Blog

Does it seem like the insurance company is taking too long to decide your claim?  Are they asking you for extension, after extension after extension to decide your claim?  Do they ask you to send them more evidence of your disability only send you back a big fat denial?  Delays and denials by the insurance company are just some of the frustrations expressed by our clients in ERISA disability clients.  While the regulations set the standard on the time limits of when the insurance company must decide an initial application or an appeal of a denied claim, as well as how many extensions they can request and the length of the extensions, there are things you can do to help…Read More

Did you know that in insurance disability claims the insurance company can secretly videotape your activities?  That’s right; the van parked down the street could have a video camera watching your every move. When they send you that activity log to fill out, don’t be fooled.  They are not really wanting to know how limited you are in your activities; they want to see if they can catch you in a lie about your activities.  When you complete those activity logs NEVER say you NEVER engage in any specific activity. Follow your doctor’s advice on what activities you can engage in and those you should avoid. Keep a diary of your daily activates which you can refer to when completing…Read More

By Will Dunham Tue Mar 18, 2:44 AM ET WASHINGTON (Reuters) - A surprising number of people — more than 60 percent — still suffer significant pain a year after a traumatic injury in a car crash or other cause, showing the need for better pain treatment, researchers said. In a study published on Monday in the journal Archives of Surgery, researchers tracked 3,047 patients ages 18 to 84 from 14 U.S. states who survived an acute traumatic injury.A year after the injury, 63 percent reported that they still experienced pain related to the injury, with most having pain in more than one region of the body. On average, the patients assessed their pain at 5.5 on a 10-point scale…Read More

If you are accused of malingering based upon the fake bad scale on the mmpi2, read about the creator of the fake bad scale in an article called: Welding’s Toxic Legacy: Did a 5 Billion Dollar Industry Cover up the Health Risks of Manganese to Thousands of Workers? It showed Paul Lees Haley, the creator of the fake bad scale, being paid 860,000.00 (he’s not even a medical doctor) The same article cites Dr. Erin Bigler, a professor of psychology at Brigham Yong University saying, “It has every appearance of the industry buying science” www.publicintegrity.orgRead More

A new article was recently published indicating the Fake Bad Scale adopted by the University of Minnesota Press as a part of the MMPI2 scoring package has results in over 50% of women, depending on the cut score used, in a hospital with documented eating disorders actually failing the scale. The article is critical of the process by which the scale was actually adopted and concludes, “The FBS does not appear to be sufficiently reliable or valid test for measuring “faking bad” nor should it be used to impute the motivation to malinger in those reaching its variable and imprecise cutting scores.” 12/17/07, Butcher, James, Gass, Carlton, Cumella, Edward, Zina, Kally, Willliams, Carolyn Potential for Bias in MMPI2 Assessment Using…Read More

Imagine going out on disability, losing all your benefits – health insurance, life insurance, maybe even your job –only to find out you do not qualify for disability benefits under your insurance policy. This could lead to financial disaster. Every year millions of people purchase disability insurance, negotiated by their employer, without ever reading the policy. Because they didn’t read the policy they didn’t realize that there are preexisting clauses that may disqualify them from collecting benefits or that the policy limits or denies coverage for the medical condition that they have, or that the benefits offered under the policy are not enough to replace their loss of income. Not only do they have one of these worthless policies, but…Read More

Did you know that some insurance companies blatantly discriminate against the mentally ill? Many group disability policies limit the amount of benefit they will pay if the person’s disability is caused by, or related to, a mental illness. Amazingly, some Judges have decided that this type of discrimination against the mentally ill in long-term disability policies is okay. Just think about it – what usually happens to an individual who becomes ill and unable to work? You guessed it - they become depressed. The insurance company loves to see depression mentioned in the medical record. This way they can cut their losses. They also love to see cognitive impairments in your records as well. This can result from a brain…Read More

Most individuals understand that a Plaintiff who wins his or her lawsuit will be awarded attorney’s fees and costs incurred in prosecuting their claim. Unfortunately, attorney’s fees and costs are discretionary under ERISA. Another anomaly in ERISA law is that attorney’s fees and costs may be awarded against either a losing plaintiff or defendant. That’s right. A losing plaintiff may have to pay the insurance company’s attorney’s fees and cost. Some consider it only fair that the loser pays the fee, no matter which side. Others see it as having a chilling effect on the prosecution of the claim, since an individual may forego pursuing an otherwise valid claim out of fear that they would be saddled with the other…Read More

Some employers will offer a severance package providing for salary or medical benefit continuation, if you sign a general release, releasing them from all claims. If you decide to take such a package, you must be careful not to release your ability to apply for or continue to receive disability benefits under your company’s long-term disability plan. Remember, long term disability insurance only covers you if you become disabled while employed. If your employment is terminated or if you resign and then apply for disability benefits, it may be difficult to prove that you became disabled before your employment ended. If you are considering filing a disability insurance claim you should consult with an experienced ERISA lawyer before you leave…Read More

Is There a Conflict of Interest If the Party Paying Benefits Is The Same Party Who Decides Eligibility? On Thursday, the Supreme Court answered this question with a resounding YES! The Court found, what every plaintiff ERISA practitioner already knew, that when a company determines eligibility and pay benefits out of its own pocket there is an inherent conflict of interest. Recognizing this conflict of interest, the Court went on to state that a reviewing court should consider an insurance company's conflict of interest when reviewing the denial of an employee's health or disability benefits claim. While the court did not provide much guidance on how much weight should be given to the conflict, it provides that the reviewing court…Read More