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Lloyd’s of London ordered to pay over 6 million dollars to long term disability claimant

Certain Underwriters at Lloyd’s London insurance company took almost two years to make a decision regarding a doctor’s disability application for benefits. When he sued, the Court stayed the suit until an arbitration panel could review his claim. This article discusses the how the final disability benefit award was finally settled.

Most people don’t think of cardiologists developing heart conditions. It is far more common than most people realize.

Dr. Zev Lagstein held a disability policy with Certain Underwriters at Lloyd’s, London. The policy required Lloyd’s to pay him $15,000 per month for up to 60 months if he lost his ability to practice medicine due to a disability.

When he developed complications from heart disease, including severe migraine headaches and other neurological problems he applied for benefits. He supported his claim with the opinions of several physicians who concluded after examination that he was permanently disabled from practicing not only as a cardiologist but as a physician.

Months passed without Lloyd’s reaching a decision. Lagstein went back to work against his doctor’s advice, which only complicated matters. Finally after almost two years had passed since he filed his long term disability claim, Lagstein sued. The policy mandated binding arbitration, so Lloyd’s moved that the case be stayed until a three – member arbitration panel issued its decision. A arbitration panel found Lloyd’s in the wrong and awarded Lagstein more than $6 million to cover policy benefits, emotional distress damages and punitive damages. Lloyd’s responded to this decision by filing a motion to vacate the arbitration award.

The motion was heard before the U.S. District Court, District of Nevada. The judge sitting on the bench was shocked by the size of the award and used this as his primary reason for vacating the decision of the arbitration panel. He also vacated the punitive damages the arbitrators entered as being outside its jurisdiction. Lagstein appealed.

The Ninth Circuit Court of Appeals found that the District Court did not have the authority to vacate an arbitration award just because it disagreed with the size of the award. See Collins v. D.R. Horton, Inc. Rather proof that the arbitration panel had exceeded its powers, was necessary. The Court found that § 10 of the Federal Arbitration Act does not sanction judicial review of the merits behind an arbitration award. The District Court had stepped outside the scope the law gives the Court in these matters.

Lloyds argued that the arbitration board had manifestly disregarded the law, yet could produce no evidence to demonstrate this. In Kyocera, the Court had found that an award is completely irrational “only where the arbitration decision fails to draw its essence from the agreement.” Lloyd’s claimed the issue was the fact that Lagstein was not disabled because he had returned to work. Thus the panel’s findings were irrational.

The Court of Appeals did not find the arbitration panel’s findings irrational. The majority of the panel had found that Lloyd’s violated the policy’s “referee provision” by hiring a physician of its own choosing while failing to inform him of the import of this action. The majority also found that he was disabled thus Lanstein was entitled to benefits, whether Lloyd’s agreed with these conclusions or not.

The Court of Appeals also found fault with the District Court’s finding vacating the punitive damages which were awarded by the panel after they had issued their initial arbitration award. The panel had requested an extension of an additional 15 days in which to submit its initial award. Both parties agreed. The filing occurred before the deadline with punitive damages set to be determined at a later date. Nothing in Lagstein’s policy expressly withdrew determination of procedural issues from the panel, so the panel was within its rights to set another hearing for determining what punitive damages, if any, would be awarded.

Both rulings by the District Court were vacated and Lloyd was ordered to pay over $6 million dollars to Dr. Lagstein.

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Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Lloyds Of London. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Lloyds Of London.

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Our lawyers help individuals that have either purchased a Lloyds Of London long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

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Cynthia B.

I learned in March 2014, that my LTD insurance provider was auditing my case. Two weeks later I received a denial letter. I didn’t even have time to provide the info requests to my doctors much less have them completed and sent back to the LTD company. I promptly called the rep who fumbled about for a few minutes then stated that the letter was mistakenly sent to me. The rep (I’ll refer to him as L) was often rude and aggressive even bordering on threatening on the phone.

They did not contact me from early June, I think, until September when L called me to inform me that my payments had already been stopped and a denial letter was in route. This letter informed me I had not complied in getting information from my Doctors and, he claimed in part that since they were not responsive to the insurance company, I was now in receipt of this denial letter. After all he claimed, I really was just fine (not quoted but implied in my opinion). I had not heard a word from L in 3 months prior to that call. I had been promised I no longer had to talk to L after I complained to the insurance company. How surprised I was to pick up a call from L. He seemed quite pleased to let me know they had already stopped my payments. Long story short, like you perhaps, I was scared and had no idea where to turn. Did I need to find a local attorney? That’s what I started doing. I quickly learned there were a lot of people who had or were currently going through the same thing. Misery really does seem to love company.

I started reading other people’s stories and often ran into the Dell & Schaefer name. I was skeptical. I mean, who chooses an attorney over the internet? I learned there were topics this law firm had placed on You Tube? I intently read everyone of them. I admittedly was impressed as they carefully described the process and what to expect. I read more than once. I called the national number listed. I made my choice when I spoke with Alexander Palamara, Esc. He was very informative, confident and encouraging. All of which I was not feeling prior to that call. I made my decision and never looked back. I knew without question that I would never be able to win this case on my own. I was so naive that I didn’t understand that what I thought was a very reputable and certainly well known Insurance company, would blatantly lie. They did. My attorney learned during the discovery process that they had, had much of the information they said they never got. They had had it for months. I never had to wait for response from Alexander, my attorney. If he was not available, his assistant would contact me. I was always in the loop and well informed. I was still shocked at the glaring discrepancies noted in my filing as opposed to what was noted by the insurance company’s denial letter. Some say, “Trust but verify”. I would Strongly recommend, “Don’t trust And Verify!” Act as early as you are able. Expect to provide your doctors names, addresses and phone numbers and dates. Then expect to be well represented. It’s well worth your time and money to pursue your case with Dell & Schaefer.

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