Insurance claims and lawsuits

September 13, 2019

Kantor & Kantor Presents a Webinar About Getting Insurance Coverage for Explant Surgeries

Attend our October 2 Webinar About Insurance Coverage

You have had or are considering explant surgery. We understand the physical and emotional pains that made you decide on the procedure. We also understand that thinking about insurance coverage should be the farthest thing from your mind.

We have spoken with so many women about their troubles getting insurance coverage for these explants, that we thought it may help to put together some ideas, facts and resources that may resolve at least one part of these ordeals.

August 7, 2019

Your Medical Records – What Goes in Them Matters

by Beth A. Davis

When you become ill with what may turn out to be a disabling condition, you are not likely thinking about whether the things you say to your physician might impact a short or long term disability claim, but you should be. Unfortunately, insurance companies use comments by claimants and their physicians found in the claimant’s medical records to discredit their claims. They can also be used to apply provisions in the policy that limit the duration of benefits. In some cases, depending on the medical facility where you treat, even your email and telephonic communications are recorded and placed in your medical records. These can be extremely detrimental to your disability claim.

Here are some examples from real claims: A man went to his physician and was diagnosed with Parkinson’s Disease. His symptoms were already pretty advanced and his doctor determined he should stop working. We helped him make a claim for disability benefits. One of the symptoms of PD is depression. Our client had mentioned to his neurologist on many occasions that he was suddenly feeling very depressed. Even though his physician attributed his depression to his PD and even though he had never before had depression, his LTD carrier tried to apply the policy’s mental/nervous limitation which would have limited his benefits to only 24 months, claiming he was disabled by depression, not PD.

In another case, a client who was already receiving long term disability benefits whose claim had been terminated came to our firm for assistance. We told him he would need assistance from his physician for his appeal of the denial. We explained the points the doctor’s letter would need to address and the client listed those points in an email to his physician. Because the client treats at Kaiser Permanente, that email was included in his medical records. When his insurer requested copied of his medical records, his insurer was able to obtain communications between the client and his attorney all because he sent an email to his doctor asking for help.

June 7, 2019

Insurance Companies Certainly Do Not Make It Easy: Be On the Lookout for Some of Their Tactics

by Andrew M. Kantor

Yahoo Finance published an article about how insurers try to prevent individuals from obtaining disability benefits. While the article discusses Canadian insurers, our experience is that the tactics described in that article also happen in the United States.

This blog elaborates on some of the points raised in the article, especially as they relate to ERISA insureds. The Yahoo article observed:

“Surveillance is a common tactic. Insurers will hire private investigators to try to catch you in the act of doing something a disabled or injured person couldn’t, like moving a ladder or other heavy objects.

June 6, 2019

The Importance of Being Timely

by Beth A. Davis

Missing a deadline in your ERISA claim is deadly to your claim.

Accordingly, it is extremely important that any and all deadlines are met. One deadline of particular importance is the 180-day deadline by which to submit an appeal of a denial of benefits covered by ERISA. The federal regulations that govern ERISA require insurance companies to allow claimants 180 days to submit an appeal of a denial of benefits. While the regulations state that the claimant is to be allowed 180 days from the date of receipt of the denial, the safest course of action is to calculate the deadline from the date of the letter denying the benefits. This is one of many good reasons to come to Kantor & Kantor with your claim.

Six Months Will Fly By

May 2, 2019

May is Mental Health Awareness Month – You Can Start a #RealConvo

by Kantor & Kantor LLP

As part of Mental Health Awareness Month 2019, the American Foundation for Suicide Prevention (“AFSP”) has launched a public awareness campaign called #RealConvo. The goal of the campaign is to inspire people to

shares their stories;
have conversations about mental health; and

April 12, 2019

May Is Mental Health Awareness Month

by Kantor & Kantor LLP

Mental Health Awareness Month has been observed in May in the United States since 1949 by Presidential proclamation. Each year millions of Americans face the reality of living with a mental condition. According to the National Institute for Mental Health, an estimated 26.2 percent of Americans ages 18 and older—about one in four adults—suffer from a diagnosable mental illness in any given year. Not only are these adults affected by one mental illness; 45% of these adults meet criteria for two or more disorders.

Mental illness is a real and treatable set of conditions that includes major depression, bipolar disorder, eating disorders, panic attacks, generalized anxiety disorder, attention deficit hyperactivity disorder, and schizophrenia, among dozens of others. These disorders are serious enough to significantly impact a person’s daily life functioning, whether at school, work or in their relationships with others.

Among children, ADHD, behavior problems, anxiety, and depression are the most commonly diagnosed mental disorders. According to The Journal of Pediatrics, 2018,

April 8, 2019

The Importance of Neuropyschological Testing in Disability Claims Involving Cognitive Impairment

by Kantor & Kantor LLP

If you suffer from certain medical conditions including Multiple Sclerosis, Complex Seizure Disorder, Dementia to name just a few, you may also suffer from cognitive impairment which can affect your ability to perform the duties of your job. If you become disabled and make a claim for disability benefits, it is extremely important to document the cognitive impairment you suffer. Neuropsychological testing is the way to document your cognitive impairment.

If you suffer from cognitive impairment, you likely are already treating with a neurologist. He or she may order this testing as a routine part of your care. If that has happened, you may be able to use the test results as part of the evidence you provide to your disability insurer. If that has not already happened, we strongly recommend you get this testing done to support your claim. Note that if your neurologist orders the testing as part of your treatment and care, your medical insurance may cover the cost, which is high. If, however, you have the testing done on your own or through your attorney, insurance most likely will not cover the cost as it is forensic testing – testing to provide evidence.

Not all neuropsychologists understand the intricacies of documenting cognitive impairment to support a disability claim. At Kantor & Kantor, we work with several highly esteemed and experienced neuropsychologists who do understand what we need to document. They work with us to determine the which tests to conduct to best document your cognitive losses.

April 4, 2019

Are Today’s Teenagers More Susceptible to Depression and Anxiety?

by Kantor & Kantor LLP

In the last decade in the U.S., teenagers and young adults are experiencing a dramatic increase in mental health conditions that is not present in other American age groups. According to a recent article in the Journal of Abnormal Psychology, 2010 teenagers are much more likely to develop major depression, have suicidal thoughts, or live with crippling anxiety than teenagers from the 2000s.

Why are today’s teenagers more susceptible to depression and anxiety? Researchers who studied the data theorize that because the biggest increase occurred around 2011, it is unlikely the cause is the political climate, the economy, or genetics. Instead this uptick in mental health concerns is attributed to the cultural changes in the way young people spend their time outside school and work and how they communicate with each other. Teenagers are sleeping less, exercising less, and spending less time interacting with other people face-to-face, instead spending significantly more time scrolling through social media and communicating electronically. The researchers conclude that teenagers and young adults should focus on activities known to improve mental health – face-to-face social interaction, exercise, and sleep. You can read more about the study and its findings HERE.

Put the Phones Down for a Bit

March 14, 2019

Kantor & Kantor Proves in Court the Limited Value of Social Media in Evaluating Disability

by Kantor & Kantor LLP

We recently wrote about how the Trump administration wants to expand the use of social media, such as Facebook and Twitter, in evaluating disability claims. In that post we noted that Kantor & Kantor proved, in Court, that social media posts are of limited value in deciding if someone is unable to work. What did the Court say?

The issue came before Judge Yvonne Gonzalez Rogers, United States District Court Judge in the Northern District of California. She was asked to decide if our client had proven he was disabled by back and leg pain of unknown origin. For years our client struggled to continue working as a tax professional at Hitachi despite ever increasing back and leg pain. This job required high cognitive ability, including critical thinking, decision-making, complex problem solving, and high levels of concentration.

He underwent multiple back surgeries, but this did not give him pain relief. In order to get some degree of pain relief, he had to take opioid medications. While this somewhat helped the pain, a medication side effect was difficulty concentrating. Because of the pain and inability to concentrate, our client’s work performance suffered. He had to stop working.

March 12, 2019

The Trump Administration Wants to see Your Facebook to Show You are Not Disabled.

by Kantor & Kantor LLP

On March 10, 2019, the New York Times reported the Trump administration has been working on a proposal to use social media, such as Facebook and Twitter, to help identify people who claim disability benefits without actually being disabled. The example the Times gave was if a person claimed disability benefits due to a back injury but was shown playing golf in a photograph posted on Facebook, that social medial post could be used as evidence that the injury was not disabling.

While the Trump administration’s concern is related to Social Security disability benefits, in the private long-term disability world it has long been known that the likes of Unum, MetLife, Aetna, Hartford, or Mutual of Omaha have a keen interest in the social media of disability claimants. This is based on the belief that social media is a goldmine of information about people applying for or receiving long term disability benefits.

It is not impossible for this to be true. But as with many things related to long term disability insurance, the topic has layers. Social media is often an outlet for the disabled. A place where a person unable to work goes to socialize and post pictures of themselves in better times or when they are having a good day (not a bad day). Sure, some of our client’s use social media to share with the world their struggles with MS, or back pain, or fibromyalgia, or lupus, but it’s the exception.