Articles Posted in Insurance Bad Faith

One of the most common mistakes we see with long term disability (“LTD”)  denials (ERISA and non-ERISA/bad faith) is claimants rushing to submit their appeal. The desire to move quickly is understandable:

  • You have no money coming in;
  • You are angry at the insurance company and want to give them a piece of your mind;

Why pass on free personalized advice?

One of the people who contacted us this week was a woman who had her Long Term Disability benefits terminated by Standard Insurance Company after Standard had paid her those benefits for many years. Despite multiple surgeries, her symptoms had not improved. Each morning she takes powerful pain medications. Sometimes those medications offer enough relief to enable her to attend to daily functions, but often, they do not.

Either way, she was certainly not able to perform the duties of her job when Standard cut off her benefits. Nonetheless, Standard Insurance Company all of the sudden determined she had not provided sufficient proof of disability and terminated her Long Term Disability benefits. Thinking this was simply a misunderstanding, she appealed the denial on her own without speaking to an attorney first. After all she reasoned, Standard Insurance Company had told her all she needed to do was explain to them why she was still disabled.

On January 13, 2017, the Los Angeles Times published a column entitled Healthcare insurance hell: If at first your claim is denied, try, try again

The article describes on insured’s extreme difficulty in obtaining approval for treatments of her multiple autoimmune disorders that cause chronic pain, migraines, extreme dizziness and debilitating chronic fatigue. As the title shows, the main thrust of the argument is to never give up if your health insurance claim is denied – however, this advice is not only applicable to health insurance claims – the same holds true, believe it or not, for Long Term Disability, Long Term Care, and even Life Insurance claims!  

Some interesting additional information is also included in the column:

As part of Kantor & Kantor’s”Throwback Thursday”, we take a look at Mondolo v. Unum Life Ins. Co. of Amer., CV-11-07435 CAS (MRWx) (C.D. Cal. 2013).

Kantor & Kantor LLP achieved a victory on behalf of client Tanya Mondolo, who sued Unum Life Insurance Co. in U.S. District Court for the Central District of California for wrongfully denying her disability insurance benefits. The court ruled that Unum, a Fortune 500 company and the largest group and individual disability carrier in the United States, abused its discretion in terminating Mondolo’s disability benefits. The court ordered Unum to reinstate benefits, with interest, and that Kantor & Kantor could make a motion for attorneys’ fees and costs.

Mondolo suffered from fibromyalgia and avascular necrosis, often called bone death. Her physicians believed the bone death was a late developing side effect from the chemotherapy regimen used years ago to treat her leukemia. She had difficulty walking, suffered from uncontrolled pain, and was too weak to tolerate prolonged sitting or typing.

Kantor and Kantor LLP was nominated and has now been awarded the 2015 Best of Business Award for the Small Business category.

The Small Business Community Association has been dedicated to empowering and recognizing small business owners who make a difference in their respective communities since 2006.

We are honored to accept this award and grateful that our firm is recognized in this way.

Kantor & Kantor is honored to announce the selection of four attorneys from the firm for the 2015 Southern California Super Lawyers list. Inclusion in this list is reserved for attorneys who exhibit distinct excellence in their practice.

Super Lawyers, a prominent attorney rating service, identifies exceptional lawyers from more than 70 practice areas. The selected attorneys have attained substantial peer recognition and widespread professional achievement. The extensive and multiphase process used to determine 2014 California Super Lawyers relies on peer nominations, evaluations, and independent research.

All four lawyers were selected for their successes in representing people denied disability – particularly those with disabling conditions such as eating disorders, autoimmune diseases, Alzheimer’s, Parkinson’s, Multiple Sclerosis, cancer and mental illness – as well as assisting people recover benefits under long-term care, health and life insurance policies. This recognition and honor demonstrates the talent, dedication, and diligence of these attorneys; all of which they utilize to obtain the insurance benefits to which their clients are entitled.

Have you been denied medically necessary prescription drug treatment for Hepatitis C? If you have, Kantor & Kantor, LLP has a solution to help navigate you toward insurance carrier approval of Harvoni treatment for Hepatitis C.

In October 2014, the FDA approved Harvoni (ledipasvir-sofosbuvir), a prescription drug that dramatically changes the lives of those infected with Hepatitis C. Harvoni is a once daily tablet that contains two drugs, ledipasvir and sofosbuvir, and has been shown to successfully treat patients with chronic Hepatitis C.

Harvoni tablet treatment lasts for eight, twelve or twenty-four weeks depending on the viral load of the individual who has been diagnosed with Hepatitis C. Harvoni’s efficacy has been well-documented and established. Various clinical trials, consisting of more than 1,500 participants, have shown treatment success rates of well over 90% for patients with varying stages of Hepatitis C. It is now the standard of practice in the medical community to prescribe Harvoni regimens for individuals with varying levels of Hepatitis C.

After Kantor & Kantor helped a client recover her long term disability benefits on appeal, Aetna decided that no further benefits would be provided unless the client filed a lawsuit. Kantor & Kantor obliged. The attorneys defending Aetna’s actions must now show good cause to a Federal Judge explaining Aetna’s actions.

Our client started working for Bristol-Myers Squibb in 1989 – staying with the company until she became disabled in November 2010. At that time our client’s doctors determined she was no longer able to work due to a multitude of medical conditions including post-traumatic stress syndrome, depression, anxiety, hypertension, a right knee injury, lumbar strain, and insomnia.

After our client submitted a claim for disability plan benefits, Aetna (the insurance policy’s claim administrator) found her to be disabled under the terms of the plan and long term disability benefits were paid. The Social Security Administration also found our client to be disabled and has continued finding her disabled.

Courts struggle with disability claims caused by subjective symptoms due to the difficulty in quantifying the level of pain and fatigue experienced by a claimant. Unfortunately, pain and fatigue are the principle disabling symptoms caused by many diseases such as multiple sclerosis, fibromyalgia, rheumatoid arthritis, degenerative spine conditions, etc. The Ninth Circuit has recognized that an insurer may not disregard subjective symptoms merely they cannot be quantified or “proved” by objective testing. However, at the same time, courts also recognize the difficulty in assessing or quantifying the level of pain and fatigue caused by a disease.

There are means for helping to determine the severity of one’s pain or fatigue. We encourage clients to keep logs or journals of their symptoms. This is especially useful for those who suffer from migraines, which are unpredictable. Written notes from family members and co-workers who have observed expressions of, or limitations caused by pain may also be instructive.

Courts also look to the treatment obtained by a claimant in an effort to alleviate pain. If one undergoes nerve block injections or a subsequent surgery in an effort to alleviate pain, this is useful evidence. A person does not undergo painful treatments merely to obtain disability benefits.

Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years.

In lupus, something goes wrong with your immune system, which is the part of the body that fights off viruses, bacteria, and germs (“foreign invaders,” like the flu). Normally our immune system produces proteins called antibodies that protect the body from these invaders. Autoimmune means your immune system cannot tell the difference between these foreign invaders and your body’s healthy tissues (“auto” means”self”) and creates autoantibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.

Lupus is also a disease of flares (the symptoms worsen and you feel ill) and remissions (the symptoms improve and you feel better). These are some additional facts about lupus from the U.S Department of Health and Human Services, Office on Women’s Health:

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