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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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Disability Company Reviews

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Showing 8 of 650 Reviews

MetLife

MetLife for disability? Avoid the surgery unless it's life-threatening

Reviewed by Jeff on August 22nd 2024 Verified Policyholder | August 2024 date of disability

The worst company I ever dealt with, never received a call from my claim manager.

Reliance Standard

Short Term Disability Claim/Inconsistent to NO Communication

Reviewed by GaKRN on August 22nd 2024 Verified Policyholder | June 2024 date of disability

When I did call & reach a live person they were kind & helpful. The person assigned to my claim left one phone message & I have not spoken to her since. Information she re... read more >

Unum

Unum Closed My Case Today

Reviewed by Scott C. on July 5th 2024 Verified Policyholder | March 2023 date of disability

Unum will keep you around, if they pay you 100 a month. But as soon as have to pay more than 2700 a month, they will drop you. We will be going to the attorneys office fir... read more >

Hartford

Ran me Around for Months

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

Scammers. Immoral horrible people.

Reply

Sent on July 5th 2024 by Attorney Gregory Dell

David:

It’s horrible that Hartford did that to you.

Prudential

Denied but Not Denied but I am Denied

Reviewed by KDDK on July 5th 2024 Verified Policyholder | August 2022 date of disability

I went out in Aug. 2022 for neck pain. After seeing a neurologist I had to get an ACDF C5-7, it was also determined I had carpal tunnel in my right hand and bulging disk i... read more >

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Claiming They Are Not Receiving Paperwork

Reviewed by Macey on June 26th 2024 Verified Policyholder | February 2024 date of disability

After suffering from medical issues from my delivery in February, I had to have a colostomy bag placed. Now New York Life is trying to claim my condition was pre-existing ... read more >

Hartford

Truly Horrible and Immoral Company with No Customer Service

Reviewed by William M. on June 26th 2024 Verified Policyholder | June 2020 date of disability

My experiences with Hartford have been nothing short of cruel. They started off by claiming that having Glioblastoma, which has an expected life span of about fifteen mont... read more >

Hartford

Sent my Direct Deposit to a Strangers Bank Acct

Reviewed by Brad on May 2nd 2024 Verified Policyholder | February 2024 date of disability

I went on short term disability and The Hartford put my direct deposit into someone else’s bank account. Somehow they messed up a number or two and they are refusing to ... read more >

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Reviews from Our Clients

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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