SMDA was contacted by a physician to evaluate a repayment request by a well known Long Term Disability Insurer.  The doctor had been diagnosed with a medical condition which interfered with the surgical aspects of his practice.  The disability insurer convinced the doctor that he was only residually disabled and intermittently paid a residual disability benefit whenever he had a qualifying loss of earnings each month.  The Disability insurer took this position because the doctor continued performing a portion of the office-based tasks associated with his specialty.  This went on for more than 5 years. Eventually the disability insurer requested repayment when it determined that it had mistakenly overpaid benefits for several months.

Upon investigation, counsel determined that the physician actually was totally disabled under the several policies he had in place which were purchased when he completed his residency several decades earlier.  (In counsel’s experience, the older the policy the better the language is for the claimant.)  SMDA also learned the physician/client actually had multiple disability policies with several different Long Term Disability insurers.  Counsel was able to favorably resolve the doctor’s  claims with each of the LTD Insurers.  All because of the disability insurer’s  initial repayment request.

If you are a physician who has been forced to curtail the nature of your practice but your disability insurer has refused to honor your claim for Total Disability benefits please contact SMDA for a free consultation.

The attorneys at SMDA were recently able to get Cigna (Life Insurance Company of North America) to overturn the claim denial decision for Long Term Disability insurance benefits for a client who had developed significant and progressive cognitive problems.

The client underwent neuropsychiatric testing which confirmed a number of impairments including to his memory, information processing,  focus and attention.  MRI testing confirmed some non-specific changes in the brain.

SMDA convinced CIGNA to approve and pay the claim including all past due benefits.

SMDA was recently able to get Long Term Disability insurance benefits reinstated for a client who had developed significant orthopedic spine problems.  The client had last worked at a sedentary job for an engineering firm.  The Disability insurance company (Reliance Standard) had initially approved and paid benefits for more than a year.  However, they subsequently  reversed course and terminated benefits.

SMDA filed a comprehensive administrative appeal including voluminous medical records as well as a comprehensive analysis of the client’s various medical conditions with supporting documentation from numerous treating physicians.  Upon review, the disability insurance company agreed to reinstate the benefit claim.

This is a good example of why a claimant should prepare a comprehensive administrative appeal-Because it may result in the reinstatement of benefits without the need for lengthy and time consuming litigation all while the claimant has no income coming in.

SMDA was recently able to convince a Long Term Disability Insurer to settle a challenging claim brought by a local public school teacher.

Long Term Disability insurance claims for public school teachers (or other public school employees) are somewhat unique because these claims are not governed by the Employee Retirement Income Security Act (ERISA). This is because the ERISA statute does not apply to government plans (or church plans).   Accordingly, the normal rules (which apply to the vast majority of LTD claims) regarding ERISA and the Department of Labor regulations do not apply.  There is usually no claim appeal or  exhaustion requirement. There is no discretionary standard of review.  These are just a few of the important differences that apply to Long Term Disability Insurance claims for public school teachers.

Instead of  filing a federal court lawsuit for a violation of the ERISA statute a public school teacher’s claim is filed as  a breach of contract claim usually in the circuit court for the county where they either work or reside.  Unlike ERISA, these cases proceed with discovery, case evaluation and a trial.  These are very important differences that impact the claim and the litigation strategy from day 1.

SMDA was hired by a physician to try and convince a disability insurance company to overturn its decision to terminate their claim for disability benefits.

The client had been working as an Emergency Department physician at a rural hospital when they developed a very unusual neurological condition that resulted in significant functional limitations.  The disability insurer originally approved and paid the claim for a period of time.  However, it terminated the claim when the “own occupation” period expired, even while the client continued  to experience significant functional problems that interfered with the performance of even routine activities of daily living.

SMDA filed a comprehensive administrative  appeal providing  substantial documentation regarding the rare diagnosis convincing the disability insurer to reinstate the claim and pay the client  additional benefits.  If you are a medical professional who has had your claim for disability insurance benefits denied, please contact the experts at Serafini, Michalowski, Derkacz & Associates to help get the disability insurance benefits you deserve.

SMDA was able to negotiate a favorable settlement for a Deloitte manager’s claim for Permanent and Total Disability benefits  after a tortuous claim process.  The injured client retained SMDA  after an unsuccessful  application for benefits.  Her disability benefit claim was significantly hampered because she waited several years to hire a lawyer while her claim languished waiting for a decision.  After Mutual of Omaha finally denied her claim (after years had elapsed) SMDA was hired and filed a comprehensive administrative appeal.  Suit was filed shortly after the appeal was denied.  Counsel was able to craft several persuasive arguments that the statute of limitations had not expired despite the passage of so much time which convinced the insurer it would be best served to settle the case.  The case was further complicated by the nature of the disability-a traumatic brain injury.

We have started getting calls for disability claims  related to the Covid-19 pandemic.  Most LTD insurance policies have an elimination period of either 90 or 180 days which mandate that you be continuously disabled for this period of time in order to be eligible for long term benefits.  The duration of many short term disability insurance polices will correspond with the elimination period of the LTD policy.  (i.e. STD will pay for 90 or 180 days) Given the  nature of the pandemic there are a significant number of people  who have become gravely ill with this disease.  We would encourage you to make sure that you timely  apply for both Short and Long term disability insurance if available to protect your family from the financial impact of the pandemic.

At Serafini, Michalowski, Derkacz & Associates, P.C., one of our areas of expertise is representing and fighting for those who have been injured as a result of a motor vehicle collision, whether that be against your own personal insurance company or the person whose negligence caused the collision in the first place.

On June 11, 2019, the Governor of Michigan, Gretchen Whitmer, approved and filed with the Secretary of State Act No. 21, Public Acts of 2019, commonly referred to as No-Fault Reform.  Based upon our years of experienced and reading of the new law, we want to offer our guidance regarding your coverage choices as you are no doubt receiving information from your automobile insurer about renewing your policy, and the options at your disposal.

This legislation has brought significant changes to the Michigan No-Fault Act, which is the law that governs Michigan automobile insurance and the rights and duties of those Michigan residents who own and drive vehicles on our highways, as well as those who are unfortunately involved in a motor vehicle collision.  You should understand that these changes only relate to the portions of your automobile insurance policy relating to Personal Injury Protection (PIP) benefits in the event you are injured in an accident.

In compliance with the governor’s order regarding shelter in place and stay safe at home policies, the firm has implemented the following policies consistent with Executive Order 2020-21.

Pursuant to Section 4 paragraph (b) the firm has identified its essential employees necessary to conduct minimal business transactions, like banking, payroll processing, employee benefits and ensuring that those of us that are working from home have the ability to work remotely.   Each designated employee has a “transit letter” within his or her possession.

For compliance with the executive order the following information is available: