COVID-19 Update: How We Are Serving and Protecting Our Clients.

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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:

We are closely tracking the rapidly evolving public health and community concerns related to the new coronavirus or COVID-19. Rest assured that we are taking all available steps to remain accessible to our clients as we continue to act in accordance with their best interests during this difficult time.

Please see below for answers to some frequently asked questions, and feel free to reach out to us any time at patd@smdalaw.com or 586-264-3756 for assistance with your legal matter.

Is your office currently open during normal business hours?  No.  Although we will have staff present intermittently through the week.

SMDA recently convinced disability insurer Lincoln National Life Insurance Company to overturn its decision denying disability benefits for a  client who was working as a Computer Support Technician.  The client had developed serious orthopedic problems which resulted in significant functional limitations.  SMDA filed a comprehensive administrative appeal demonstrating the client’s inability to perform the actual duties of his own occupation.  This is a prime example, especially in claims governed by the Employee Retirement Income Security Act (ERISA), of the importance of getting legal counsel involved early in the process to short-circuit any effort to deny a claim for disability benefits.  Remember that the disability insurance company is inherently conflicted as it both determines eligibility and then must pay benefits if the claim is approved.

Registered Nurses have an incredibly demanding occupation.  As a result we have seen many prospective RN’s who have suffered some form of orthopedic problems which unsurprisingly prevent them from continuing to provide direct patient care.

SMDA successfully appealed Cigna’s decision denying Long Term Disability Insurance benefits to our client who was forced to stop working as a registered nurse at Henry Ford Hospital due to her significant and progressive orthopedic spine problems.

SMDA filed a comprehensive administrative appeal with significant supportive documentation demonstrating the marked restrictions and limitations the client experienced as a result of her neck and back pain and problems.  Cigna overturned the claim denial decision and retroactively reinstated the monthly disability payments to the original date fo denial.

The 5th Circuit Court of appeals recently reversed a ruling for a worker suffering from Reynaud’s Disease, which is a condition preventing the claimant from working in a cold environment.  Unfortunately, the claimant worked at a chicken processing plant as a Hazard Analysis coordinator.  Her job duties required  that she inspect each part of the processing plant, including the refrigerated sections where the temperature was maintained at approximately 40 degrees.  The LTD insurance policy provided benefits if she was disabled from  “performing the duties of her Regular Occupation.”  Reliance Standard, the Long Term Disability Insurer, denied the claim based upon an in-house vocational reviewer who concluded her regular occupation would be classified as a “Sanitarium” as defined by the DOT and that the material duties “include neither employment at a poultry processing plant nor exposure to the cold.”   Utilizing an abuse of discretion standard the Appellate court overturned the lower court’s decision for the claimant.

This is just one more in a very long line of cases demonstrating the difficulty claimant’s face in pursuing ERISA claims for Long Term Disability Insurance benefits.  And, in my opinion, the inherent unfairness in the current state of the law.

SMDA recently obtained a reversal of CIGNA’s decision denying Long Term disability Insurance Benefits to a Henry Ford Hospital employee.  As a result of our comprehensive administrative appeal CIGNA (aka Life insurance Company of North America) overturned its decision denying our client’s claim for benefits.  Our client suffered from a number of conditions including Type 2 Diabetes Mellitus, Neuropathy, Asthma, COPD, Arthritis, and carpal tunnel syndrome. We convinced CIGNA to reinstate the disability insurance benefits even under the more stringent “any Occupation” definition of disability.

It can be confusing trying to figure out the amount of Long Term Disability Insurance benefits the insurance company should pay.  Here is a brief outline of how the amount is commonly determined.

Step 1.-Figure out your base monthly income.  (Take your yearly income and divide by 12.  Beware however-commonly excludes overtime and bonuses.)

Step 2.  Multiply by the benefit percentage listed in the Insurance Policy.  Commonly 66 2/3%.  (However, I have seen many other rates from 40-70%.)

SMDA recently convinced  LTD insurer Cigna to overturn its claims denial decision for a registered nurse who developed significant low back pain that prevented her from performing her own occupation.  Our client had degenerative disc disease that had progressed over the years eventually leaving her unable to work.  Cigna initially denied her claim finding she was not disabled.

SMDA filed a comprehensive administrative appeal which established that the functional limitations the client experienced made it impossible for her to perform the material duties of her own occupation.  Cigna overturned the claims denial decision and agreed to retroactively reinstate her LTD benefits and put her back on claim.

A US District Court Judge recently granted a motion filed by SMDA granting LTD benefits to one of our clients.  The Court found that the third party administrator had abused its discretion in recommending a denial of benefits.  The Court found that the client’s serious back problems along with the multiple powerful pain medications prevented him from performing the duties of his own occupation.

SMDA partner, Patrick Derkacz, recently recovered $1.2 million dollars on behalf of his seriously injured clients.  Mr. Derkacz convinced State Farm to pay this significant settlement the day after taking the deposition of the at-fault driver who offered testimony  that he was not responsible for causing this rear end accident.  The at-fault driver tried to blame everyone but himself, including the seriously injured driver of the car he struck for not traveling the minimum speed on the freeway.  (The  freeway traffic was slowing to a stop for a previous accident!)  State Farm likely realized that any potential jury would not look kindly upon Defendant’s ridiculous testimony.

This significant recovery should help the elderly couple injured in the crash the economic cushion they need to live their lives as they wish.