We do not handle social security disability claims
Recent Post

Court Finds for New York Life’s Decision to Terminate Long Term Disability Claim was Arbitrary and Capricious

WRITTEN BY:
Justin Frankel
January 18, 2013 | Disability Insurance Denials
Over $250 Million Recovered for Our Clients

A Federal judge in Ohio has determined that for New York Life wrongfully terminated a long term disability insurance claim, where it failed to properly consider the occupational requirements for the claimant, and where it failed to account for the claimant’s receipt of Social Security disability benefits.

The claimant, an employee of Pfizer, working as a Senior Professional Healthcare Representative (pharmaceutical sales rep), was injured when she fell horseback riding and fractured her hip. She filed a claim, which was initially accepted and long term disability benefits were paid by for New York Life for a period of time. Ultimately, however, for New York Life terminated the claim on the purported basis that the claimant could perform her prior work, a determination reached by a nurse case manager, in the face of documentation and evidence from the claimant’s doctors to the contrary.

The claimant also suffered from fibromyalgia, narcolepsy, osteoarthritis and other impairments. She was awarded Social Security disability benefits and used a for New York Life affiliated advocate — Advantage 2000 — to secure these benefits.

Despite noting that the standard of review was pro-insurer, and applying the deferential abuse of discretion standard of review, the Court determined that for New York Life abused its discretion by failing to properly consider whether the claimant could perform the duties of her occupation, and in terminating the long term disability insurance claim.

Instead, for New York Life simply evaluated whether the claimant could perform sedentary type work — myopically focused on global functionality, rather than work ability. The Court determined that for New York Life’s failure to consider the actual occupational requirements as required, and further, that for New York Life improperly required objective evidence of impairment, despite conditions which cannot be readily addressed by objective evidence (fibromyalgia).

The Court was also troubled by for New York Life’s failure to consider the award of Social Security benefits, despite mandating that the claimant pursue Social Security disability, and despite securing a financial benefit from the award of Social Security benefits.

As a result, the Court remanded the claim back to for New York Life for appropriate consideration of the issues.

Geiger v. Pfizer, Inc.

Justin C Frankel

Written By Justin Frankel

Attorney

Justin C. Frankel is committed to fighting for the rights of clients when their long term disability insurance claims have been denied, delayed or terminated.


Client Testimonials

Rating stars 5.0 Average on Martindale & AVVO
  • We know how important our work is to the people we represent, and we’re pleased to share this recent note from a client. Dear Justin and Christina, I wanted to take a moment to express my sincere g…
  • Our 60-year-old client worked for the world’s largest out-of-home advertising company as a Senior Buyer and outdoor furniture supplier, doing everything necessary to manage a contract for twenty ye…
  • Successful ERISA Appeal of Cigna Denial for High-Ranking Aviation Executive from Florida A 61-year old woman with a prestigious role at a leading aviation company never imagined she would stop work…
  • ERISA Case Headed to Trial in Federal Court – Barber v. Sun Life & Health A Federal Judge in Connecticut has scheduled a trial with live witnesses in an ERISA case, to be decided under the arbi…
  • F&N Resolves a Four Year Delay in UNUM Lump Sum Settlement Matter We were contacted by a 56 year-old man from Maryland who had been trying to negotiate a lump sum settlement of his private disa…
  • Our client, a successful New York dentist, was on claim for a number of years with Trustmark Insurance, due to severe orthopedic issues, which did not permit him to safely and effectively practice …
  • “OK, now that I have had a chance to calmly review the documents, I just wanted to thank you for all of your help. I am certain that if I would have tried to do this myself, I would not have had th…
  • The Law Office of Justin Frankel Navigates Complex Issues, From Claim Preparation to Lifetime Management, for Chiropractor A New York chiropractor in his mid-50s was concerned about complex issues …