Chiropractor Obtains Lump-Sum Disability Insurance Settlement Despite Wrong Date of Disability

Caution, the timing of a disability claim can mean the difference between having your claim approved or denied. Far too many times I have seen disability insurance claims denied because the claimant either failed to promptly file their disability claim, mistakenly adopted the date which the insurance company claimed their disability began or state an inaccurate date of disability on the initial application for benefits. The claimant’s date of disability is crucial in determining: 1) what the claimant’s “Own” or “Regular” Occupation is; 2) how long the claim could be paid; and 3) if the claim will be paid.

When The Claimant Purchased His Disability Policy He Was Gainfully Employed As A Chiropractor

Our client, Dr. Z, had attended college and trained to become a chiropractor. When he purchased his individual disability insurance policy with Metropolitan Life Insurance Company (“MetLife”), he had recently begun working as a chiropractor and his duties consisted of performing manual chiropractic adjustments on patients. Dr. Z soon successfully grew his practice and was operating 4 different chiropractic offices.

Generally, the definition of “own/regular occupation” in an individual long-term disability policy (Non-ERISA) means the usual occupation (or occupations, if more than one) in which you are Gainfully Employed at the time that you become disabled. This means that the disability insurance coverage should follow you from occupation to occupation, and will not be limited to only covering the occupation that the insured is performing at the time that the disability insurance policy is purchased.

Metlife Denies Disability Claim Of Chiropractor Due To Change In Occupation Prior To Date Of Disability

Dr. Z began experiencing bilateral pain in his knees and feet, and would experience difficulty walking. It was discovered that Dr. Z suffered from complex regional pain syndrome. He continued working in his practice, but was eventually forced to close most of his offices due to the pain and discomfort he experienced especially when treating patients. At around this time, Dr. Z also began teaching part-time for a local university and working as a Residual Functional Capacity/Vocational Specialist for the Social Security Administration. Dr. Z also notified MetLife that he had become disabled from performing his duties as a chiropractor, however, on his application for disability benefits he provided MetLife with a date of disability which followed the date that he began working for the university and the social security administration.

MetLife had Dr. Z’s claim reviewed by a physician consultant who determined that Dr. Z would indeed have restrictions and limitations from running, jump, climbing stairs, standing, stooping and kneeling, and perhaps even performing the duties of a chiropractor. However, MetLife determined that although Dr. Z had these restrictions and limitations, he was not disabled under the terms of the policy since he was continuing to work and could work in his teaching and vocational consultant positions. Dr. Z was shocked and could not believe that his claim was denied, as it was his belief that he should be paid since he could no longer perform his regular occupation as a chiropractor.

Dell & Schaefer argues that Dr. Z’s regular occupation was his occupation as a chiropractor, the usual occupation (or occupations, if more than one) in which he was Gainfully Employed at the time that he become disabled.

Following his denial of disability benefits, Dr. Z consulted and retained Cesar Gavidia and Dell and Schaefer to represent him in his disability claim with MetLife. Following several meetings, a review of the claim documents, medical records, and financial records for Dr. Z’s chiropractic practice, it was determined that Dr. Z had chosen an incorrect date of disability. Dr. Z had assumed that his date of disability was the date he completely discontinued seeing patients, when, in fact, his date of disability should have been stated as being even earlier – when he began reducing his patient volume and duties, and before he began working as a vocational consultant and teacher. MetLife was notified of the incorrect date of disability, but they were not willing to change their determination.

MetLife was provided with the opportunity to correct Dr. Z’s date of disability and pay his disability claim; however, it continued to deny that he was eligible for disability benefits. Following several weeks of negotiations, which included threat of suit by Dr. Z, attorney Gavidia negotiated a confidential settlement between Dr. Z and MetLife.

Dr. Z’s case is a perfect example of why the timing of a disability claim and the actual date the insured claims disability are so important. In Dr. Z’s case, claiming total disability 12 months earlier meant the difference of thousands of dollars, and the difference between his claim being approved or denied. As in Dr. Z’s case, most disability policies state that the claimant is disabled from the occupation or occupations that they are performing at the time that disability begins. It is important to carefully analyze how and when the claimant’s disability began affecting their ability to work and generate income.

Contact us for a free consultation to discuss how we can assist you with your disability insurance claim. For more Metlife disability cases and user reviews please click here.

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FAQ

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 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 telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. 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 attorney. We can be reached at 800-682-8331 or by email. Lawyer 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.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

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