Assurant Disability Help

Can a disability insurance company rely on a Functional Capacity Exam ("FCE") to deny long-term disability benefits?

Unfortunately a recent Appellate court answered this question yes. Every disability case is distinguishable so for every case that says an FCE is reliable evidence of disability, there is another case that will say it is not reliable. Additionally, it is rare that an FCE on its own is enough to support a disability denial. Functional Capacity Examinations (FCE) requested by disability insurance companies are frequently used by disability insurance companies in an effort to deny disability benefits. There is no consistent law which states that if an FCE determines a person can work, then the claimant must not be disabled. To learn more about FCE exams and what to expect you should watch our video discussing FCE exams.

Lets take a look at a recent disability denial that was reversed by the district court, but then overturned in favor of the insurance company by the Appellate court. This disability insurance case against Union Security Insurance Company (“Union”), also known as ASSURANT, sheds light on how a court can view a Functional Capacity Exams.

Disability Attorney Sues Union Security Insurance Co. (ASSURANT)

When he was thirty-five years old, Charles Green began working as a light industrial warehouse worker for Andersen Distribution, Inc (“Andersen”). As an eligible employee, Green participated in Andersen’s LTD-benefits disability plan insured by Union. In February of 2001, Green stopped working citing physical pain as preventing him from being able to work. Under his policy, during the first 24-months of disability, a claimant must be prevented from performing at least one of the material duties of his “regular occupation” to qualify for benefits. After the 24-month period, a claimant qualifies if his disability prevents him from performing at least one material duties of “any occupation.”

After applying for benefits, Green was awarded LTD benefits under the “regular occupation” of the policy for 24-months. However, after 24 months, Green was denied LTD benefits after Union determined Green did not meet the Policy’s “any occupation” definition of disability.

Green subsequently brought an action against Union in the United States District Court for the Western District of Missouri challenging Union’s decision. The District Court issued judgment in favor of Green and Union Security appealed the decision.

District Court improperly concluded FCE was of “limited value”

When reviewing Union’s decision, the District Court reviewed the record containing records of an FCE and video surveillance conducted by Union of Green’s activities. The district court had discounted the FCE which was conducted over a period of two days and which concluded that Green was capable of working in a full-time sedentary job, contrary to Green’s assertions.

The Court of Appeals disagreed with the lower court and concluded that the district court improperly discounted the FCE explaining that “it is true an FCE can only provide a ‘snapshot’ of a claimant’s functional capacities, but this does not render the FCE of ‘limited value.'” Rather, the court concluded that an FCE provides objective clinical evidence regarding how a claimant’s condition affects his ability to work.

Assurant Relies on FCE exam and Video Surveillance to Deny Disability Benefits

This case is unusual as it is not often that an Appellate court will reverse a lower court finding in favor of a disability claimant. Additionally, this case is not great for disability claimants as it can allow insurance companies to try to rely on unreliable FCE exams. If a claimant has an FCE set by an insurance company, then must be aware of the type of testing that will be administered and they must be prepared. The case against Assurant is distinguishable as the Assurant also conducted video surveillance of the claimant for two days. The combination of the video surveillance and the FCE was something that made the Appellate court overrule the decision of the lower court. Due to the unfavorable arbitrary and capricious standard of review in ERISA governed cases, the appellate court found that ASSURANT did not act unreasonably.

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Reviewed by David on July 5th 2024 Verified Policyholder | January 2024 date of disability

Scammers. Immoral horrible people.

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Sent on July 5th 2024 by Attorney Gregory Dell

David:

It’s horrible that Hartford did that to you.

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S.S.

I am a physician in my 30s who was practicing in my hospital based medical specialty until my Multiple Sclerosis diagnosis began to severely limit my physical ability to work.

My husband and I were obviously in distress at these very unwanted life changes and frankly overwhelmed with the possibility of a long and traumatizing legal battle ahead of us. We knew we were legally entitled to benefits through the separate private individual and employer based ERISA disability insurance policies we had, but even cursory research and discussion with colleagues made it clear that insurance companies will strategize with their own legal teams to find ways to not pay out benefits. We found many before us who had fallen unwittingly into legal pitfalls that prevented them from ultimately obtaining benefits. We realized we needed to seek legal counseling.

We found Dell Disability Firm through their youtube channel where their associates have videos discussing the legal intricacies and latest developments in private disability law. I was impressed by their dedication to the field and reached out through their website to request a free consultation.

We were delighted to hear that Mr. Steven Dell himself would be willing to take our case and felt assured that we would be represented by the best of the best.

We have not been disappointed in our expectation and have, in fact, been consistently very impressed. Steven Dell is clearly both knowledgeable and wise about dealing with these issues but more importantly, has shown kindness and impeccable honesty at each step of the way.

Merlin has demonstrated a very high capacity for organizing and handling the endless myriad of documents and communications between us and the insurance companies. She has also been very compassionate, accessible and forthcoming in dealing with our many anxiety fueled emails and telephone calls to her and we are very grateful for her involvement.

For over 7 months, we have been working closely with Steven Dell and Merlin Bryan from Dell Disability Lawyers as they have guided us through the process of review and initial application for benefits from our two insurance policies (Hartford and Ameritas).

We are happy to announce we just received approval of claim from the Hartford insurance company.

At this time we are still working with this firm as we await the final decisions from Ameritas policy that we are hopeful will have a similar outcome.

As anyone with a chronic and progressive illness can tell you, time becomes a very precious commodity. Through their representation, Dell Disability Associates has allowed us to focus the majority of our time enjoying the time and function I have left while resting assured that our disability case laid in competent and caring hands.

The truth is that no amount of money can make up for what we have lost, but it is a huge comfort to have a team like Dell Disability Lawyers at our sides to help us ensure we will be able to continue to care for ourselves and our families.

We highly recommend Dell Disability Lawyers, Mr. Steven Dell and Ms. Merlin Bryan to handle your disability insurance claim.

Thank you Steven, thank you Merlin!

We will certainly plan on leaving another review for completeness once we have our final decision from Ameritas.

Paula B.

I have been working with Dell Disability Lawyers for the past 5 years concerning my disability as it pertained to my employer. I have been more than pleased with them the entire time. They have always kept me informed of any paperwork needing completed or any changes coming ahead. Nothing has been a surprise. I would recommend them to you to help with your disability case if you’re trying to dip into the policy you’ve been paying for.

Michael M.

I am a physician who has been disabled for over 10 years. During this time I have been represented by Cesar Gavidia and his assistant Danielle Lauria. Their representation on my behalf has allowed me to concentrate on dealing with my disability/disease process and all associated complications and not having to deal with all the things that are necessary in a disability claim. Based on my personal experience from many years of practicing medicine I would consider their work product, insight and effort in the disability claim procedures to be superior. I would recommnend them, which I have done, with my highest level of confidence. In short, you well served with this practice.

Dan P.

I had to retire from my career due to a bad back that restricted me from performing my duties. I had LTD insurance and after a few years of receiving monthly benefits from this insurance company, they notified me that my benefits were terminated stating that I don’t qualify due to my duties not fitting into some “national job description” and a nurse had deemed me eligible to go back to work. Its a crushing feeling to have this told to you over the phone with hardly any information given. Luckily, I came across Dell Disability Lawyers and spoke with Attorney Palamara who calmed me down and stated they would take my case. Within a couple of months my benefits were restored, and I had piece of mind. I cannot thank Attorney Palamara and the staff enough at Dell Disability for their professionalism, no nonsense approach, personal and timely communication and quick ability to litigate my case.

Jen S.

I wanted to thank Mr. Symonds and his legal assistant Sonia for their professionalism, guidance and dedication towards my LTD claim. Going through the denial process on my own was going to get me sicker and knew it was time for help right away. I reached out to Dell Disability Lawyers for assistance and not too long after my call, I was connected with Sonia – Soon after that, I was talking about my case with Mr. Symonds. After a long and tedious process with the LTD insurer, we won the case. The wait can absolutely be lengthy, but in the end, it was all very much worth the fight. Thank you both so much for all that you have done for me! I also want to thank those who assisted in keeping me updated, as needed. Highly recommended for anyone who is going through the brutal process of an LTD denial.

Carl G.

I would like to thank Dell Disability Lawyers for taking care of my case and help me get the insurance coverage that I was rightfully in need of. Specially, I would like to thank Lawyer Alexander Palamara and RIGHT-HAND legal assistant, Sonia Nogueira, who made this process less stressful. They answered all my questions and kept me informed every step of the way.

Don’t get me wrong. They never promised or told me that I was going to win my case, as no one can guarantee that for you. What they did do, was letting me know that they were working hard for me and to keep positive. Something that I recommend everyone to do is to subscribe to their YouTube channel. That will give you an idea on how they operate and why they (for most of their cases) win their cases.

Since I was awarded disability, I am still having surgeries and thanks to Dell Lawyers, I’ve been able to cover all those expenses.

Warm regards to everyone at Dell.

Clarisa B.

I’m so very Grateful and Thankful for the team at Dell. They worked tirelessly to get the best outcome for me. I’m so glad that I found them!!

Carole S.

Exceptional efficient and professional service from Jay Symonds and Sonia Nogueira. They were both so helpful and knowledgeable and navigated me through a very stressful and difficult situation with New York Life.

K. S.

Awesome team. Jay and his team, Sonia and Francesca, truly care. This team is very Professional and quick to respond. Jay always provided answers in detail to my questions. I strongly recommend Jay Symonds.

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