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Long Term Disability Appeal For Cancer Denial – Client Wins!

Long Term Disability Appeal Cancer Win

Long Term Disability Appeal For Cancer Denial – Client Wins!

Long Term Disability Appeal For Cancer Denial – Client Wins!

McDonald & McDonald Wins Long Term Disability case in Federal Court for Disabled Client!

See Spina v. CVS Long Term Disability et al

In 2011 the United States District Court for the Southern District of Ohio ruled in favor of our client, who suffers from dumping syndrome.  After having stomach cancer and the removal of a significant portion of her stomach, our client began to experience intolerable difficulties because of “dumping syndrome”.  Common symptoms of dumping syndrome include frequent diarrhea, extensive bathroom use, the “rapid transit” of ingested food, heart palpitations and many other unpleasant problems.

The Hartford denied her Long Term Disability coverage when our client transitioned to the “any occupation” period of her policy.  The Hartford relied on peer reviewers to conjure up an untrue estimation of our client’s capacity.  Our administrative appeal, despite its thorough approach to explaining the disease, its symptoms, and vocational limitations, was denied by the Hartford.

We quickly filed suit against the Hartford.  On March 2, 2011, Judge Sandra Beckwith of the United States District Court for the Southern District of Ohio at Cincinnati ruled that the behavior of the Hartford was Arbitrary and Capricious.  Specifically, Judge Beckwith found the following behaviors to be Arbitrary and Capricious:

  1.  The peer reviewer’s failure to respond to the treating physician’s narrative report, which stated that claimant’s symptoms would impair her attention and concentration to the point of precluding work.
  1. The peer reviewer’s inappropriate reliance on one observation (limited weight loss), when so much other evidence was pointing to a contrary view of medical severity.
  1. Stretching the interpretation of a single comment by the treating physician   to deny disability benefits for our client.
  1. And our personal favorite: The peer reviewers, “cherry picking” through the evidence to support an unjustified conclusion.

 

The peer reviewers in this case included Dr. Nelson Chao, Dr. Rakesh Vinayek, and Dr. Robert A. Marciniak.  Dr. Vinayek & Dr. Marcinak were supplied to the Hartford by MES, a “clearing house” for peer review reports for the insurance industry.  Both Dr. Vinayek & Dr. Marcinak received a thorough undressing from the court.  Not only were their conclusions found to be unsupported, but their medical “logic” or methodology was lacking.

The court relied heavily on our administrative appeal to get to the truth in this case.  In the end, the Hartford paid all of the litigation fees we requested, and our client was placed back “on claim” and receives her monthly benefit!

Thanks to our client, who was so patient…but so certain that she was right!  You inspire us.  Also thanks to our great paralegal Katie, who brilliantly supports our mission to help the disabled!!

 

Questions about your long term disability insurance claim?

 Call (877)-428-9806 for a free consultation and we will be happy to answer your questions or concerns and talk about what we can do for you.

 

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