Post-Covid Syndrome Can Support a Claim for Disability Benefits.
Most people with Covid-19 recover completely within a few weeks. However, some people, even those with mild versions of the disease, continue to experience symptoms after their initial recovery. Even people without Covid-19 symptoms in the days or weeks after they were infected can have post-Covid conditions. These conditions can present as different types and combinations of health problems for different lengths of time. These post-Covid conditions may also be known as long-Covid, long-haul Covid, post or chronic Covid. The Center for Disease Control (CDC) and experts around the world are working to learn more about short and long-term [...]
Who Has The Burden of Proof In An Insurance Claim
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 [...]
Coverage Under Accidental Death Insurance Policies for Drug and Alcohol Overdoses
Accidental Death and Disability policies (AD&D) require that one’s death be caused by an “accident” to trigger coverage. The term “accident” is usually defined as an “unforeseeable, unintended, and sudden event.” These policies will also contain several exclusions including one for death due to an illness or the treatment thereof. Insurers continually deny benefits under an accidental death policy when death results from an accidental overdose of prescription drugs. When death is caused by medication that is prescribed to treat an illness insurers cite the “illness and treatment thereof” clause to deny the claim. Despite this exclusion Stennett & Casino [...]
Zurich Claims Subdural Hematoma Not Caused by Fall.
Our client’s husband died as a result of a subdural hematoma (bleeding on the brain). Subdural hematomas are typically caused by trauma to the head. Our client found her husband unconscious on the bedroom floor upon returning from church. He died several days later in the hospital. Zurich, who provided Accidental Death Coverage, claimed that the subdural hematoma was caused by a spontaneous bleed due to the use of Coumadin (a blood thinner), and not by the fall. Zurich pointed to the lack of evidence of external trauma to the head and medical literature supporting the potential for spontaneous bleeds [...]
District Court Finds That A Formal Functional Capacity Evaluation is Compelling Evidence of Disability
Stennett & Casino filed a complaint in San Diego Federal District Court against United of Omaha Life Ins. Co. for terminating its client's long-term disability (LTD) benefits. United of Omaha initially paid LTD benefits due to disability related to the client's low back pain following two surgeries. Omaha, however terminated benefits after one year concluding that the surgeries had resolved client's low back problems. Stennett & Casino had their client undergo functional capacity testing and submitted the findings of that testing to Omaha during the administrative appeal process. The Functional Capacity Evaluation (FCE) found that the client had a maximum sitting [...]
MetLife Denies Accidental Death Benefits Under Exclusion For Death Caused Or Contributed To By Illness Or Sickness.
We are seeing more and more claims for Accidental Death benefits denied under an exclusion for “loss” caused by “illness or the treatment thereof.” Whenever an insured involved in an accident is taking prescription medication, the insurer argues that the accident was, in part, caused by the medication side effects. Likewise, when an insured has an illness that weakens his/her ability to recover from a physical trauma, the insurer argues that the illness contributes to the death and thus is excluded under the policy. These arguments taken to their extreme would result in almost all Accidental Death Claims being [...]
The Danger of Replacing Your Old Life Insurance Policies
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) [...]
DISABLING SYMPTOMS OF PARKINSON DISEASE
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 [...]
MLS Website Supports Fibromyalgia Disability Claims
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 [...]
Court Declares That Unum Has A History of Biased Claims Handling
The 9th Circuit Federal Court of Appeals, in the case of Stephan v. Unum Life Insurance Company, 697 F.3d 917 (9th Cir. 2012) overturned a trial court’s finding that the public record did not demonstrate that UNUM had a history of “biased claims administration.” The Stephen Court specifically stated “Numerous courts, including ours, have commented on Unum’s history “’of erroneous and arbitrary benefits denials, bad faith contract misinterpretations, and other unscrupulous tactics.’” Indeed, in Saffon, we attributed the trend of state prohibitions on discretionary provisions in insurance contracts to ‘the cupidity of one particular insurer, Unum-Provident Corp., which boosted its [...]