Surveillance Video and Independent Medical Examination (IME) Leads to Disability Insurer Terminating Disability Claim After Paying Partially Disabled Insurance Agents Claim For 21 Years
Our client, Richard, was working as an insurance agent when he began experiencing pain in his lower back. After consulting a physician and undergoing a CT scan and MRI, a ruptured lumbosacral disk was discovered. As an insurance agent, Richard understood the importance of maintaining disability insurance and he had personally purchased an individual disability insurance policy, insuring him for both total and partial disability from his occupation as an insurance agent.
Following the diagnosis of his ruptured disk, Richard’s physicians recommended surgical laminectomy and discectomy to repair the lumbosacral space. Ten days following his surgery Richard began experiencing severe pain in his low back and right side. Richard presented to the ER, where they treated him conservatively and sent him home. Richard’s pain persisted so he returned to the hospital where an MRI was performed, which revealed to be mostly normal. He was once again treated conservatively and sent home with instructions to remain on bed rest. Richard continued to suffer severe pain to the point that he returned to the Emergency Room and a repeat MRI showed definite discitis and destructive inflammation.
With treatment, therapy, and medication, Richard’s inflammation soon lessened, but, his pain persisted. Richard eventually returned to work, but his chronic back pain only allowed him to work part-time. Despite his best efforts to generate income similar to the income he was generating prior to his surgery, Richard’s sales and revenue suffered. It was simply impossible to generate his pre-disability income working only ten hours per week, when he had previously worked 50+.
Richard contacted his disability insurer and informed them that would need to file a claim under his policy. Richard was not surprised when his disability insurer, after reviewing his claim, determined that he was indeed unable to spend as much time at his occupation as he did before his disability started, and that he had at least a 20% loss of income, thus qualifying him to receive partial disability benefits.
For the next 21 years Richard’s long-term disability in surer paid his partial disability claim. Although Richard left his employer soon after his disability claim was approved to run own insurance agency, where he could manage his own hours and accommodate his medical issues, his disability insurance company, paid faithfully for the entire period.
Around year 21 of the disability claim, the claim transferred to a new claim representative. The new claim representative requested updated medical records, which they had reviewed by their internal medical consultant. Following the medical consultants review, they determined that they should obtain surveillance video of Richard, and request an Independent Medical Examination (IME) by a physician outside of the disability insurance company. The IME examined Richard and reviewed the surveillance video provided by long-term disability insurance company, which showed Richard getting in and out of cars, engaging in conversations, running errands, walking, rolling a suitcase, and using a cane.
The IME concluded, based on a brief examination of Richard’s lower back, but without reviewing any recent MRI, that Richard was capable of working full-time as an insurance agent and in any sedentary occupation. In reaching his opinion, the IME never discussed Richard’s occupation with him, much less his specific occupational duties or the physical, intellectual and cognitive demands of working in insurance sales and operating your own agency. No mention of any of Richard’s occupational duties appeared in the IME’s report. Without knowing anything about the actual physical demands of his job in insurance sales, the IME opined that Richard was capable of not only performing the sedentary duties of an insurance agent, but also those of a light duty occupation. At the conclusion of his IME he acknowledged that he based his opinion without an updated MRI, and stated that he did not have enough information to say whether or not additional treatment including surgery would be of benefit to Richard.
The long-term disability insurance company decided to terminate Richard’s claim, and its decision essentially mirrored the opinion of its IME. It claimed that Richard was not only capable of the sedentary duties of an insurance agent, but also those of a light duty occupation.
For a short time, Richard attempted to resolve the matter directly with his disability insurance carrier. He wrote letters, provided more medical records and spoke numerous times with the claim representative. However, none of his strategies and efforts proved to be fruitful, and he contacted Dell Disability Lawyers, hiring Attorney Cesar Gavidia to represent him.
Richard and his long-term disability insurance carrier, with their attorneys, agreed to participate in a pre-suit mediation, where Attorney Gavidia and the disability insurance company’s in-house general counsel gave compelling and well-prepared presentations and arguments. The evidence, including Richard’s recent medical treatments, MRI’s, and even the surveillance videos were discussed and argued over. After many hours of negotiation and presenting evidence and arguments, the parties reached a confidential monetary settlement to their mutual satisfaction.
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Every month I get paid on a different date
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Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
Submit A Strong Appeal Package
If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
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We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
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Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
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Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
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Who are Dell Disability Lawyers?
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
Do you work in my state?
Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
What are your fees?
Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
Do I have to come to your office to work with your law firm?
No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
How can I contact you?
When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.