Disability Insurance Claims Success Stories
Disability Claim: Neuromuscular Disease
Our client was employed as the Clinical Director of a medical research company whose job was classified as sedentary, even though it required her to travel. She developed a neuromuscular disorder which became progressively debilitating and eventually totally disabled her from work. Her condition was considered to be permanent and had no treatment or cure.
The insurance company after having her examined by their own rheumatologist determined that our client was able to perform sedentary work. Their doctor’s report of the examination confirmed that our client had difficulty walking up and down the hall, used a cane, had difficulty getting out of a chair and had measurable moderate weakness in all the muscles of her upper and lower extremities. Their doctor further reported tenderness in her lower back, swelling in her knees, an inability to perform repetitive grasping and opined that her ability to function would gradually become much more limited. The insurance company’s doctor summarized these findings to the insurance company and even with these observable limitations, the insurance company continued to deny her disability.
When our client retained us we immediately informed the insurance carrier that the client was being seen by a neuromuscular specialist and submitted a report from the specialist confirming her total disability. The report reiterated the fact that the disease was progressive. The insurance company refused to consider this report and refused to reconsider their denial of benefits.
StennettCasino filed a lawsuit against the insurance company and was successful in getting the client all of her past due benefits, interest on those benefits and attorney fees as well as having her future monthly benefits reinstated.
Disability Claim: Buy Out of Future Benefits
Our client received a letter from her disability insurance company offering to buy out the future benefits owed to her under her disability policy. In that letter, a lump sum of money was offered and she was told that the insurance company would pay a minimal amount to have an attorney review the offer. StennettCasino were retained and reviewed the client’s entire disability claim. Through our review we discovered that the insurance company had been paying our client the wrong monthly benefits for the last five years. We convinced the insurance company that they underpaid our client $27,755.00 in benefits. In addition we negotiated the buy out of her future benefits and our client received $9,000.00 more than what was originally offered.
By hiring our firm, our client received additional benefits totaling $346,775.00.
Disability Claim: Surveillance Video
Our client was in a serious auto accident at the age of 22, which confined him to a wheelchair due to serious back injuries. Despite his serious disability, he returned to school to learn computer programming. He returned to the workforce and eventually became a program manager for Oracle Corp. Due to a combination of his serious back injuries and the wear and tear after 17 years of working as a computer programmer and manager, his back finally gave out, precluding him from working full time. He applied for and received long term disability benefits.
Four years later, on December 23rd, the insurance carrier placed our client under video surveillance. The video showed him Christmas shopping with his wife for several hours. Client was driving with his specially equipped vehicle, getting in and out of his car into a wheelchair and going to various stores. Based on the video and client’s refusal to take constant pain medication, his benefits were terminated. We had our client tested through a Functional Capacity Evaluation and had his doctor prepare additional reports; however, the insurance company refused to pay additional benefits. A lawsuit was filed in Federal Court and the court found in our client’s favor. In referencing the surveillance video the court noted that “the plan does not require a claimant to be utterly helpless in order to be eligible for disability benefits…and plaintiff would hardly be the only person overtaxing his abilities when shopping on December 23rd.”
Disability Claim: Cancer
The client had been employed for 8 years as a registered nurse at a San Diego hospital. In July 1999, she was diagnosed with Stage IV metastasized breast cancer, and underwent a lumpectomy, chemotherapy, radiation and a bone marrow transplant. All of her doctors considered her to be disabled from work. She received disability benefits until 2002, when the insurance carrier abruptly denied her disability.
The client sought our help. We found that the insurance company had misinterpreted her doctors’ reports and violated its own claims manual when it denied her disability. That claims manual defined what internal rules, guidelines, protocol and criteria the insurance adjuster had to follow in evaluating a claim for disability. We found that the insurance company’s own manual listed health conditions which, if confirmed, would give the client a presumption of disability. Metastasized breast cancer was one of those health conditions. Since this case was not bound by ERISA, we pursued not only the client’s contractual rights but also damages for bad faith under California insurance law.
After a settlement conference we were able to successfully settle the matter with the insurance company. Our client received her disability payments, plus additional money based on our evidence of the insurer’s bad faith.
Disability Claim: Toxic Chemical Exposure
The client was a supervisor in the aerospace industry for 26 years. In May 2002, he became aware of increased fatigue, coughing, shortness of breath and irritation in his eyes and throat that interfered with his work. According to the doctor who treated him, the client’s disability was due to a condition called RADS (reactive airways dysfunction syndrome) caused by his longtime exposure to toxic chemicals at his job. Evidence that he had RADS included his symptoms of achy joints and muscles, chronic fatigue, headaches, difficulty concentrating, irritation of the eyes, nose, ears, throat and skin, and hypersensitivity to odors, lights, sounds and temperature extremes.
The client applied for disability and was denied. An insurance company doctor said all his symptoms were related to his asthma or the side effects from the various medications he took to control his asthma. This doctor only reviewed his medical records and never saw the client.
The client came to us. We contacted the doctor who was the client’s pulmonary/critical care specialist, asking him to comment on the insurance doctor’s report. Our client’s doctor refuted all of the opinions of the insurance company’s doctor, and said the client was unequivocally, permanently disabled.
StennettCasino appealed the decision of the insurance company, based on the strong medical report of the client’s own treating doctor, and the client was awarded disability benefits.