A  42 year old woman suffered from co-morbid conditions of Chronic Fatigue Syndrome and Lyme disease. We had initially successfully appealed her claim for benefits under the Prudential disability insurance policy. After being on claim for several years, however, Prudential terminated her claim during the “any occupation” phase, finding her no longer eligible for benefits, despite no improvement in her condition.

To accomplish this, Prudential relied upon a report from a well-known insurance pandering paper reviewing physician who determined that the testing, which previously was sufficient for Prudential to accept liability, was no longer “valid.“ Prudential was only too pleased to embrace this report as a good reason to terminate the claim.

Under our direction, our client had gone for Cardiopulmonary Exercise Testing (CPET), considered to be the gold standard for developing evidence to support dysfunction from Chronic Fatigue Syndrome. The CPET results were criticized by the paper-reviewing doctor and Prudential subsequently engaged another doctor to review and embrace the erroneous report concerning the CPET testing.

These two reports formed the basis of Prudential’s termination of the claim.

We fought back on behalf of our clients, first by securing a for the report from the CPET physician who performed the initial test to validate the results and refute Prudential’s doctor.  This report, along with other physician support and additional evidence we gathered, created a record we were confident would succeed in litigation. 

Given the significant financial exposure Prudential faced if we were successful in court, we were able to negotiate with our adversaries early in litigation, providing the client with closure, certainty, and the ability to move on with her life.


Our client came to us after a claim denial from Lincoln Financial. A successful Science and Regulatory Manager at a major health company, when he was unable to work, he filed his claim and provided all support requested by his insurance company, for which premiums had been paid over several years. 

Shocked that they refused to pay, we explored his issues and took this interesting appeal on. He was suffering from symptoms characterized as similar to “Havana Syndrome,” which causes significant impairment across numerous symptoms and often result in pervasive headaches, unbearable pain, and other manifestations. Our client, age 56, had been successful when his career was abruptly ended by the significance of his symptoms, which were largely debilitating and rendered him completely unable to work in any job. Despite the severity, Lincoln Financial chose to minimize his problems, ignore his subjective complaints, and refused to credit his doctor.

Havana Syndrome is controversial, as the government continues to deny that it exists, or that electromagnetic energy weaponry is being utilized. Literature runs the spectrum on the issues, and a community of advocates is emerging, yet it remains underappreciated. It may be organic brain injury, but its manifestations are differ than other brain injuries. He suffered from some auditory-vestibular disorder. Lincoln and its hired doctors took the position that because Havana Syndrome was a cluster of “idiopathic” symptoms, it did not need to credit ANY of his symptoms, despite how pervasive, frequent, and intense.

He suffered unpredictable attacks, which caused him to need to scream and rest, and which frustrated his ability to engage in any sustained activity. He was compelled to take significant pain medications, but his disability insurance company took no interest in appreciating the significance of his challenges. Nor would they credit his vestibular dysfunction, despite evidence revealing its significance. 

To succeed with his appeal, we identified that cognitive testing was necessary to support his impairments, since Lincoln was largely ignoring his documented and subjective symptoms or believing it was psychogenic and not real. We were able to create audio files of his manifestations, which resulted in screaming attacks that would offer last for several minutes.

Coupled with the objective results from the cognitive testing, we were able to work with his treating physician to ascribe further limitations that were verifiable to the additional symptoms, restrictions and limitations which had been supported throughout to demonstrate to Lincoln the severity of our client’s impairments. 

Despite the awkward working diagnosis of Havana Syndrome, despite our client not having been to Cuba, where Havana Syndrome has been claimed to originate, his symptoms and manifestations resulted in his impairment, regardless of his condition’s name. We advise clients regularly that the name of the diagnosis is not nearly as important – if at all – compared to the symptoms, restrictions and limitations that result from the condition, regardless of name. 

Lincoin noted the significant support provided and appreciated that it could not sustain its weak claim position in litigation, compelling it to overturn its claim decision and pay benefits to our client.

A 51-year-old manager and supervisor of an industrial plant enjoyed a successful career working for a major international technology and business consulting firm. He suffered from numerous orthopedic due to degenerative disc disease, cervical (C6-C7) and lumbar disc herniation, spinal stenosis, cervical and lumbar radiculopathy, lumbar spondylolisthesis, bilateral hip/pelvis osteoarthritis, arthritis of the spine, sciatica, a labral tear of right hip joint and peripheral neuropathy.

He lived with a great deal of pain for many years and like many claimants of his generation with a strong work ethic, continued to work despite the pain, but at a certain point, his multiple co-morbid conditions made it impossible to perform the duties of his position. It became too physically demanding and he could no longer handle the intense and constant pain. He was also taking a number of medications, and the side effects took a significant toll on his cognitive abilities. Thus, he could not find a happy medium to allow him to work; either medications hurt his functionality, or pain impaired him. 

When his physicians advised him to stop working and to apply for short-term disability, Unum approved his short-term claim and agreed that he was disabled from performing his own occupation on a full-time, sustained basis. It seemed as if they appreciated the significance of his impairment. However, after his short-term disability claim was exhausted, and because his condition remained poor, his physicians told him not to return to work and advised him to apply for long-term disability. Despite no change in his medical condition, Unum denied his long-term disability claim. The same evidence which supported short-term disability was no longer effective support for the long-term claim.

We attacked Unum’s purported “independent” peer-reviewing consultants and the well-known pro-insurance company vendors Unum typically retains to bolster its claim denials.  Many of these doctors are weathered from years of blanketly denying claims and being chastised by judges.  Additionally, to further influence the issues, and develop a strong case for litigation if necessary, we developed powerful arguments revealing Unum’s bias and egregious conduct. These arguments included Unum’s failure to consider our client’s chronic pain, overall co-morbid conditions, side effects of his medication, and the nature of his work situated in a manufacturing plant.  This is placed in the context of Unum’s vast history of biased claim administration and adversarial conduct toward claimants.

With this appeal, Unum based its determination on a faulty vocational analysis which miscategorized our client’s occupation as a manager and supervisor of an industrial plant and failed to appreciate his functional deficits. He had been reassigned to lighter duty but was not able to perform the necessary tasks.   That did not seem to matter to Unum.  Unum erroneously misconstrued his duties by only acknowledging the sedentary duties of the occupation.

On appeal, we worked closely with our client in establishing evidence with his employer delineating his day-to-day occupational duties, reinforcing the fact that his own occupation by no means could possibly be considered “sedentary.” Even with the reassignment of his occupation, Unum refused to acknowledge his restrictions and limitations.  We were able to demonstrate, through functional testing, that his condition removed him from the competitive work landscape and that he was entitled to benefits.

We were excited to reverse Unum’s decision through aggressive, meticulous, and unwavering representation, the use of supporting materials documenting the material and substantial duties of our client’s job and highlighting the biased nature of the medical reviews created by Unum’s doctors. By working harmoniously with our client for this collaborative effort, success was achieved.

think this success story should be prominent on the link the them, for ERISA successes. OVERPAYMENT SUCCESS STORY -ERISA

Our client, a 58-year-old Strategy Plan and Administrative Manager, enjoyed her successful career working for a well-regarded banking institution on the West Coast.  Unfortunately, she suffered from numerous aliments which impacted upon her ability to work.  Her Chronic Intractable Migraines and Vestibular Migraines, Vertigo, and Chronic Pain, combined with her Persistent Postural-Perceptual dizziness (PPPD), resulting in her deficits and inability to perform her daily activities. 

When she could no longer continue working, her physicians advised her to stop working and to apply for short term disability. MetLife willingly approved her short-term claim on the basis of finding her disabled from performing her own occupation on a full-time sustained basis.   It was not Met Life’s money when they agreed she was disabled.   After her short-term disability claim was exhausted, her physicians did not release her for work and advised her to apply for long term disability, which was subsequently denied by MetLife – despite the same evidence and support.  This time, it was Met Life’s money. 

MetLife denied the claim predicated upon a faulty vocational analysis which miscategorized our client’s occupation as a Management Analyst. Although our client’s own occupation was a Strategy Plan and Administrative Manager, as often occurs, MetLife performed an erroneous vocational analysis.   Because our client was still within her OWN occupation period of disability, MetLife’s actions were premature and arbitrary and capricious. In doing so, MetLife completely disregarded her duties as a Strategy Plan and Administrative Manager and only acknowledged the sedentary physical requirements of the occupation, despite the position being significantly more physically demanding requiring travel.  Nor did Met Life properly consider the cognitive work requirements, which were deeply impacted by her conditions.  

On appeal, utilizing a Vocational Expert – coupled with our strong attack of the arbitrary transferrable skills analysis, and working closely with our client’s medical providers, we developed powerful support for why our client could no longer work on a full-time sustained basis on both a physically and cognitively demanding career.   Furthermore, on appeal, we worked closely with our client in establishing evidence with her employer delineating her day-to-day occupational duties as a Strategy Plan and Administrative Manager, reinforcing the fact that her own occupation could not possibly be viewed as “sedentary”. 

We attacked MetLife’s purported “independent” peer reviewing consultants, and the well-known pro-insurance and symbiotic third-party vendor MetLife collaborated with to engage these “independent” consultants.  We also worked closely with her physicians in rebutting MetLife’s inaccurate and unreliable peer reviews. The appeal contained subjective medical support, an expert vocational report and a plethora of medical literature – informing MetLife of the severity of our client’s conditions and the resulting impact upon her functionality.

Additionally, we developed powerful arguments revealing MetLife’s bias and egregious conduct. These arguments included MetLife’s failure to consider our client’s well documented and credible subjective complaints of impairment; MetLife’s failure to consider her co-morbid conditions; MetLife’s failure to properly evaluate our client’s own occupation and its refusal to consider the nature of the institution where she was employed and the general characteristics of her position.

After providing supporting materials documenting the material and substantial duties of our client’s job and undercutting the biased reviews of its insurance pandering medical reviews were we able to reverse MetLife’s decision. As we often do upon our successful appeals, we continue to represent our client in monitoring her claim in ensuring that MetLife does not terminate her disability claim. 

Our 50-year-old client worked in upper management for a multi-media advertising agency as a Senior Buyer of advertising. Her job had significant financial pressures, quotas, and a constant need to hit numbers. After she began suffering unexpected but intensely debilitating back pain, she was not able to continue to travel for business and was confined to local work, which was also difficult, and resulted in a marked decline in performance. On top of this, her condition required significant medical care, including chiropractic and physical therapy, leaving little time to get work accomplished. Those issues were not considered during the claim process by CIGNA.  Care and treatment to a level that interrupts multiple work days per week must be a factor considered.

She was suffering from numerous disabling orthopedic conditions, including multiple failed back surgeries, L4-L5 and L5–S1 lumbar fusions, lumbar radiculopathy, and chronic bilateral low back pain. She still suffers daily from symptoms, restrictions, and limitations, including chronic pain, erratic gait, numbness and tingling, weakness, cramping, joint and muscle pain, back pain, and musculoskeletal problems that impact and impair both her daily life and her ability to work. 

To support the claim, we ensured that our client consulted a number of medical professionals for evaluation, treatment and claim support for her conditions.   We worked to gather this support with our client, who needed much assistance in the process.  With our collaboration, all of her doctors were extremely supportive of her disability insurance claim and provided strong articulations of her functional deficits.

As is typical, CIGNA had initially denied the claim, based on a nurse review, refusing to consider the well documented complaints. Once her claim had been denied, she engaged Jason Newfield to battle on her behalf, and fight her claim on appeal, which was accomplished in a team approach with the client and her medical providers.  Using our formula for success, we were able to submit an appeal to overturn CIGNA’s wrongful determination.

We created this successful appeal for our client, developing medical, vocational, factual, and legal support, and overwhelmed CIGNA with this powerful array of support showing why our client could no longer work on a full-time sustained basis in both a physically and cognitively demanding career.  Her functionality had been too compromised, and we were able to demonstrate this to CIGNA.

With our client’s support, we also worked with her physicians in guiding them on issues to focus upon in order to rebut CIGNA’s medical portrayal of the issues. The medical review performed on behalf of CIGNA was both inaccurate and unreliable.   We went through the issues and each and every position advanced, in an effort to undercut the foundation of the claim decision.  

Our appeal on our client’s behalf contained significant support, including medical narratives from her doctors, forms, subjective medical support, and medical literature addressing many of the issues presented and how they impact – guiding CIGNA as to the severity of our client’s conditions.   

With this array of support, we convinced CIGNA to accept further liability and pay benefits to our client.  Shortly after our appeal was submitted, CIGNA reversed its decision.  Our client remains on claim, with light monitoring of the claim.  Our approach and process, combined with our years of experience identifying the weak areas in CIGNA’s claim decision, led to a successful appeal, and payment of our client’s claim.  

A breast cancer survivor, suffering from lupus, Hashimoto’s Disease (a thyroid disorder) and obesity, contacted Jason Newfield after Prudential denied her long term disability benefits. Our client was a Vice President with a worldwide financial services company, but even her high level executive skills were no match for the wall of denial constructed by Prudential.

Disability attorney Jason Newfield submitted a vigorous appeal that attacked Prudential on several fronts. Prudential hired MCMC to conduct the medical review — one of Prudential’s frequently used vendors, well known among the disability community for giving insurance companies what they pay so generously for – medical reviews that support the insurance company’s policy of claim denial.

According to its own website, MCMC’s objective is “to evaluate claims, review cases……that allow our clients to achieve positive outcomes through cost effective solutions.”  With the peer review services in particular, MCMC’s stated goal is to provide assistance in “resolving disability claims questions in an effort to manage risk, control claim costs and increase productivity.”

In other words, the insurance companies are their target market and the goal is to limit the insurance company’s costs.  This corporate mission is in complete opposition to the idea of the Independent Medical Review.  MCMC’s success in the insurance industry is arguably the result of its ability to provide medical reports that can be utilized to deny or terminate claims, thereby reducing the costs of managing disability benefits.  This symbiotic relationship has been identified by several courts, but the pervasiveness of this volume of doctors working for these vendors far exceeds judicial scrutiny.  We submitted volumes of support for this bias to show Prudential what litigation would look like.

We also attacked Prudential’s failure to provide the complete medical records for review – lessening the quality of any such report.  Over many years, we continue to see this happen frequently: only a part of the medical records are provided for review, and as a result, the medical professional does not get a total picture of the person’s true disability.   The law requires that a set of complete medical records be reviewed by a qualified medical professional.  Opinions which lack this consideration are less valuable. 

The next prong of our attack concerned Prudential’s’ failure to provide an accurate job description, making it impossible to evaluate the material tasks and duties of her job.   The duties of a high level executive are not the same as a mid-level manager or a clerk.  To perform at this high a level in a global firm requires high level analytical abilities and physical stamina. Not only did Prudential use an outdated Dictionary of Occupational Titles, but they used a generic classification of our client as a Manager with light duty tasks.    

These numerous claim infirmities were identified, and exploited in our appeal process.   After we submitted the appeal, Prudential decided that it needed a proper Independent Medical Exam (IME), which was conducted.   We guided our client through this process, procured a witness to attend to ensure accuracy of the examination, and followed with her and her providers to assess her contemporaneously.  Following this process, benefits were approved, and our client is now on claim.

If your disability claim has been denied and you are not able to work, it’s a safe bet that the claim has not been evaluated properly and the insurance company is counting on your not fighting back.  Call our office today at 877-406-7883 and learn how we can help. 

Our client came to us to pursue an accelerated appeal of her terminated claim, which was not governed by ERISA, as she was employed by a governmental entity. She only had 60 days to file her appeal.  With 45 days to get her appeal assembled, we engaged an expert to conduct an evaluation, in an effort to objectively document the impairments our client sustained.  

As a Security Manager for Information, our formerly high functioning client became  was disabled as a result of her co-morbid conditions, including but not limited to her history of lung cancer resulting in partial lobectomy and lymph node removal, her post-chemotherapy brain fog,  chemotherapy induced peripheral neuropathy, fibromyalgia, headaches, chronic pain, and other problems associated with these conditions. 

These numerous conditions resulted in physical challenges and neurocognitive difficulties in her ability to perform her high level occupation.  Her myriad of symptoms and functional restrictions and limitations,  prevented her from performing the material and substantial duties of her regular occupation or any occupation with reasonable continuity on a full-time sustained basis.  Her claim was managed by Matrix, a third-party administrator used by Reliance Insurance to evaluate claims for Long Term Disability (LTD).  In its effort to reduce liability, Matrix engaged in a myriad of problematic conduct, where it erroneously or improperly:

  • Failed to undertake an appropriate investigation, relying upon biased paper reviews conducted by its in-house medical staff and paid consultants, who never met or examined the insured but merely performed paper reviews of the insured’s medical records;
  • Relied upon selective portions of medical records to the exclusion of more persuasive information;
  • Failed to conduct a true and proper employability analysis before claiming the insured had the functional ability to return to work; 
  • Ignored the insured’s medically supported subjective evidence of impairment; 
  • Failed to consider the insured’s treating physician’s opinions regarding  chemotherapy induced conditions, most prominently cognitive dysfunction and functional restrictions and limitations associated with these conditions; 
  • Failed to have the insured examined in person by a neutral third-party examiner despite the opposing opinions between the insured’s treating physicians and Matrix’s biased staff;
  • Cherry-picked information to support its predetermined goal; and
  • Failed to act in good faith and fair dealing as a neutral fiduciary

The severity of our client’s condition was confirmed by Social Security, who awarded benefits to our client for her disability, which was also ignored by Matrix.  

Success on the appeal was predicated upon developing additional support, medically and vocationally, to demonstrate ongoing and continued impairment.  This was accomplished through neurocognitive testing – which revealed significant deficits across a wide swath of testing of memory, executive functioning, speed of processing and other domains, to support impairments that would translate and support the claim.  

We were able to take the updated medical support developed, along with the prior medical evidence, to rebut Matrix’s medical review, and when our vocational support was developed, success was ensured.  

Our client is now receiving disability benefits and her past due money.

We were retained by a financial advisor after her long term disability claim was terminated by Mass Mutual.  The disability insurance company said the termination of her claim was based on a medical review by doctor who performed Neuropsychological testing. The doctor, an outside consultant to the insurance company, reported that based on the test, her claim was no longer valid, and that she was not continuing to suffer from depression. This was a one-time evaluation from a doctor with no history of either treating or knowing the woman, which is a common strategy used by disability insurance companies to terminate claims.  

The woman had been a high functioning financial advisor whose ability to operate at her previous level was greatly diminished due to a series of significant life events which caused her baseline depression to manifest more severely.  It prevented her from engaging in the activities of her work, both the day-to-day operational side and the business development and client management aspects.  

To combat the determination reached by Mass Mutual, the hired doctor and the evidence developed by Mass Mutual, we engaged an expert to perform a review of the materials and conduct an interview with our client to gain a more comprehensive perspective on the issues.  

Following the expert’s review and analysis of materials, client interview and research, including an analysis of the raw data from the cognitive testing, we successfully reversed Mass Mutual’s determination.   

We succeeded in demonstrating that contrary to their conclusions, our client had provided appropriate effort during the testing, and that her limitations, as revealed by the testing, were impacting her functionality to such a degree that they prevented her from performing the array of duties which her work required.   The accusations of limited effort were overcome, and left Mass Mutual with nothing to defend its position.

Her depression was impacting her energy level, her cognitive ability, and her ability to interact with people, including potential clients. We knew how to demonstrate the powerful connection between her testing limitations, functional deficits, and occupational requirements, which compelled Mass Mutual to appreciate the ongoing nature and severity of our client’s impairment.

Our client is now paid to current status and continues to remain on claim – while she focuses on her recovery.  

By engaging and working closely with the appropriate expert to consider the issues and develop the appropriate rebuttal issues, we were able to overcome a case that was presented to us with great challenges.

Our client was wise not to try to overcome this determination on her own, and to allow us to guide her through this challenging legal landscape.    

Our client, a successful and young professor at a university, initially came to us to appeal her denied short term disability insurance claim. Her ERISA disability policy was through her employment.  She was unable to return to work, but her claim had been denied, leaving her with few options.  She was suffering from Chronic Fatigue Syndrome (CFE/ME) and could not even engage in simple tasks, much less continue to work.

We took on her appeal and shared our confidence in the ability to overturn the claim denial.  We succeeded and were able to navigate her claim for her short term claim and provide support to allow her to also transition into long term disability. 

She was paid for a period of time, until Sun Life terminated the claim at the transition definition from “own occupation” to “any occupation.” To secure this twisted result, Sun Life relied upon limited surveillance and a paper reviewing physician’s opinion, and then coupled that with a deficient vocational review, which did not account for any of our client’s physical or cognitive limitations.   

Our client was a Professor in her 30s whose work required significant cognitive challenges and was also physical in nature: she needed to be able to stand for extended periods of time.  When she first began suffering symptoms, like most claimants, she was unsure of the diagnosis, and spent time, money and energy seeking a variety of tests in the hope that she would be able to determine what was causing her symptoms, especially the fatigue.

When we engaged with the client, we were able to guide her client toward the necessary and appropriate testing to help demonstrate impairment in a CFS/ME claim. Our client was examined and evaluated for CPET (Cardio Pulmonary Exercise Testing), by Dr. Betsy Keller, from Ithaca College, one of a small handful of facilities who produce this testing, which has been held by courts to be the “gold standard” for providing evidence of impairment in CFS/ME claims. This two-day exercise test yields results which translate into one’s level of functionality and is a data driven analysis, making it difficult to challenge. 

We also secured cognitive testing, which demonstrated impairments in functionality that we were able to tease out to support her inability to engage in any occupation on any sustained or predictable basis.  We also were able to demonstrate that the deficits were not mental health or depression related, but due to her lack of energy, focus and physical functionality.

Using these powerful test results and objective findings to support impairment, we worked with our client’s doctors to develop responsive information and documentation to support the claim and rebut the underlying medical support for Sun Life’s position.  

We also developed a powerful statement from our client describing the impact of her conditions upon her career, and upon her ability to engage in any sustained activity.  We worked to rebut the limited surveillance, arguing that it supported her claim of impairment, rather than any level of functionality.  Collectively, this powerful appeal evidence was submitted in support of further benefits.

Armed with this evidence and our advocacy, we were able to undercut Sun Life’s medical and vocational reviews, demonstrating that the evidence upon which its decision was made was utterly lacking in quality.   Undercutting the claim decision, like the foundation of a home, forced the house to fold.

Despite efforts to diffuse the power of our appeal submission, Sun Life ultimately relented and determined that our client did, in fact, meet the definition of disability for any occupation, and her long-term disability insurance benefits have been reinstated.  She has now been paid to current status and remains on claim and under our guidance.

Our 29-year-old client had a promising career ahead of him as an Actuarial Associate.  Bright, outgoing, and excited to pursue a career in his industry, he was devastated when his career came crashing to a halt. 

Once an avid golfer and tennis player, he never anticipated having to stop working and enjoying an active lifestyle because of a medical issue. He suffers from Fluroquinolone toxic poisoning caused by fluroquinolone (FQ) antibiotics, which have been documented in medical literature to cause irreversible nerve damage resulting in peripheral neuropathy. This occurred from taking Cipro, a widely used antibiotic.

As a result of this condition, he suffered additional co-morbid conditions include ligament laxity, where his ligaments are too loose and joints are not held in correct alignment when they move; cervical disc disorder and radiculopathy; severe alar instability (excessive motion at the head and neck junction); kyphotic neck (the cervical spine curves forward instead of towards the back) and numerous related restrictions and limitations, including chronic pain, myofascial pain, neck, back, wrist, shoulder, knee and hip pain, headaches, cognitive issues, as well as difficulty with gait and standing, sitting or walking for any length of time. 

He could not work and could barely engage in day to day functioning, and certainly not with any predictability.  

Our client’s claim for disability insurance benefits from New York Life was wrongly terminated while he was still in the short-term disability process.  The denial came despite medical support from a wide range of specialists provided to New York Life by no less than seventeen doctors, including many specialists.  

His age was a glaring red flag for New York Life; at age 29, his claim will be paid for decades, making it an expensive disability claim for the company.

After engaging our office to submit an ERISA appeal to overturn New York Life’s wrongful termination of his short term disability claim and prepare for the expected denial of his long term disability claim, we got to work developing his case.  

New York Life’s denial was not only inaccurate but lacked any proper medical or vocational analysis.  Working closely with our client, his treating doctors, and providers, we developed a powerful ERISA appeal, providing New York Life with ample support as to why our client could no longer work on a full-time sustained basis in what had been a physically and cognitively demanding career.  To support the appeal, we engaged a vocational expert to conduct functional testing, which served to support with objective evidence the impact of his conditions upon his work abilities.

Our appeal contained a wealth of support, including powerful medical support from numerous doctors, a comprehensive Functional Capacity Evaluation conducted by a Licensed Occupational Therapist and Certified Vocational Evaluator, strong subjective support, and statements from many people within our client’s sphere, and a wealth of medical literature – informing New York Life of the severity of our client’s conditions and educating the insurance company about Fluroquinolone toxicity.  

Upon review of our ERISA appeal, New York Life admitted that its prior determination was improper, and reversed its decision. Our client’s short term benefits were reinstated and equally importantly, his long-term claim was approved. 

He is now devoting what energy he has to learning to live with his disability, rather than squandering precious time and energy doing battle with an insurance company. New York Life benefits are being paid monthly and we manage his claim to be sure the payments continue.

The importance of defining one’s own occupation in a private disability insurance policy cannot be understated. We recently represented a surgeon who owns a private (individual) disability insurance policy, purchased from a major insurance company. 

He was approaching his maximum benefit of eligibility to continue the policy with lifetime benefits still potentially available when he came to us to pursue a claim, while he wished to continue to work in some capacity.  

In order to succeed with his claim, we needed to demonstrate that he was totally disabled from his “own occupation.” This situation occurs often, but most people don’t know how or if it can be resolved. Without the guidance of an experienced disability insurance attorney, hundreds of thousands of dollars may be lost. 

He was referred to the firm, having friends who had prior claims and had successfully worked with our office. Knowing that every claim was different, he sought a similar result to what we had achieved for his colleagues. His claim, however, posed more challenges than his colleagues claims had.

He was performing an array of procedures that were adjunctive to his practice but would likely not be considered surgical by the disability insurance company if it were trying to find a way out of paying his benefits, which would be substantial.

Our concern was that he might be viewed as a surgeon with another potential occupation. 

We carefully crafted his occupation description to address and focus upon his significant surgical practice, and the impairments that related directly thereto. His inability to continue to operate without putting patients at risk was a significant factor in proving his impairment.

Another challenge came from his age: because he was approaching 65, his claim for residual benefits, if that were the determination, would have yielded very little return for his claim.

It was mission critical to declare him totally disabled. It meant the difference between lifetime benefits and very little benefits.

Our development of the claim support, his occupation, and all of his collateral materials, including his change of malpractice insurance, were critical elements to support our contentions. His claim was successful and he is continuing to be paid by the disability insurance company.

He did two very smart things: he listened to colleagues who similarly protected their claim by working with us, and he made the decision to work with Disability Attorney Jason Newfield to guide his claim to success.