on the specific physical and mental limitations that kept her from working. We also attacked CIGNA's poor review process, pointing out the many discrepancies and weaknesses in its initial review of the claim.

Given the substantial medical support we obtained for our client's disability, coupled with the glaring issues with CIGNA's initial analysis, we were successful in getting CIGNA to overturn their decision, and our client is currently receiving her benefits.

Lump Sum Buyout of Disability Benefits

Thu, 26 Apr 2012 10:08:25 -0500

After years of worrying about having a claim terminated or living with the intrusions of field visits and required medical exams, some claimants prefer to obtain a lump sum buyout of their disability insurance benefits. This is the phrase used to describe the payout of the remaining disability insurance policy in one lump sum payment.

A lump sum payment is helpful for individuals and families who are able to manage the money in a planned manner. In a perfect world, the claimant invests the money so that it generates a steady income. The freedom from worry allows claimants to focus on getting better, if that is possible, or at least lessens the worries about the intrusive nature of on-going investigations from insurance companies.

Other times, an insurer will approach a claimant who has been on claim for years, and unilaterally offer a buy out of the remainder of the policy, at a steep discount
.
Still other times, insurers will create a situation whereby they suggest a claim is going to be terminated, but prior to termination, will be interested in pursuing a compromise of the claim.

Can you get a lump sum buyout of your disability benefit payments? It depends upon a host of factors.

These different scenarios all present different dynamics for a claimant, and cry out for assistance from an experienced disability insurance attorney. Given the value of the entire policy, and how dependent many claimants are upon receipt of their benefits, it is wise to consult with an experienced disability insurance attorney who has experience negotiating and obtaining lump sum buyouts.

What to do when they knock on your door

Fri, 20 Apr 2012 13:05:23 -0500

Claimants are vulnerable to the men and women who come to their homes for what are politely called "Field Visits." After weeks, months or years in the isolation of disability, the idea of a visit from an adult who is interested in their condition seems like an opportunity to have a friendly chat. But that's the last thing on the field representative's mind.

Field investigators are hired guns, professionals who are paid for their interviews and reports, and whose only loyalty is to the insurance company. They are hired for their deductive and analytical abilities. They may seem friendly and genuine, but any field visit should be seen for what it is - an information gathering session, no different than an EBT - examination before trial.

Consider the conversation that would take place between a field service representative and a home-bound individual being treated for a debilitating and chronic condition. Chances are the disabled individual is on medication or may be in a state of chronic pain that makes clear thinking difficult.

Compare the disabled individual to the field representative - who is being paid an average of $1,000 for each home interview and who has a skill set that is rewarded by finding reasons for the insurance company to deny a claim. The claimant doesn't stand a chance. Field reps are masters at using the same kind of tactics as hard-driving sales people - leading questions, getting agreements in a series that lead to a conclusion, matching behavior, pretending to be peers and even friends. And don't forget about the "observations" these field representatives will form about you based upon the way your home is kept, or your ability to sit with them for any extended period. It's a shoddy situation. Some may call it sleazy. We call it deceptive and unprofessional.

If you are on claim and a field rep knocks on your door, tell them that you require at least 30 days notice from the insurance company itself before agreeing to a meeting at your home. Here are a few other pointers:

• Your policy may not require you to meet with a field representative.
• Don't believe their verbal assurances that "it's okay for us to talk." It is not in your best interest.
• NEVER meet with a field representative without a family member, trusted friend or your attorney present.
• Do not answer questions from a field representative without the assistance or representation of an attorney.
• If you are too sick to have an interview, contact your attorney and your primary care physician and have them write a letter stating that your condition does not allow for such an interview. Work with your attorney to make sure it addresses any requirements from your long term disability insurance contract.

Just like the scam artists who prey on the loneliness of the elderly, the field representative uses their knowledge of your situation as an isolated individual to obtain the information that will, if at all possible, be used against you. And given the skill set of the field representatives, it would be hard for them to leave your home without something that can be used to deny your long term disability insurance benefit.

Disability Insurance: Private, Group, Association

Thu, 05 Apr 2012 17:10:30 -0500

Chances are, if you are reading this blog, you are either having a problem with your disability insurance, or concerned that you may be about to have a problem. Most disability insurance policies fall into one of these three categories: private, group and association. If you don't know which one you have, now would be a good time to find out. Here's why:

Private or Individual - purchased as an individual, often by business owners, high income professionals, or purchased to supplement other disability insurance policies. The most expensive kind of policy, as the risk is not spread out by being part of a larger group. Also likely to provide the best coverage. Legal problems can be addressed in civil court, where you have a right to recover the benefits that were not paid to you. No damage awards, no pain and suffering or hardship awards brought about by the failure of the insurance company to provide you with the benefits that are in your contract. Still, being able to go straight to court when negotiations fail can speed up the process.

Group - The least expensive, the most difficult to fight when disputes arise, and also the most prevalent. Group disability policies are part of many employee benefit packages and as such fall under ERISA, a federal law governing how disputes can be resolved. If you are paying for your disability insurance via a paycheck deduction, you most likely have an ERISA policy.

If you have an ERISA policy and your claim is denied or is being delayed, consulting with an experienced disability insurance law attorney is critical to fighting for your policy benefits.

Your options are more limited from the start in a group policy. You start with an administrative appeal, and when in litigation, typically the only materials that can be reviewed by a Judge are those that are already in your file that has been assembled by the insurer (and your claim support). If your doctor has not been creating reports and sending them to the insurance company, they have to be made a part of the file or they will NOT be considered in the review. This is where an experienced attorney can make all the difference.

Association - Professional associations offer their members disability insurance policies that are sold to the association, which then sells the policies to their members. Association policies often have a pricing structure based on age - not too expensive for younger physicians, and incrementally more expensive each decade of practice. There may be discounts, but there may be strict limits on the discounts - or they may be removed entirely at the discretion of the disability insurance company.

Waiting periods, own occ, or any occ provisions are similar to most group plans - whatever is in the policy is what you are buying.From our perspective, association policies are usually only slightly more advantageous than group disability insurance policies.

Whatever kind of policy you have, an experience disability insurance lawyer is your best protection when the disability insurance company denies or delays your claim. Call our office today to learn how we can help.

What to Look for When Buying Disability Insurance

Thu, 29 Mar 2012 10:36:36 -0500

As experienced long term disability insurance policy lawyers, we have a lot of experience with what we call the "critical points" of a disability insurance policy - the provisions in the policies that tend to be the major points of contention and concern. These are the top ones to look for when considering the purchase of a private policy.

If you had to choose a disability policy instead of buying one through your business, what features should you look for?

Mental and Nervous Provisions - This is one of the most challenging provisions in disability insurance policies. Many policies limit any mental and nervous conditions (depression and anxiety related diagnoses) to a period of 24 months. Where possible, try to secure a policy that does not limit benefits for these types of conditions.

Own Occupation/Any Occupation - Own occupation, or "own occ" means that if you can no longer perform the specific tasks and duties of your own occupation, you are considered disabled. We see many cases where job descriptions are inaccurate and insurance companies rely on outdated occupational categories to assess one's occupation.

"Any occupation" policy disputes often center around the issue of potentially comparable positions. An Ivy League MBA who previously ran a Fortune 500 company cannot be asked to flip hamburgers if he cannot perform the duties of the more complex position. The position must be comparable. However, we have represented claimants whose abilities to do their specific jobs also mean that they cannot perform the tasks required by a comparable position either. An "Own Occ" policy is a superior policy and usually worth the extra premiums.

Guaranteed Renewable - This type of policy cannot be cancelled, even if there is a change in your life that makes you a greater risk. The insurance company can't change the provisions or add any restrictions. Note that this is not a guaranteed premium policy - premiums may increase.

Noncancellable - Premiums will not rise as long as you pay on a timely basis.

Best policies are those that are both noncancellable and guaranteed renewable.

Accident/Illness - make sure the policy covers disabilities that are caused by either accidents or illnesses. Many people assume that they will not become ill with a chronic disease. Statistically speaking, you are more likely to become disabled as the result of an illness than as result of an accident. You need to have disability insurance in place for both possibilities.

Cost of Living Adjustments (COLA) - a COLA provision ensures that inflation and increasing costs don't consume benefits if you become disabled for an extended period of time. Thus, your base benefit will get increased on an annual basis. If this is not a feature of the policy, make sure it is added as a rider.

Residual Benefits - in many instances, claimants are not 100% disabled and can work on a reduced basis, but their income is reduced. A disability insurance policy with residual benefits will pay a percentage of the lost income. This allows the policyholder to maintain their standard of living, while working within the limitations of the disability.

Waiver of Premium - a waiver of premium provision means that if you are disabled, the insurance company will waive the premium to your policy. Usually there is a time limitation, strict requirements for notification and an age limit.

These are the most important features of a long term disability insurance policy, but they are by no means the only important features. Working with an experienced sales agent who is able and willing to take the time to explain all of these features and answer your questions is an important part of purchasing a disability insurance policy.

Our firm has reviewed policies for clients before they are purchased - the peace of mind that comes of knowing that the proper disability protection is in place is well worth the additional research.

Federal Court Finds CIGNA Abused Its Discretion in Denying LTD Claim

Wed, 21 Mar 2012 14:16:45 -0500

Another judge has criticized CIGNA for its claim handling of long term disability insurance claimants, determining that the decision to deny benefits to a man suffering from significant orthopedic impairments was an abuse of its discretion. The Court rested its determination upon a number of commonly seen tactics from CIGNA, and ultimately found that the claim review process was flawed and that the claimant was not afforded a full and fair review of his claim.

The Court focused upon the failure of CIGNA to give appropriate consideration to the consistent opinions of impairment of the claimant's numerous doctors, finding such conduct to be problematic. The Court also was troubled by CIGNA's failure to properly consider the occupational duties of the claimant, focusing instead on a generic definition of the claimant's occupation, and not considering any of the specific job duties which the claimant engaged in.

Lastly, the Court was concerned that while CIGNA indicated objective evidence of impairment was required, it chose to ignore the objective evidence submitted by the claimant. Thus, despite the fact that the claimant's award of Social Security benefits was not considered by the Court -- as it was not within the administrative record, there was sufficient evidence to support impairment, and evidence to demonstrate that CIGNA abused its discretion.

The Court thus awarded payment of benefits, with pre-judgment interest and attorneys fees.

Rucker v. Life Ins. Co. of N.Am.

Long Term Disability Claimant Awarded Benefits Following Court Review of Remand

Tue, 13 Mar 2012 10:27:18 -0500

A Federal judge has awarded benefits to a long term disability insurance claimant, whose claim had previously been before the Court. Originally, the Court remanded the claim back to the administrator to properly consider the claim, including evidence supporting impairment, to include the Social Security determination and other evidence.

Upon remand, the administrator largely ignored the SSDI determination. The Court, in deciding to award benefits to the claimant, determined the administrator failed to provide appropriate consideration to the SSDI decision and that such failure caused the claim process to be significantly flawed. While the Court noted that SSDI determinations are not binding upon insurers in long term disability insurance claims, the Court also opined that the administrator did not give the necessary consideration to the SSDI decision, without properly articulating why it did not give such consideration.

As such, the Court awarded payment of all back benefits to the claimant, as well as attorneys fees and costs.

Torrey v. Qwest Communications

Mutual of Omaha's Long Term Disability Determination Overturned

Tue, 06 Mar 2012 14:15:45 -0500

A Federal Judge has overturned a long term disability insurance claim, finding that Mutual of Omaha acted improperly in terminating a claim on the basis of a lack of significant change in the disability insurance claimant's condition prior to the claim filing.

The claimant suffered a number of co-morbid medical conditions, several of which she had suffered from for some time, and Mutual of Omaha, relying upon an nurse review and its own in house doctor's conclusions, determined that the medical evidence did not demonstrate an impairment of sufficient severity to accept the claim.

The Court, in overturning Mutual of Omaha's decision, noted that Mutual of Omaha's minimal analysis of the medical evidence, improperly focused upon the symptoms the claimant did not exhibit, instead of focusing upon the symptoms she did exhibit and then analyzing how these symptoms impacted her functionality. The Court was also disturbed by the lack of consideration of the side effects of medications, and how they might impact upon her ability to work. Lastly, the Court found Mutual of Omaha's consideration of the claimant's medical support to be woefully lacking.

Carpenter v. Mutual of Omaha

Should you undergo a FCE at the insurance carrier's request?

Fri, 02 Mar 2012 13:53:34 -0500

A growing trend seen in long term disability insurance claims is an insurers' request for a claimant to undergo a Functional Capacity Evaluation ("FCE"). However, for several reasons, attending an FCE may be harmful to your claim. And, many policies do not have any contractual language obligating claimants to attend. Even those that may require a claimant's attendance at an FCE may still permit a claimant to object.

An FCE is a series of tests of strength, flexibility, endurance, pain, cardiovascular fitness, materials handling (lifting ability), coordination, static posturing, repetitive movements and other tests. These types of activities could cause claimants to suffer severe exacerbation of their conditions and is potentially extremely dangerous to their health.

It is the position of Frankel & Newfield, P.C. that an FCE is both dangerous and inherently unreliable evaluation which does not afford a claimant a fair review of their claim. In the medical journal Physical Therapy, an extensive article was published concerning FCEs. In this leading article, the authors concluded that there are significant safety issues regarding FCEs. They note that injury can clearly occur because the patient is being asked to perform physical tasks in order to demonstrate maximal effort. The only way that exacerbation of injury and additional injury could be avoided is if a therapist were able to note an exterior visual sign that there was unsafe performance of a particular procedure. However the authors conclude there should be criteria available for determining when maximal effort has been put forth and when to intervene. To date, no such criteria exist. They also note that intervention by the therapist decreases the validity and reliability of the tests. Thus, there is a built-in incentive for the therapist to not intervene, thereby placing the patient at significant risk of harm. The authors conclude that currently there is no infallible method for determining a safe stopping point during the conduct of an FCE. Rather, as seen time and again in our review of claimant's FCE results, a claimant forced to stop due to health risks will be accused of a sub-maximal effort.

Moreover, the above referenced article published in Physical Therapy contains innumerable reasons why FCEs are completely unreliable. Those reasons include lack of research, lack of protocol, lack of uniform criteria, lack of standardization, lack of an ability to project what a patient could perform during an 8-hour work day, significant safety deficiencies, and nearly no peer-reviewed journal articles regarding reliability. The article details these numerous deficiencies, as well as many others. For example, if a patient is unable to participate in various aspects of the FCE, there is no reliable and valid method of determining, by any research whatsoever, whether the patients lack of participation is due to the experience of pain or inability. The tester could unilaterally conclude, without any valid or reliable basis, that the patient is not putting forth her maximal effort.

Therefore, a Claimant should ensure that they are required, from a contractual standpoint, to undergo an FCE. Even if required, an insured should discuss the potential for harm with their treating provider, who should be required to authorize a claimants participation in such testing. If your insurer has sought to compel an FCE, for continued consideration of your long term disability insurance claim, please do not hesitate to contact our office to see how we can assist you.

UNUM Wants Stage IVA Cancer Patient to Wait for Disability Benefits -- Frankel & Newfield Cuts through the Delay to get Benefits Paid

Wed, 22 Feb 2012 14:06:13 -0500

Our client is a vascular surgeon who is unable to perform the duties of his profession due to numerous co-morbid conditions, including Hepatitis C, fatigue, diabetes, hemochromatosis, chronic and recurrent alcoholism, hyperparathyroidism, lumbosacral disc herniations, degenerative disc disease, facet arthopathy, forominal stenosis, chronic pain, depression, and anxiety.

His residual disability benefits were terminated on September 6, 2011 by Unum. At the same time of Unum's termination of his claim, he received worse news: he was diagnosed with Stage IVA oropharyngeal cancer.

Unum determined that our client was disabled due to oropharyngeal cancer and indicated that he would have to satisfy a new elimination period (because his prior claim had been terminated). We fought back, and we won.

Frankel & Newfield successfully argued that his oropharyngeal cancer was a complication of and co-morbidity to excessive alcohol usage. We provided medical research literature and statistics documenting that in 70% of all oropharyngeal cancer cases, excessive alcohol use is a common risk factor. We further supported our argument by providing medical research literature that oral cancers are twice as common in men as in women, and the likelihood of developing oral cancer increases with age, which supported our assertion that our client's oropharyngeal cancer was a complication of and co-morbidity to excessive alcohol usage - a disability for which our client had been receiving benefits.

We also educated Unum with background information on our client's particular type of cancer. The symptoms of throat cancer are not specific to cancer. The symptoms -- cough, hoarseness, difficulty swallowing, ear pain, and/or sore throat -- are common to many illnesses. Our client's symptoms began in late July 2011. When the symptoms persisted, our client scheduled a consultation with an ENT (Ear, Nose and Throat) doctor.

Our client was diagnosed with Stage Iva tonsillar carcinoma (T2 N2b M0), a type of oropharyngeal cancer considered to be advanced cancer. It was unlikely that his cancer advanced from Stage 0 to Stage IVa within the short time from when he started to experience the symptoms and called for an appointment, to when he was diagnosed.

After considering the extensive the medical records, the exhaustive medical research information, including the statistics, literature, and studies that we provided, combined with the duties and tasks required to perform his position as a vascular surgeon, and the side effects of the treatment, Unum had no choice but to reverse the termination of our client's benefits, with no requirement to satisfy a new elimination period.

Insurer Avoids Providing Documentation Which Would Reveal Bias of Hired Doctors

Tue, 14 Feb 2012 14:23:51 -0500

In ERISA long term disability insurance claim disputes, a fertile battleground has been found regarding the issue of the doctors repeatedly hired by insurance companies, either directly, or through various third part vendors, to review records and issue reports to support the denial or termination of a long term disability insurance claim. The evidence of bias which can be gathered through discovery can be significant, and in some cases, could mean the difference between success and failure in litigation.

A recent decision highlights the significance of the issue. Hartford Insurance, one of the largest providers of long term disability insurance benefits, recently sought to overturn a decision from a California federal court that ordered it to produce significant materials which would reflect on the nature and scope of its relationships with third party vendors and the hired doctors. To accomplish its goal of overturning the discovery decision, Hartford Insurance chose to agree to a less favorable standard of review of its claim determination for the termination of a long term disability claim.

By way of background, in ERISA disability insurance litigation, claims are reviewed by a Judge either under a de novo standard of review or an abuse of discretion standard of review. The abuse of discretion standard is favorable to insurance companies, as many courts have indicated that a claim decision will be upheld under that standard as long as it is supported by some evidence in the record. In contrast, the de novo standard of review will determine whose position is more correct, rather than whether the insurance company abused its discretion.

So here, Hartford Insurance agreed to lessen the deference afforded by the Court for the sole purpose of avoiding producing the discovery materials about its relationships with the doctors and vendors. The clear implication of Hartford Insurance's strategic decision is that they would rather lose this one long term disability litigation than reveal evidence of its relationships which could impact a myriad of other ERISA disability litigation.

Rowell v. Aviza Technology (Hartford Life)

DISABILITY INSURANCE CLAIMS APPEALS: NOT A DO-IT-YOURSELF PROJECT

Tue, 07 Feb 2012 13:26:30 -0500

We are noticing a disturbing trend in our office. Phone calls are coming from policy owners who are contacting us after they have tried and failed to appeal a termination or denial of long term disability insurance benefits. People often do not think they are permitted to engage an attorney to handle the issues, or think it is simple enough to handle on their own. Too often, these people are wrong, and failing to engage counsel for this critical timeframe of their claim becomes their undoing.

Here's the problem: unlike other kinds of insurance coverage, disability insurance is a very expensive cost for insurance companies. For example, a claim filed by a private policy owner, age 46, with a monthly benefit of $4,000, is the equivalent of waving a big red flag under the nose of an angry bull. $48,000 a year for what might be as long as nineteen years is a huge exposure and cost for the long term disability insurance company.

Even a smaller disability policy, one owned by an employee under the employer's benefits umbrella for $2,000 a month, is a problem if the employee is relatively young.

Ask any actuary. The business of denying, delaying or requiring further information is not a personal judgment on the person making the claim, although it often feels that way to the policyholder and the family. It is a very hard and fast numbers game. How much is it going to cost the insurance company to pay out on the claim over time?

Remember, there are no real penalties for the insurance company if the claim is delayed or denied. They generally cannot be hit with punitive damages. So while you are struggling to figure out how to pay the mortgage while your disability insurance company determines whether or not it is going to pay a claim, their costs for the delay or denial are zero. Your costs, and the impact the delay/denial has on your financial and personal life can be staggering.

Appealing a denial from a long term disability insurance company is not a do-it-yourself project. This is one where experience and knowledge is necessary and vital to the potential success of the claim, and the reinstatement of financial security.

If your disability insurance claim has been denied and you are considering filing an appeal on your own, call our office. The stakes are high - and you don't have to go it alone.

CIGNA'S LONG TERM DISABILITY DETERMINATION ARBITRARY AND CAPRICIOUS

Mon, 06 Feb 2012 11:08:54 -0500

A Federal Court has determined that CIGNA abused its discretion in terminating a claim for long term disability insurance benefits, for a claimant with orthopedic problems and other co-morbid conditions. The Court determined that CIGNA improperly determined the extent of the claimant's functional capacity, and relied upon a flawed transferable skills analysis to decide that the claimant could work in some occupation.

The claimant suffered from diabetes, back problems, sleep apnea, and heart disease, and was forced to leave work due to his disability. He was awarded Social Security disability benefits, which were pursued as a result of his CIGNA policy requiring that he pursue these benefits. CIGNA sought to rely upon a report from the claimant's treating doctor, but misinterpreted the opinions of the doctor, and erroneously determined that the doctor provided a greater level of functionality for the claimant.

By misinterpreting this material and utilizing these findings to perform a transferable skills analysis, CIGNA's claim determination lacked substantial evidentiary support. The Court thus determined that the claimant remained totally disabled and awarded the payment of all back benefits, with interest on these benefits and attorneys fees to be awarded.

The mis-classification of medical evidence is a common technique of insurance companies considering the continuation of long term disability insurance benefits. When this occurs, the transferable skills analysis will also be flawed, and could lead to the wrongful termination of one's benefits.

If you have a long term disability insurance claim, take efforts to ensure that your doctors are appropriately articulating your functional deficits. If you feel concerned about your claim, feel free to contact our firm to see how we can help assist you.

Wykstra v. Life Ins. Co. of N.A. (CIGNA)