Chiropractor placed on claim despite an “any occupation” provision

Our client, a chiropractor, suffered from severe bilateral carpal tunnel syndrome, as a result of a traffic accident. Our client applied for disability insurance benefits under the terms of his contract. His disability insurance contract defined total disability for the first 24 months as the inability to perform the substantial and material duties of his occupation as a chiropractor. After 24 months the definition changed to the inability to perform the substantial and material duties of any occupation taking into consideration his education, training, experience, and pre-disability earnings. Earnings were defined as “income from work.”

Our client was paid for the first 24 months, however thereafter his insurance carrier denied further benefits, claiming that our client could engage in several other occupations and was thus, no longer disabled. His insurance carrier asserted that since our client did not withhold Social Security from the profits he obtained from his practice, the money received was deemed “dividends” rather than “income / earnings.” Therefore, the insurance carrier considered his pre-disability earnings as $0, despite the fact that he was earning upwards of $200,000 per year. As such, the insurance carrier argued that if he could engage in any job in which he could earn more than $0 per year, he was not eligible for total disability benefits.

We submitted an appeal to the insurance carrier providing ample medical documentation, a report from a vocational rehabilitation expert, and citing applicable case law. Based on our appeal, our client’s insurance carrier reversed its decision, provided all back benefits owed, including interest, commenced monthly benefits, and paid attorney’s fees and costs.

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Dell & Schaefer Client Reviews   *****

Rhonda L. (Hawaii)

Gregory Dell has saved my family from bankruptcy. I got sick with Vasculitis and had to undergo 4 years of chemo treatments. I worked during this time as pharmaceutical sales rep. Finally my doctors said that if I did not go on to disability I would die. I went on disability and my company rejected my short term disability. I was in the hospital at the time of the rejection and was not given much time to respond. I live in Hawaii and could not find anyone that would go against my company. They were very big and scared all the attorneys off.

Greg took my case immediately. He got me paid and short and long term disability. After a few years Cigna did a ridiculous review of my claim and said that I should be able to go back to work. At the time I was denied I was currently in a wheelchair and on massive doses of morphine. Vasculitis destroyed all my nerves in the legs and arms. They dropped my long term disability. Greg again went back and fought for my disability and won. My family would be completely bankrupt without Gregory Dell. My doctors said with the stress from all this fighting for my rights has cost me years of my life. But I would not have made it without Greg, Michal and team. Money is not everything but when you are sick fighting to pay your bills and insurance companies really takes a toll. I have recommended Greg and his staff to other disabled persons. I think they are the best. Thanks for everything. You have allowed me to focus on what is important staying alive for my family.

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