Thursday, May 22, 2008

Unum Games

A Long Term Disability (“LTD”) claims administrator is usually the insurance company that issues the policy that is liable for paying disability benefits under an LTD Plan. Since approving a claim means the insurer has to pay for it, the insurer goes out of its way to deny claims. Securing LTD benefits usually entails fighting to make sure the insurance company fulfills its fiduciary obligation to pay LTD benefits when a claimant is disabled.

I represent a claimant who worked on the floor of the New York Stock Exchange (the “NYSE”). After a year long battle with Unum I had the claimant’s doctors and vocational expert rebut all of the findings and conclusions of Unum’s in house and outside medical and vocational reviews. Incredibly, after Unum approved the claim in writing and via telephone, it then contended that it had not approved the claim, and would now require IMEs and their doctors contacting the treating doctors.

I told Unum that any IME or contact with the treating doctors would have to take place with my presence or another person of my choosing. Unum then decided to forego the IME, and after I arranged and participated in the first “peer to peer” phone call, Unum stated that the claimant’s application had been approved. But, once again, Unum decided to play games.

Relying on verbal evidence from an H.R. person who did not even work while the claimant was employed at his former company, Unum asserted that the claimant worked for more than 30 continuous days in 2007, ending in April 2007. That conclusion meant that LTD benefits would be denied from December 2006 through May 2007. I filed a second appeal to insist that benefits commence as of December 2006.

Working on the NYSE requires a security card. On the appeal, I submitted a statement from the General Counsel of the NYSE averring that the claimant only worked in 2007 for an 8 day period. Faced with that undeniable evidence, Unum finally agreed to pay the claimant his full entitlement to LTD benefits.

Friday, May 16, 2008

Vocational Evidence

Vocational evidence is just as important as medical evidence when applying for disability benefits. I just received an approval on an application for Social Security Disability (“SSD”) benefits after three months. The medical evidence was similar to that many other SSD applications that take several times as long to get approved. The difference was emphasizing the vocational evidence.

The claimant was 61 years old. I highlighted that when a person is over 60 years of age the regulations require “very little, if any, vocational adjustment” to another occupation. In other words, it is very hard to argue that an older person can work at a new occupation.

The claimant’s past work was medium to heavy. That was another critical piece of vocational evidence because of its application to the Social Security medical-vocational rules. Those rules provide that even if the medical evidence shows that the claimant could do sedentary work, he must be found disabled.

Lastly, the claimant had a nearly 45 year work history. The case law makes clear that a claimant with a long work history should be found credible. Essentially, the courts are saying that the good work ethic shows that the claimant would continue to work if able to do so. It was important to stress what the courts say about a lengthy work history because the regulations only focus on the last 15 years of a person’s work history.

Other claimants with medical evidence similar to that of this client have taken longer to get approved, and some were even denied initially. Letting Social Security know that you are aware of the significance of the vocational evidence reduces the chances that it will deny your application.

Tuesday, May 13, 2008

Credit Disability Insurance

Credit Disability Insurance (“CDI”) pays a monthly benefit to a lender equal to the amount of a loan’s monthly payment if you become disabled. Like other types of disability insurance, there may be a waiting period before a benefit is paid and many of negotiable terms and conditions. CDI can apply to almost any type of loan, such as loans to cover the purchase of appliances, motor vehicles and farm equipment, as well as educational, credit card, home equity and mortgage loans.

If your CDI is denied or terminated, you can contest the decision. I represent a former firefighter whose CDI was terminated after two years on the grounds that, while he could not work as a firefighter, he could do other types of work. Since I had won the claimant’s Social Security Disability case, which required showing that he was unable to do any other type of work, I strongly advised him to appeal the decision.