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Some of DI law group’s recent wins

On Behalf of | May 25, 2023 | Firm News |

Disability Insurance Law Group is proud to announce some of the recent wins we achieved for our clients. In each case, our legal team took on one of the largest insurance providers in the U.S. and won the disability insurance benefits to which our clients were legally entitled.

MetLife denial of a mental health claim

One case involved a financial services associate for a well-known financial institution. This client was forced to halt his successful career when a triggering event caused symptoms from his bipolar disorder and other mental health conditions to grow unmanageable, making it impossible for him to continue competently performing his job duties. His employer provided long term disability insurance through MetLife, but MetLife denied benefits despite ample evidence that he could not reliably and competently perform his job duties.

The employee, knowing he could not work and in need of his long term disability insurance payments to make ends meet, contacted Disability Insurance Law Group to file the appeal. Our attorneys put together a thorough and detailed appeal and submitted it to MetLife. Within only a few weeks, MetLife overturned the denial, reimbursed our client for all back benefits and continues to pay the claim.

Surveillance video leads to unfair termination of disability benefits

In another recent win, Hartford reinstated benefits based on the appeal filed by Disability Insurance Law Group. Prior to filing his claim for benefits, this client spent years working despite back pain, for which he sought a variety of treatments and surgeries. After another back operation failed to provide relief, he applied for long term disability benefits. The Hartford approved his claim.

However, after paying benefits for several years, The Hartford put their insured under covert video surveillance and then sent the video to one of its own consulting physicians. They asked their doctor to assess the surveillance footage and opine about what it indicated about his current physical state and if he now had the capacity to return to work. Based on their own doctor’s biased opinion, and without giving our client and his doctor the chance to review the video or the consulting physician’s opinion, The Hartford canceled benefits, their insured’s only source of income, and advised him of his right to appeal within 180 days.

Upset and frustrated, he contacted our office. We filed a timely appeal addressing the issues raised in the denial and noting the surveillance video showed our client being physically active for a total of about 15 minutes over three days. Our appeal included our client’s full medical history, the results of a Functional Capacity Evaluation and statements from his treating physicians, friends and relatives. The Hartford reversed its decision and restored our client’s claim. He was paid all back benefits and continues to receive his monthly benefit check.

The Hartford wrongfully applied 24 month mental/nervous cap

Both physical and mental conditions can be the basis of a long term disability claim. However, under many group disability benefits for a claim based on a mental/nervous illness like depression or anxiety, benefit payments can be limited to 24 months.

Very often, an insurance company will try to limit its liability to 24 months under the Policy’s mental/nervous cap, even where the primary disabling condition is physical in nature. Many times, an insured becomes depressed or anxious over their failing health; however, that is not the reason they are unable to work.

This situation happened to our client, Nurse Jane, a former nurse consultant who filed a claim with The Hartford based on severe generative disc disease. She subsequently became depressed because of her health. However, this was not the reason she could not work. After paying benefits for 18 months, she was advised that benefits are limited to 24 months because of her depression. That left Nurse Jane with just six months of benefits until she had no way of paying her bills.

Nurse Jane, understandably distraught, retained Disability Insurance Law Group to appeal. In addition to clarifying the physical reasons why our client could not work, we sent her to an independent functional capacity evaluation which confirmed the limits of her physical ability. The Hartford failed to timely respond to our appeal, and thus we sued on the client’s behalf. It was at that point that The Hartford admitted our client was indeed physically disabled and extended her benefits beyond 24 months.

Guardian wrongly denies benefits after paying for 20 years

After 20 years of paying long term disability claims to an insured with failed back syndrome, Guardian conducted a “review,” informed him that the evidence showed he was no longer disabled and his benefits were terminated. In fact, however, there was no evidence that his back had gotten better and plenty of evidence that it had deteriorated despite multiple surgeries.

Guardian’s Insured was not only taken by surprise; he could not fathom what evidence would suggest that his condition had improved, and he could now return to work. He hired DI Law Group to file an Appeal. As with the Hartford case noted above, Guardian failed to timely respond to the Appeal and our attorneys filed a lawsuit the day after Guardian’s Appeal response was due. Because a lawsuit in these circumstances may result in a better legal standard of review for the Insured, DI Law Group sues quickly where warranted. Before Guardian’s Attorneys filed an Answer to the Complaint, we were advised by the Guardian adjuster that Guardian had reversed its denial and was sending a check for all back benefits owed to date. Our client remains on claim, and we continue to assist him with submitting ongoing proof of disability.

Prudential long term care denials reversed

Applying for long term care benefits can be a confusing and intimidating process. In one recent case, a family reached out to Disability Insurance Law Group for help after their mother’s claim for long term care benefits had been denied.

Their mother was frail, unsteady and needed assistance with many Activities of Daily Living (ADLs). She had taken out a long term care policy many years ago in order to avoid being a financial burden to her family and was very upset when her seemingly straightforward claim was denied. DI Law Group obtained evidence from her doctors and healthcare aides proving that our client required Substantial Assistance with at least two ADLs and was clearly entitled to benefits under her policy. Based on what was submitted, Prudential quickly overturned the denial and covered the cost of the long term care expenses paid for by the family up to that point. We continue to handle her claim and Prudential has been paying her long term care benefits without issue.

Another long term care win

In another case involving Prudential, long term care benefits to an insured suffering from cognitive deficits were wrongly denied.

Prudential conducted an incomplete and poorly documented Nurse Assessment and then promptly denied benefits. The family of the Insured contacted DI Law Group, noting they could not afford the care their family member required without these benefits. Our attorneys filed a successful appeal with strong evidence that our client had severe cognitive deficiencies and required long term care for her safety and wellbeing. Prudential reversed the denial and reimbursed the family for the long term care costs they had been struggling to pay. We continue to make sure that Prudential timely covers the cost of our client’s long term care needs.

How can DI Law Group help?

A delay or denial of disability or long term care claim can be financially devastating. DI Law Group represents long term care and all disability insurance claimants at every stage of the insurance process. If you have any questions regarding your insurance claim, our team of attorneys would be happy to provide you with a free consultation. Please contact us at 866-363-3628 or visit our website at www.dilawgroup.com.