Success Stories:

Tony Y. is a retail worker from Illinois who was diagnosed with HIV/AIDS 15 years ago.

New medications for the treatment of AIDS over the years improved his quality of life and enabled Tony to continue working until the side effects of his medications caused severe bowel problems accompanied with fatigue, osteoporosis, and disorientation. Tony was forced to stop working, first by reducing his hours to part-time, then cessation of work entirely. Insured by MONY Life Insurance Company, he applied for disability benefits in 1992, and was told by Disability Management Services, Inc. to apply for Social Security Disability. SSDI benefits were quickly awarded. Disability benefits were paid by DMS until 2009 when the new claims specialist began to aggressively “risk manage” Tony’s claim by requiring multiple Independent Medical Examinations and placing his claim on Reservation of Rights Status on a month to month basis. Disability Claims Solutions, Inc. was hired and through a process of advocacy involving contact with Tony’s attending physician, HIV/AIDS advocacy groups in Illinois, and finally state and federal legislators, Tony was able to stop DMS from “doctor shopping” to obtain medical opinions in support of a denial. Tony’s case might have ended in disaster with denials of all three of his policies had he resigned himself to failure and just given up. Fortunately, DCS, Inc. was able to provide Tony with information concerning the claims process i.e. “the process of stacking the deck” and enabled him to defend his case and keep his benefits – a real success story in the area of thwarting unfair claims practices to deny claims by DMS, Inc.

Jennifer is a 40 year old school teacher who was diagnosed with fibromyalgia in 2001.

She applied for, and received group short-term and long-term disability benefits. After 24 months of paid LTD benefits, her disability insurer denied her benefits claiming she had been paid under the mental and nervous provision of her policy and had received the maximum benefit under the terms of her policy which limited mental and nervous claims to 24 months. Jennifer was devastated! As a single mother with three children, she now had no financial assistance.

In talking with Jennifer, I discovered the insurer had never informed Jennifer they were paying her for a mental and nervous claim. She continued to submit proof from her primary care physician, during the first 24 months, thinking the disability insurer accepted fibromyalgia as a “physical” impairment. She couldn’t have been more wrong.

In helping Jennifer manage her claim through the ERISA appeal, we were able to show the disability insurer fibromyalgia is a “physical impairment”, not a mental one. Jennifer’s claim denial was overturned and her benefits were reinstated.

Mr. Daniel X had been a Financial Planner for nearly 20 years when he developed Depression and Anxiety causing him to have daily panic attacks during his customer presentations.

As time went on, he found it necessary to seek counseling and found that he just could not perform the material duties of his occupation. Dan had purchased three IDI policies in the mid 1980’s and trusted the income would get him through any medical or disability emergency that came up. He was very wrong.

In working with Dan’s attorney, we were able to determine the disability insurer had required him to submit to numerous Independent Medical Evaluations which supported his disability. However, the last IME (six in total) favored the denial position of the insurance company, a practice preferred to as “doctor or IME shopping.” This routine practice among others led the disability insurer to offer Dan a settlement and the case was successfully concluded. Dan is not now working as a Financial Planner, and he received a reasonable settlement of his Individual Disability claims after they were denied by his insurance company. A real plus for the insured

Mary Y is a Registered Nurse diagnosed with chronic fatigue.

After receiving benefits under the provisions of her policy for 24 months, her claim was terminated when the definition of disability changed in her contract. The disability insurer conducted a Transferable Skills Analysis, and located alternative occupations it believed she could perform.

Upon examination of Mary’s policy provisions, I discovered that the definition of “gainful” in her policy was “60% of indexed pre-disability” earnings. When I looked very carefully at the insurer’s documentation I was able to determine the claims specialist did not “index” the pre-disability earnings, and the alternative occupations were in fact “not gainful.” When the number crunch was provided to the insurance company, they reinstated Mary’s benefits along with a letter of apology.  When a policy requires “indexing”, they need to index!

I actually discovered one of my clients’ benefits had been significantly reduced for an estimate of social security disability which was intended to be punitive since she refused to apply for SSDI. Upon looking at her policy I discovered she in fact had a “non-integrated” policy which did not allow offsets for other income such as social security. Her disability insurer was required to send her a check to compensate for the error.