Legal Updates

Whether you make a claim for benefits under an Accidental Death Policy or a Disability Policy the same burden of proof rules apply. The claimant has the burden of proving that they qualify for policy benefits (that they are disabled in a disability policy claim or that the death was accidental in an accidental death policy claim). However, the insurer has the burden of proving that any claimed exclusion in the policy applies to defeat coverage. As an example, in an accidental death claim the claimant must prove that the death resulted from an “accident” but the insurer who denies [...]

The Agent’s Commission is Their Motivation The replacement of existing life insurance policies with new policies (referred to as twisting) is a practice that has been abused by insurance agents for decades.  Because the agent’s commission is heavily weighted toward the first year’s premiums (commissions equaling as much as 120% of first year’s premiums) their financial incentive is to convince clients to buy policies, not to service old policies. The agent makes larger commissions when their client rolls over the cash value of their existing policy into a new policy because the cash value (often tens of thousands of dollars) [...]

Most people associate Parkinson Disease as a disorder characterized by resting tremor.  Often the resting tremor is not noticeable because it is controlled by medication.  However, a major aspect of the disease effects cognition which cannot be controlled by medication and which may be the most disabling symptom of Parkinson. The cognitive impairments associated with Parkinson include visuospatial ability, memory, and executive functions.   If the requirements of a job include quick decision making, supervision of employees, working with the general public, writing detailed reports, and other types of executive functions, the cognitive impairments resulting from a Parkinson diagnosis would disable [...]

Typically insurance companies hire Medical Services Companies to have one of their physicians review a disability claimant’s medical records to confirm that the claimant can work.  MLS, MES, PDA, PRN, UDC, BMI, PsyBar are some of the Medical Service Companies frequently used by insurance companies to perform a “record review” to bolster a denial of benefits.  These third party vendors claim to be independent but in truth are anything but.  In fact, many of these vendors have been formed by prior employees of insurance companies.  To try to support their claim of independence they produce Websites that claim their impartiality [...]

Lyme Disease is difficult to diagnose.  Although there are some laboratory tests that can confirm the diagnosis, the condition is mainly diagnosed clinically.  As a result, insurance companies often sieze upon the opportunity to argue that there is not objective proof of disability. Lyme Disease is a bacterial infection transmitted by the bite of an infected tick. A person may be aware of the bite; however, he may not be aware that the tick was infected. In its early stages, Lyme Disease may be a mild illness with flu like symptoms such as fever, chills, swollen lymph nodes, headache, fatigue, [...]

We have noted higher denial rates for disability claims from clients who suffer from fibromyalgia and chronic fatigue syndrome.  In order to combat these denials it is important to understand why insurance companies deny these claims.  Fibromyalgia and Chronic Fatigue - though two separate diagnoses - have several similarities.  The medical community has not yet come up with any objective testing to confirm the diagnosis of either condition.  They are diagnosed based on the subjective symptomology and the exclusion of other possible explanations for the symptomology.  The overriding symptoms are joint and muscle pain and incapacitating fatigue often referred to as [...]