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

Articles Posted in Uncategorized

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 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.

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:

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.