Lawsuit Against IME Physician Alleging Fraudulent Misrepresentation By IME Physician Dismissed by US District Court

Prior to her disability, Angel Dix was employed with Blue Cross / Blue Shield of Louisiana and insured under the company’s long-term disability insurance plan. After enduring years of chronic back pain resulting from degenerative disc disease, and having undergone multiple spinal cord surgeries with no resolution of her chronic back pain, Mrs. Dix was forced to stop working and file a claim for disability benefits under her long-term disability plan. Initially, Mrs. Dix’s claim was approved, and was paid for over three years before her benefits were terminated.

Following the termination of her long-term disability benefits, Mrs. Dix timely appealed the decision with Blue Cross / Blue Shield. As part of its review of her appeal for long-term disability benefits, Blue Cross / Blue Shield ordered an independent medical examination of Mrs. Dix by a physician selected by them or their third-party vendor. Dr. Scott Kale, an arthritis and internal medicine physician, was hired to conduct the medical review of Mrs. Dix. Following his review, Dr. Kale opined that Mrs. Dix could return to work with no restrictions. Based on Dr. Kale’s review, Blue Cross / Blue Shield upheld its decision to terminate Mrs. Dix long-term disability claim.

Claimant Files Suit Against Long-term Disability Insurance Company and IME Physician Seeking Recovery of Disability Benefits

Following the denial of her appeal, Mrs. Dix proceeded by filing a lawsuit against both Blue Cross / Blue Shield and the IME Physician, Dr. Kale. In her lawsuit, Mrs. Dix sought to recover the benefits under the long-term disability plan, attorney fees and costs, arising from alleged fraudulent behavior by Dr. Kale for misrepresenting the finding of her treating physicians. Of course, both Blue Cross / Blue Shield and Dr. Kale denied that they committed any fraud whatever, and claimed that Mrs. Dix’s claim should be dismissed as they were completely preempted by ERISA.

Federal Court Finds That Suit Against IME Physician Must Be Dismissed And Is Not Permissible Under ERISA

Shortly after Mrs. Dix filed her federal complaint, Dr. Kale filed a motion to be dismissed from the lawsuit. The US District Court for Louisiana found that Mrs. Dix could not properly maintain a cause of action against the IME Physician, Dr. Kale, since 1) Dr. Kale was neither a representative of the long-term disability plan or an administrator, and, as Mrs. Dix acknowledged, he was merely serving as an independent contractor, and therefore had no authority to make a decisions concerning the payment of benefits, and as such was not a proper defendant and 2) Mrs. Dix could not show that her state law claims for fraud and misrepresentation were not intricately bound to her ERISA claim for recovery of benefits, and therefore not preempted.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

Leave a comment or ask us a question

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   *****

Jill L.

As an attorney who found herself in the shoes of a litigant against an insurer on a disability policy, I found Cesar Gavidia and his assistant Michal, wonderful. I was distraught with grief over losing a child. Proceeds from my disability policy were keeping my practice afloat until the insurer turned on me and not only terminated my benefits but was demanding tens of thousands of money back. It was a terrible time for me and my family (losing our child is still devastatingly difficult). Once Cesar took my case, I was able to let him take care of the battle with the insurer so that I could focus on other issues: my grieving, my family, and trying to stay in practice. My family and I are grateful for his representation.

Read 424 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us