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San Francisco Long-Term Disability Insurance Blog

Dentists and their long-term disability insurance needs

We recently wrote about the unique needs of physicians who file claims for long-term disability. In that post, we talked about the difficulty for doctors — who may run expensive professional practices and rely on relatively high incomes for personal and business needs — to have their ability to practice medicine suddenly interrupted by the onset of disabling medical conditions

Many of the long-term disability issues physicians face also come up for dentists faced with disability that interrupts their ability to provide dental services. Both dentists and doctors should have appropriate long-term disability insurance policies in place to provide necessary replacement income during lengthy periods of disability.

Oklahoma federal court weighs LTD insurer conflict of interest

On August 17, the U.S. District Court in the Northern District of Oklahoma issued an opinion reversing a long-term disability insurer’s denial of benefits, ordering that the insurer pay the claimant 24 months of benefits based largely on mental-health impairments. In Redden v. Aetna Life Insurance Company, the judge explained the inherent conflict of interest that a LTD insurer has when it has both the role of discretionary decision maker on the question of claimant eligibility and is in the position of financial responsibility when it finds for the claimant. 

In other words, if the insurer decides for the claimant it is also on the hook to pay benefits, sometimes for years. This dual role of the insurance provider has given courts reason to look at the decision-making process with more skepticism.

Issues when doctors file claims for long-term disability

Physicians play a key role in their patients’ claims for long-term disability or LTD. A treating doctor’s observations and testing provide key evidence for an insurer to understand whether a claimant’s medical disability meets the definition of disability provided in his or her policy.

Tenth Circuit: STD claim denial was arbitrary and capricious

On August 13, the U.S. Court of Appeals for the 10th Circuit issued an opinion that found the short-term disability insurance company defendant had acted arbitrarily and capriciously in denying the plaintiff’s claim for a full 26 weeks of benefits. The court also said that some of the insurer’s findings were not supported by substantial evidence

Claimant Kevin McMillan worked for AT&T as an IT client consultant. In 2013, he stopped working, complaining of diabetes, kidney disease, COPD and sleep apnea, along with difficulty walking or standing for long periods, impaired concentration and short-term memory problems. Medical records also revealed other impairments like coronary disease and hypertension as well as problems with fatigue and shortness of breath.

Court finds for LTD claimant after insurer misclassified her job

At our law firm, we represent disabled clients in their applications for long-term disability benefits. It is not unusual for LTD insurers to make mistakes in their decision-making processes, causing a wrongful denial of benefits. Often when an experienced lawyer carefully reviews the administrative record of medical and vocational evidence the insurance company or its administrator relied on to deny or terminate benefits, the attorney discovers errors. 

In such a case, an internal appeal within the insurance company or a lawsuit, depending on the stage of the claim, gives the claimant and his or her attorney the opportunity to point out the mistake and advocate for an award of benefits.

Doctor must show how much income came from LTD insurer

People with long-term disability insurance file claims for benefits when their physical or mental impairments prevent them from working. All too often, LTD insurers seem to go to great lengths to find any way to deny these claims. 

One of their most common tactics is to hire a doctor or other medical professional to review the claimant’s medical records or perform a medical exam. Then, the insurance company uses any aspect of the hired physician’s opinion it can as a basis to deny the claim. It is not unusual for these denials to be against the weight of the claimant’s medical evidence provided by his or her own treating physicians and therapists.

When does an LTD insurer abuse discretion in claim processing?

At our law firm, we represent long-term disability claimants whose claims have been denied or whose benefits have been terminated. If the LTD coverage is provided through a group policy taken out by the claimant’s employer, normally, the claim’s process is governed by ERISA, a federal law that imposes standards of fairness on the insurer’s claims-processing practices and procedures. 

Under ERISA, if the policy language properly provides the plan administrator with “discretion” to decide LTD eligibility, a U.S. District Court reviewing a denial or termination will often ask the legal question: Did the administrator abuse its discretion?

LTD claim shows difficulty in diagnosis of cognitive impairment

A former highly distinguished marketing executive of a major law firm filed an ERISA lawsuit on July 3 seeking long-term disability benefits that the insurer had denied, in part, because it claimed that a long delay in applying for benefits made documentation of the disability challenging. 

The complaint describes a situation where, after a fall, it took years for symptoms of injury and disease to manifest themselves to a level where a doctor could make a definitive diagnosis, even though those symptoms prevented the claimant from holding a high-level executive position at a much earlier time.

Lab test in the works for chronic fatigue syndrome?

Earlier this year, we shared information about how medical researchers are better understanding the science behind chronic fatigue syndrome, also called CFS. In that post, we mentioned that the new name for the disease is myalgic encephalomyelitis or ME or ME/CFS. This name better describes the inflammation and muscle pain accompanying the condition.  

Scientists have announced that a new test for ME/CFS detects the presence of the disease at an accuracy rate of 84 percent. This could be very good news for people who must prove that their disabling conditions are caused by this disease in applications for long-term disability insurance benefits.

Court opinions create permanent records of LTD insurer behavior

On June 28, 2018, a federal court in Mississippi issued a scathing decision ordering payment of past and future long-term disability benefits as well as attorney’s fees to LTD claimant, Juanita Nichols. One interesting aspect of this opinion is that the court described its own research into previous lawsuits against Reliance Standard Life Insurance Co., Nichols’ LTD insurer. 

Here at Roboostoff & Kalkin, Reliance is one of the large national insurers we have opposed on behalf of our clients.

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