Michigan Long Term Disability Insurance Lawyer Blog

Four Michigan Supreme Court Justices (Young, Markman, Kelly and Zahra) issued a decision changing 30 years of No-Fault Insurance law finding that automobile insurance companies no longer need pay No-Fault benefits to a person who is injured while closing their car door.

In Frasier v Allstate, the claimant, Mona Lisa Frasier had put some personal belongings in the passenger side of her car and was in the process of closing her car door when she fell on some ice and was injured. Mona Lisa made a claim with her car insurance company, Allstate to get her medical bills paid. Why? because the the Michigan No-Fault statute says the car insurer has to pay for your medical care if you are hurt as “a direct result of physical contact with equipment permanently mounted on the vehicle[,]” or if the injury occurs “while occupying, entering into, or alighting from the vehicle.”

Continue reading "WHEN IS A DOOR NOT A DOOR? ASK THE NEW MICHIGAN SUPREME COURT" »

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Our client last worked as a RN at a local hospital when she developed significant orthopedic problems following hip replacement surgery. She filed a claim for LTD benefits with the insurance company who provided group disability insurance through her employer, Oakwood Hospital. The insurer paid her disability claim for the first 24 months and then terminated her benefits claiming she was capable of working in a sedentary capacity.

After the insurer denied the administrative appeal filed by the firm, SMDA filed suit to compel the disability insurer to reinstate her LTD benefits. On the eve of the date the Court was to consider the party's briefs the insurance company threw in the towel and voluntarily agreed to reinstate the client's LTD benefits and pay the attorney fees incurred. This result is a clear lesson that it is critical that the administrative appeal be handled correctly as the administrative record in this case was overwhelmingly favorable to the client. The insurance company realized there was little chance of convincing the Court that it was correct in terminating her benefits.

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According to a CDA press release disability companies paid out more than 8 billion dollars in disability insurance payments in 2010. This included more than 139,000 new disability claim approvals, a small increase over the previous year's numbers.

Diseases of the musculoskeletal system and connective tissue--such as arthritis, spine disorders and back pain were the leading cause of both new and continuing claims. The overwhelming majority of claims (90%) were caused by illness rather than accicdent.

For more information visit the CDA's website here.

From the CDA website-The Council for Disability Awareness (CDA) is a non-profit group dedicated to helping the American workforce become aware of the growing likelihood of disability and its financial consequences. The CDA engages in communications, research and educational activities that provide information and helpful resources to wage earners, their families, employers and others who are concerned about disability and the impact it can have on wage earners and their families.

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We recently received notice that another administrative appeal of the denial of a client's LTD claim has been successful.

When a claim for LTD benefits is denied, pursuant to the ERISA regulations the claimant must file an administrative appeal of the denial decision with the entity that denied the claim, usually an insurer. This is part of the requirement that the claimant exhaust their administrative remedies before suit can be filed.

In this claim, despite ongoing treatment our client continued to experience disabling Migraine headaches on a regular basis multiple times per week. When she experiences these headaches she is disabled from any activity. As a result of the ongoing headaches she experiences severe difficulty with focus and concentration. Her headaches are aggravated by routine physical activity. She also experience phonophobia and photophobia and nausea. As a result of her medical condition, the client has functional limitations related to any activity including sitting, standing, and routine computer usage.

The firm prepared a comprehensive administrative appeal that included medical records, treating doctors opinions, and medical journal articles as part of the successful appeal.

This case demonstrates the importance of a properly prepared administrative appeal, especially in light of difficult case-law in this circuit regarding medical conditions where there is no objective medical test available to verify the subjective complaints of pain.

If your claim for LTD benefits has been denied, please contact SMDA to see if we can help get your benefits reinstated.

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SMDA had the opportunity to represent a registered nurse who stopped working in the Emergency Department after two level cervical disc fusion surgery. Several months after the surgery the LTD insurer terminated her benefits when it determined “that the medical on file does not appear to support any significant functional impairment other than that contributed by your cervical fusion.” The insurer ignored the fact that after the surgery she developed significant fatigue and was referred to a rheumatologist. She has been diagnosed with Lupus, Sjorgen’s Syndrome, Mitral Valve Prolapse, Migraine Headaches and Raynaud’s Syndrome. As a result of her illness she experienced marked fatigue, joint pain and shortness of breath. She also had significant sit/stand restriction.

SMDA succesfully argued that her occupation as a registered nurse working in the emergency department required a high level of cognitive functioning. She must be able to effectively assess and immediately determine the appropriate response to emergent life-threatening medical developments. Given her cognitive limitations related to her fatigue and multiple medications, her ability to satisfactorily perform is impaired.

Upon considering the Administrative Appeal, the insurer reversed its denial decision and reinstated the client's LTD benefits retroactive to the termination date.

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It has been quite awhile since I last posted a blog. I have not had the time to post because while I was away I tried several cases.

In addition to handling Long Term Disability cases our firm also handles various other types of matters including automobile accident insurance claims.

In December I tried a case for a client who was injured in a 2005 motor vehicle crash. She had neck surgery for a herniated disc but continued to have pain and problems for which she received ongoing treatment. Her Insurance company, which I will not identify, (State Farm) refused to pay for any of her medical care. When a person is injured in a car crash their insurer is responsible for paying their personal injury protection (PIP) benefits, including lifetime medical care.

My client is the nicest person who takes care of an adult child with profound disabilities. The Insurance company did everything it could to try and avoid paying her medical bills going so far as to argue that she could perform physical therapy on herself at home.

I am glad to say that the jury completely rejected the Insurance Companies arguments and decided they should pay every single penny that we sought.

Continue reading "While I was away-PIP, UM and Trials" »

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Michigan Lawyers Weekly recently published an article "Long term Disability Insurance and ERISA" written by SMDA Partner, Patrick Derkacz. Following is an excerpt from the article.

THE SET-UP

So your client got sick or hurt and hasn’t been able to work for months. They applied for LTD benefits when their doctor told them they cannot work anymore and haven’t had a paycheck for months. They are behind on their mortgage and car payment. They are getting hammered by late fees and might lose the house. They are holding on by their fingernails. They call in a panic because they just received a letter from the LTD insurer, explaining that the claim has been denied because the Insurer’s in-house nurse determined “there is no objective evidence that you are unable to perform the material and substantial duties of your occupation.”

After recovering from their shock and surprise they get angry. The client wants you to immediately file suit to make the insurer pays for their emotional distress, for all those late fees, for the insurance companies obvious bad faith. They want punitive damages. They want a million dollars. Surely a jury of their peers will punish this kind of behavior.

Not so fast you get to say. Have you ever heard of ERISA? No? Well, let me explain.

The article may be viewed at http://milawyersweekly.com/. A subscription is required.

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A federal Court Judge recently ordered a Long Term Disability Insurance Plan to pay all of Plaintiff's (our client) attorney fees. As a result the claimant got to keep all of his LTD benefits.

In Deloach v The Great Atlantic & Pacific Tea Company LTD plan, the Honorable George Steeh found that the plan and its administrator Connecticut General should never have denied Mr. Deloach's claim for LTD benefits in the first place. The Court also granted Plaintiff's motion for attorney fees and ordered Defendant to pay for all but a small portion of the time spent by counsel on the claim. The Court also determined that $325 per hour was a reasonable hourly attorney fee.

This ruling demonstrates an important aspect of ERISA for LTD claimants. Specifically, the amount of benefits at stake in this case were such that without the prospect of Court awarded attorney fees it may have been difficult for the Plaintiff to find counsel willing to take the case.

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Another Eastern District of Michigan federal court recently granted my motion for discovery in a long term disability insurance ERISA case without requiring a predicate showing.

This time the Court specifically decided that there was no requirement that a predicate showing be made. Instead, the federal rules generally governing discovery should be applied.

Judge Lawson ruled in Price v Hartford (09-14171):

Continue reading "ANOTHER COURT ORDERS DISCOVERY IN LONG TERM DISABILITY ERISA CASE" »

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Here is a link to the Senate Hearing on Long Term Disability Insurance. Anyone who has a claim or may become disabled should watch this for a brief glimpse into the difficulties associated with obtaining Long Term Disability Benefits.

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Senior United States District Court Judge William Acker offered his views on ERISA LTD cases to the Senate. Follow this link to read his views.

The Judge has a number of interesting insights including the overwhelming difficulty faced by most LTD claimaints that is simply built into the system.

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As reported by Scott Mulhauser/Erin Shields on the insurancenewsnet.com website.

Senate Finance Committee Chairman Max Baucus (D-Mont.) will convene a hearing on Tuesday to examine the difficulties workers face in securing benefits they are entitled to from private long-term disability insurance plans. The hearing, entitled "Do Private Long-Term Disability Policies Provide the Protection They Promise?" will take place at 10:00 a.m. on Tuesday, September 28 in Room 215 of the Dirksen Senate Office Building.

At the hearing, Baucus will focus on whether private-sector long-term insurance claims are being unfairly denied or terminated by the companies providing long-term disability insurance covered under the Employee Retirement Income Security Act (ERISA). The hearing will also examine how these private insurance companies have handled workers' appeals of denials and terminations. Baucus will raise questions about possible improvements that can be made to ensure claimants and beneficiaries of long-term disability insurance plans covered under ERISA are treated fairly.

Continue reading "SENATE TO EXAMINE DIFFICULTIES WORKERS FACE WITH LONG-TERM DISABILITY CLAIMS" »

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