Litigating Claims In Court
| Success stories : |
| Chronic Fatigue Syndrome attacks a Data Manager |
"Christine" was employed as a data manager at a newspaper when she became terribly ill with Chronic Fatigue Syndrome. For more than a year Christine struggled to continue to work, only to find that each day it became more and more difficult.
She applied for long term disability benefits to the insurance company that the newspaper had hired to administer its Plan. She was denied benefits and appealed the denial through several levels of appeal at both the insurer and at the Plan. She was never told a specific reason for her denial, only that what she submitted was not enough.
Christine contacted Riemer & Associates for help. As part of our litigation strategy, we decided to file another appeal which contained additional tests and reports. In litigating this type of claim, it is imperative that the 'administrative record' of medical reports which had been submitted to the insurance company is complete because a court will often limit its review to what the insurance company had considered. The Court determined that the insurer and plan failed to provide Christine with a "full and fair review" by failing to tell her what documentation was specifically missing from her claim. When the plan was forced to tell Christine what was missing from her application, Christine provided it and benefits were granted. The Court also ordered the Plan to pay Christine for all attorney's fees and costs she incurred.
| Fibromyalgia devastates an Engineer |
"Carol" was a feisty engineer at a major communications company working in the field with a group of men. She was required to conduct on-site inspections, sometimes requiring her to crawl through cable tunnels. It was a very demanding job, but she loved it. When Carol became afflicted with Fibromyalgia she attempted a part-time schedule but was ultimately unable to work even in a limited capacity.
Upon submitting her claim for LTD benefits, the Company's plan denied Carol's benefits on the ground that she did not submit objective proof of disability from her "sedentary" occupation.
Carol was referred to Riemer & Associates by her Social Security representative.
The Firm commenced a lawsuit in Federal court on Carol's behalf. A settlement agreement was ultimately negotiated by the Firm, which included a lump sum for past benefits, interest and attorney fees.
Under the settlement agreement, Carol was permitted to submit proof of continued disability in the future. Initially, the administrator for the LTD plan denied Carol's claim for continued benefits. Once again, however, Riemer & Associates persisted and ultimately the plan placed Carol on long term disability and has paid her benefits without interruption.
| Spondylolisthesis ravages a young Attorney |
"Barbara" was an ambitious young associate attorney at a major law firm. She had been hampered by a degenerative back and spine condition most of her life but was still driven to complete law school and obtain a job at a prestigious law firm. By the time that she reached her early 30's, however, Barbara could no longer fight her debilitating pain. She stopped work and applied for disability benefits on her own.
The insurance company turned down Barbara's claim as well as her subsequent appeals, asserting that Barbara submitted insufficient proof of disability for her "sedentary" occupation.
Barbara came to Riemer & Associates, knowing that she needed expert advice.
Prior to commencing litigation, the Firm submitted an additional appeal in an effort to bolster the claim file. The appeal contained substantial new evidence from Barbara's treating physicians and a detailed affidavit from Barbara explaining the activity level required of her job. When, as expected, the insurer turned down the additional appeal, the Firm commenced a lawsuit on Barbara's behalf in Federal court. With the potential impact of the newly submitted evidence, a settlement was reached providing Barbara with a substantial lump sum. Barbara can now get on with her life without the constant fear of financial ruin.
| Hearing Loss impairs a Wall Street Trader |
"Arnold" was a successful trader at a small brokerage firm reaping the benefits of a strong market. Unfortunately, Arnold was struck in the head during a mugging, and as a result suffered permanent left-sided hearing loss, including conductive as well as high frequency sensorineural hearing losses. Even though Arnold can hold a conversation with someone in a quiet room, he has tremendous difficulty hearing in a noisy environment such as a trading room. The insurance company denied Arnold's claim for long term disability benefits on the unscientific premise that his hearing deficit could be corrected by a hearing aid.
Riemer & Associates commenced a lawsuit on his behalf in Federal court. The Firm prepared a detailed motion for summary judgment arguing that there was substantial scientific evidence establishing that a hearing aid would make Arnold's hearing loss worse not better. Rather than opposing the Firm's motion, the insurer approached the Firm for a settlement. A settlement was reached providing Arnold with a substantial lump sum payment.
| Depression incapacitates a Senior Manager |
"Larry" was a senior manager at a major consulting firm. As a result of a series of major stresses in both his personal and professional life, Larry was hospitalized with major depression and suicidal ideation. When the insurance company denied Larry's claim, Larry hired Riemer & Associates to prepare an appeal. The Firm submitted comprehensive letters from Larry's treating psychiatrists, who opined that Larry was disabled from any occupation; detailed statements of Larry's family and co-workers, corroborating his incapacity; and an in depth affidavit from Larry describing how depression slowly but surely made him unable to function and took away all joy in his life. The insurance company still denied Larry's appeal, asserting that Larry did not submit objective proof of his depression even though it is well known that disability from depression cannot be demonstrated "objectively."
Riemer & Associates immediately commenced a lawsuit on Larry's behalf in Federal Court. Our persistence eventually convinced the insurer to settle the case. Larry received a substantial lump sum settlement and can now get on with his life.