Attorney Blog

MetLife Will Grab Onto Anything To Deny Your Claim

blog@www.robberywithoutagun.com (news Author)13986 — Fri, 09 Apr 2010 08:00:00 EST

Here's a recent case involving MetLife and some of their ridiculous procedures. The plaintiff, Kaufmann, was a Senior Project Manager at Siemens who suffered from severe chronic back pain that severely limited her physical abilities. Her job entailed traveling around and giving IT support to various hospital systems along with the normal tasks of working in an office, carrying files, bending, stooping, etc.

Anyways, her doctors opined that she couldn't work anymore and she submitted a claim to MetLife with all her records and a detailed explanation of her job description and duties that put it in the "light work" category. MetLife received the information, saw that she was a "Senior Project Manager" and assigned the job a "sedentary" classification, basing the classification on the Department of Labor's employment dictionary. Unfortunately for MetLife, Kaufmann's policy clearly states that the definition of "occupation" is what the claimant actually does, not what their title is.

MetLife forwarded all the medical records to a doc for review and the doctor comes back and says that, although she has limitation, she can work in a sedentary position and should be able to return to work: claim denied. Kaufmann gets the denial and goes and gets an occupational therapist to run exhaustive testing to show that she can't perform her job. They appeal the claim with the new medical info and MetLife sends it to a second doctor. The second doctor declares that Kaufmann has ZERO limitations that would preclude her from working in ANY CAPACITY. That's like saying she could work construction if necessary. The doctor claimed that there was no "objective evidence" and didn't even address the new test results from the occupational therapist.

So MetLife's first doctor says that there are limitations but that Kaufmann can do sedentary work while the second doctor says that she has no limitations whatsoever. All this while her light work job is being referred to as sedentary. Neither doctor received any job description but somehow they were able to determine whether or not Kaufmann could do her job. MetLife denied the claim again, ignoring their first doc and relying completely on the second.

Luckily, the court saw exactly what MetLife was up to and declared their denial arbitrary. They didn't even attempt to reconcile the conflicting opinions of their two reviewers, not to mention their intentional misreading of the plan that lead to their typifying the occupation as sedentary. Just another reason why it's important to have a skilled ERISA attorney on your side, so you can deal with companies like MetLife.

Check out the full opinion on this MetLife ERISA denial case.

Alabama Judge Explains ERISA's Flaws

blog@www.robberywithoutagun.com (news Author)12320 — Fri, 22 Jan 2010 08:00:00 EST

Judge William Acker, Jr., a staunch critic of how the judiciary has applied ERISA made his position clear once again in his opinion on Blankenship v. MetLife, a recent disability case out of USDC of Northern Alabama.

See his entire opinion in which he discusses the problems and shortcomings of ERISA and disability law.

First UNUM Finally Loses After 15 Years

blog@www.robberywithoutagun.com (news Author)10376 — Tue, 15 Sep 2009 08:00:00 EST

First UNUM denied John McCauley his benefits casting him into financial hardship. Mr. McCauley fought through his disability to work in order to make enough money to pay for his bills. Then UNUM tried to deny him benefits at a later date because of his attempts to return to work. This court recognized the Catch 22 that UNUM was playing at and put an end to it. UNUM forced McCauley into work through denial and then tried to deny him because of that work. Here is the opinion in McCauley v. First UNUM

Insurance Psychiatrist Must Be On Auto-Deny

blog@www.robberywithoutagun.com (news Author)10091 — Tue, 25 Aug 2009 08:00:00 EST

Dr. Grimes concluded that Ms. Allen could perform the duties of her job without a) knowing the duties of her job b) interviewing the psychiatric patient c) contacting all of the treating mental health professionals.

That means that Dr. Grimes had almost no information when making a very important decision. It seems that, at least in the interest of protecting herself, she would've waited to gather at least some information before recommending denial. Otherwise she'd just be asking for a day in court, which is exactly what the claim administrator got. Read the full opinion and press release for Allen v. AT&T Disability Income Program here.

Insurance Doctors Make Diagnoses Without Patient

blog@www.robberywithoutagun.com (news Author)9695 — Fri, 31 Jul 2009 08:00:00 EST

Press release on the United States District Court of Eastern Louisiana's recent ruling in the LTD benefits case of Schully v. Continental Casualty company. Read the release followed by the entire opinion for more on ho insurance companies and their doctors conspire to deny your claims.

Insurance Company Tries To Bury Court Decision

blog@www.robberywithoutagun.com (news Author)9471 — Thu, 23 Jul 2009 08:00:00 EST

Yet another example of insurance companies trying to cover their butts.

US District Court in Charlottesville denied Aetna's motion to vacate some rulings that didn't go their way. The cases are already settled and Aetna has already paid out, so you might ask what they're up to.

Well, Aetna doesn't want these rulings to effect their other cases and potential cases. If they can get the court to vacate the rulings, they still lose the case, but the courts opinions and judgments can't be used as precedent in any future cases.

Rather than fixing their plans or attempting to salvage some semblance of humanity and change their procedures, the insurance company has elected to try to sweep this one under the rug. Basically they're throwing the ruling into the closet and locking it up where it can't be cited to show how Aetna's plans have previously been interpreted.

In this case the two sides settled and the plaintiff granted the defense the right to vacatur. So the plaintiff said you could throw it out. But that's not how it works, guys! Courts are public and so are the laws they uphold and the opinions they create. Allowing insurance companies to buy-out a plaintiff with the condition that the case be vacated is basically them buying the repeal of a law.

Once again the court gets it right though. And Judge Moon says it best that "the integrity of the judiciary... outweighs the defendant's private interest in vacating the court's opinions."

CUNA Mutual Insurance Society Loses Big For Paying Small

blog@www.robberywithoutagun.com (news Author)9473 — Thu, 23 Jul 2009 08:00:00 EST

CUNA Mutual was robbing this poor old lady. Literally. They took her premiums for over a year and then, when she had to quit working because of many problems, told her she didn't qualify.

These problems weren't hangnails or a twisted ankle. We're talking about some serious arthritis followed by the onset of cancer. CUNA tried to argue that she wasn't disabled when she had cancer, cancer that eventually took her life, and that she was still able to work!

The insurance companies just don't know when to quit. There's a line between running a business and human decency. I mean the insurance company is basically trying to sell a product that they find ways to make impossible to utilize. People buy these plans to protect themselves from even less than what Ms. Powell went through. I'm not going to say don't buy insurance, but be careful what insurance you do buy.

That's not the end of it though. CUNA has been found to have been doing this similar thing to a lot of people, at least 18 were brought up in court. Ms. Powell said before her passing "I want to be treated fairly, but I also want to know that other people are not going to be abused like I am being abused. And I want this company to come clean and treat their clients with respect." Thanks to her fight, CUNA and other insurers will have to think even harder before denying genuine claims.

The Insurance Company's Fight Against Itself

blog@www.robberywithoutagun.com (news Author)9548 — Thu, 23 Jul 2009 08:00:00 EST

In Barteau v. Prudential a college professor suffered from near blindness, debilitating pain, and decreased cognitive ability. Prudential approved benefits and even helped Barteau with his Social Security Disability benefits appeal. After all this, they decided to terminate his claim.

There is an inherent contradiction in all this. The insurance company decides to grant or deny benefits. If they grant it they often require the claimant to file for Social Security, which offsets the insurance benefits, making it cheaper for the company. So the company goes through all this trouble to show the Social Security people that their insured is disabled. Of course we all know the other side of the story where the insurance company is doing everything they can to show to the courts that the insured is not disabled.

The Barteau case is a prime example of this being taken to extremes. Fortunately, the judgment went in favor of Barteau based on the record. Unfortunately, this two-faced approach from the insurance companies often goes unchecked and unimpeded. Read the entire opinion on Prudential and their two-faced approach to claim review here .

Your Insurance Company and the University Disability Consortium (UDC): A Match Made In Hell

blog@www.robberywithoutagun.com (news Author)9549 — Thu, 23 Jul 2009 08:00:00 EST

Another case involving University Disability Consortium (UDC) and their shady relationship with insurance companies. Insurance companies hire UDC to perform IMEs. Now, UDC advertises that using them for IMEs will probably result in "improved denial and closure rates at a reduced cost." So they basically advertise that if you hire them they will deny more claims to save you money. It's no wonder their relationship has been scrutinized and criticized so much.

This relationship is alluded to by the judge and is one of the main reasons that the opinion of Dr. Brian Mercer, a UDC doctor, was ignored as inherently bias. Dr. Mercer supported his denial opinion with erroneous information that never even approached the matters at hand. I guess one of UDC's go to strategies is to make things up when they can't spin the evidence another way. Maybe that's why they're able to advertise increased denial rates with such confidence. You can read the entire opinion on UDC's bias and Dr. Mercer's erroneous medical opinions here .

CIGNA Loses Out As Judge Gives Weight to Treating Physicians' Opinions

blog@www.robberywithoutagun.com (news Author)9550 — Thu, 23 Jul 2009 08:00:00 EST

Another good bit of news for those seeking disability benefits. In the recent case of Toth v. INA a judge granted the plaintiffs motion for summary judgment based on the fact that CIGNA's medical team, made up of Drs. Dan Gerstenblitt and Paul Seiferth, didn't offer any evidence to back up their opinions of non-disability other than pointing out that the plaintiff's treating physicians lacked objective evidence. Maybe the CIGNA doctors should leave the lawyering to the lawyers.

In a lot of these cases one of the major problems is that many debilitating disorders and syndromes are beyond current means of objective testing. The insurance docs, such as CIGNA's, use this fact to claim that there is no evidence of disability, when in reality the level of evidence they want is unattainable with current medical technology.

In this case, the judge decided that this wasn't good enough for CIGNA to deny benefits and that the overwhelming record from the treating physicians was more than enough to justify benefits despite that much of it was based on "self-reports" from the plaintiff. This a great ruling in that it basically recognizes the impossibility of attaining a certain level of proof that insurance claim as necessary for granting benefits.
Read the entire opinion on Toth v INA for more on how treating physicians opinions can hold more weight than insurance doctors .

Ignorance Is Not Bliss, It's the Insurance Company Denying Claim

blog@www.robberywithoutagun.com (news Author)9551 — Thu, 23 Jul 2009 08:00:00 EST

Here's a case in which the insurance company IME simply ignored half the claimant's medical record.

The Hartford hired one of their friendly companies, the University Disability Consortium (UDC), to review the records to see if they should keep paying LTD benefits. Dr. Beth Aaronson reviewed the case and determined that although the patient had limitations in her left hand, there were still three jobs out of 12,000 that she could do.

The problem is that Dr. Aaronson arbitrarily and capriciously ignored the several other debilitating problems which included temporal lobe epilepsy, protein S deficiency, and deep venous thrombosis among others.
UDC's doc just didn't feel it was necessary to include anything on these serious problems when reporting on disability. Did they think it would just go away if they glossed over such maladies? Read more on this insurance 'employee' helping to deny claims .

MetLife, You Can't Use 'Employees' As Independent Medical Examiners!

blog@www.robberywithoutagun.com (news Author)9552 — Thu, 23 Jul 2009 08:00:00 EST

More about IMEs and their questionable independence, here's a judge that actually took a look at the facts and figures and really cut into the Doc.

In the case of Solomon v. MetLife, the insurer hired an "independent" doctor to review Ms. Solomon's file to determine if benefits should be awarded. Here's an excerpt from the Judge Sweet's decision in which he hammers MetLife and Dr. Amy Hopkins:

"Although MetLife describes Dr. Hopkins as an 'independent reviewing physician,' she derived 99% of her income in the years 2002-2004 from paper medical reviews for third parties, 58% to 63%, or over $100,000, of which was derived from reviews for MetLife. To the extent Dr. Hopkins relied on MetLife for over half of her income, she was not 'independent' at the time she reviewed Solomon's file."

Now there's a judge looking at the right things and who's unwilling to put up with insurance shenanigans. Don't think that the racket going on between Hopkins and MetLife is a unique either. I've blogged about it before and witnessed it plenty of times. Read the entire opinion on Solomon v. MetLife and it's independent medical reviewer here .

Court Reverses Metlife Ruling on Benefit Termination

blog@www.robberywithoutagun.com (news Author)6762 — Mon, 22 Dec 2008 08:00:00 EST

Janet Gorski had undergone back surgery and had been receiving disability benefits since 1999. Since that time, she had been in excruciating pain after hardware which was dislodged in her surgery caused nerve root compression. MetLife sent out a surveillance team to watch Ms. Gorski, but the team was unable to show that Gorski could sustain physical activities over a long period of time.

The Fourth Circuit Court of Appeals reversed a decision by Metlife to terminate Janet Gorski's disability benefits. The Court's opinion may be signaling a change in the winds, as the Court is finally beginning to require the Federal Courts that review disability benefit termiantions to actually assess the entire record and consider a 'combination of factors' when determining whether the initial denial of benefits was legitimately made.

Read the full opinion here.

Court Awards Pilot Attorney's Fees and Reinstates his Benefits

blog@www.robberywithoutagun.com (news Author)6764 — Mon, 22 Dec 2008 08:00:00 EST

A Virginia federal district court reinstated Christopher McIntyre's long-term disabilty benefits and awarded him attorney's fees after AETNA had terminated his benefits. McIntyre's diabetes had prevented him from passing the physical exam required by the FAA. However, because he then started a screenprinting business, AETNA terminated his benefits.

The Court ruled that McIntyre was entitled to a reading of the contract under the special provisions for pilots, rather than the general disability definition. Read the full opinion here.

This is a blog

blog@www.robberywithoutagun.com (blog Author)3087 — Mon, 17 Nov 2008 08:00:00 EST

This is a blog.

Ben Glass quoted in Lawyers Weekly in New ERISA case

blog@www.robberywithoutagun.com (blog Author)4205 — Mon, 17 Nov 2008 08:00:00 EST

Fairfax, Virginia disability insurance attorney Ben Glass was quoted in the August 25, 2008 issue of Virginia Lawyers Weekly. At issue was a new disability case from Abingdon, Virginia. The case involved the interpretation of the newest ERISA disability case from the United States Supreme Court.

Ben Glass's comments on this new ERISA disability case are here.

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blog@www.robberywithoutagun.com (blog Author)5057 — Mon, 17 Nov 2008 08:00:00 EST

Unum Found Guilty of Fraud In Forcing Claimants to file for Social Security

blog@www.robberywithoutagun.com (news Author)6091 — Fri, 24 Oct 2008 08:00:00 EST

A jury has found Unum, the largest disability insurance company in the world, guity of fraud in forcing some claimants to apply for social security disability benefits.

The full story on Unum is here.

The lawsuit was filed under a federal whistle-blower statute that allows private citizens to sue on behalf of government programs if they believe they have evidence of fraud. The lawsuit is being tried in United States District Court in Boston.

Claimant Wins CIGNA Cardiac Disability Case

blog@www.robberywithoutagun.com (news Author)5788 — Fri, 26 Sep 2008 08:00:00 EST

Unum Tries to Rewrite Policy After Claim Was Made

blog@www.robberywithoutagun.com (news Author)5765 — Mon, 22 Sep 2008 08:00:00 EST

How Does a "Transferrable Skills" Analysis Work?

blog@www.robberywithoutagun.com (news Author)5758 — Mon, 22 Sep 2008 08:00:00 EST

MetLife spying on claimant at son's Little League game not enough to terminate benefits

blog@www.robberywithoutagun.com (news Author)5737 — Fri, 19 Sep 2008 08:00:00 EST

Here is an interesting case where the court rejected as "proof" video surveillance of a guy at his son's Little League baseball game. This is a MetLife Disability Case.

Virginia Disability Attorney Ben Glass

How Should A Judge Assess Disability?

blog@www.robberywithoutagun.com (news Author)5742 — Fri, 19 Sep 2008 08:00:00 EST

Court Blasts MetLife, exposes Relationship Between it and independent reviewers

blog@www.robberywithoutagun.com (news Author)5730 — Thu, 18 Sep 2008 08:00:00 EST

Wright v. Raytheon. Huge some of money being paid by these insurance companies to so-called indepedent reviewers. Read this opinion if your disability case has been "reviewed" by Amy Hopkins or Michael Rosenberg (cardiologist). You will find it interesting. The case is here.

Court Rips MetLife and Jeffrey Lieberman, M.D. in "review" of fibromyalgia case

blog@www.robberywithoutagun.com (news Author)5710 — Wed, 17 Sep 2008 08:00:00 EST

This is an interesting case in which the court exposes MetLife's connection to a major review service and walks you through a really bad analysis of a fibromyalgia disability case.

Finally, the Government Looks at the Disability Insurance Company Practice of Forcing Almost Everyone to Apply for Social Security

blog@www.robberywithoutagun.com (news Author)5307 — Mon, 08 Sep 2008 08:00:00 EST

The United States Senate is finally looking into the practice of insurance companies forcing able-bodied people to apply for Social Security disability benefits, worsening a severe backlog in the government program while increasing their own profits. Most disability insurance plans provide for payments even if the claimant is not so disabled that they would qualify for social security disability. This, many claim, is costing the government a ton of money.

Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee, has sent letters to nine insurers, including giants UNUM and Aetna, requesting more information about their handling of disability claims and their requirement that virtually everyone apply for social security disability payments.

(One of the deep dark secrets of why most employer sponsored plans are virtual shams is that if you get SSDI benefits it reduces what the disability company has to pay you.)

“The last thing those who rely on Social Security need is for insurance companies to be clogging up the system by forcing ineligible applicants to apply,” he said.

Mr. Grassley told the insurers to report on how many of their claimants they had compelled to apply for Social Security in the last five years; how many appeals they had required people to file; and what methods they had used to screen the people beforehand to make sure they truly had a chance of qualifying for the government benefits.