Friday, August 22, 2014

IMA Disability Services

Typing “IMA Disability Services” (“IMA”) in the search box on my blog page will reveal that I probably have written about IMA more than any other topic. 

I was notified that the Social Security Disability (“SSD”) application of one of my client’s, a 54 year old custodian with back and knee problems, was approved today. On June 13, 2014, July 8, 2014, July 28, 2014, and July 29, 2014, the State agency sent my client letters stating that he had to be examined by IMA. Moreover, IMA telephoned my office and stated that they can schedule an exam and, they don’t have to send my office a letter. 

Social Security has paid IMA millions of dollars to examine disability claimants. IMA is charged with knowing the rules and regulations for scheduling and performing exams as part of its contractual obligation for the exclusive right to perform the exams for Social Security. IMA is obligated to send written notification to claimants when scheduling exams. 

Perhaps more importantly, when applying, I notify Social Security that neither they nor the State Agency are authorized to communicate with the claimant directly, and I cite the applicable sections of the POMS, where the attorney must be contacted after advising that the claimant does not want to be contacted by the State agency directly. As far as I am concerned, if I do not receive written notification that the State agency wants a claimant to attend an exam, then it was never scheduled. Notwithstanding the above, despite the fact that IMA sent four letters demanding that the claimant attend its exam, and despite the fact that IMA insisted that it was imperative for the claimant be examined, his SSD application was approved today, three months after it was filed.

Friday, August 8, 2014

Federal Court Reverses CIGNA

U.S. District Court Judge Bianco reversed the termination of long term disability (“LTD”) benefits yesterday by CIGNA. CIGNA claimed that it could terminate my client’s LTD benefits because he did not submit “time concurrent” evidence of disability. CIGNA’s in house shill, Dr. John Mendez, said that evidence was “time concurrent” if submitted within one month of CIGNA’s termination decision. 

Mendez testified at his deposition that the need for “time concurrent” evidence to establish disability was based on his “clinical experience, expertise, and knowledge.” Gary Person, who supervises CIGNA disability appeals, admitted during his deposition that neither the Policy, nor any other CIGNA document, required “time concurrent” evidence to establish disability. Judge Bianco accepted my argument that since CIGNA’s Disability Policy did not state that “time concurrent” evidence was required, it could not provide a basis to terminate Plaintiff’s LTD benefits. 

Judge Bianco also agreed that CIGNA failed to identify any affirmative finding that the claimant’s condition improved to justify terminating LTD benefits. Since CIGNA had previously found the claimant was disabled, Judge Bianco found the claimant remained disabled because CIGNA terminated LTD benefits based upon a purported absence of evidence, as opposed to affirmative evidence showing the claimant got better. Judge Bianco added that implying that the claimant had improved because he took an overseas trip was unpersuasive selective cherry-picking.