anksgiving
National Union Fire Insurance Company (NUFIC) attempted to exploit our client Dan’s (not his real name) commendable but unsuccessful attempt to return to work while totally disabled. Dan, 60, was a Process Technician at Dow Chemical Company. While on a fishing trip, he fell and severely injured his shoulder. After multiple surgeries, his arm remained useless. Dow had an ERISA- governed permanent and total disability plan insured by NUFIC. Benefits were payable if he became “permanently and totally” disabled within 365 days of the accident. Insurance companies exploit good-faith work attempts. At Dan’s insistence, his surgeon reluctantly released him to attempt “light duty” desk work before the 365 days were up. The surgeon told Dan he would never succeed, as he believed he was permanently and totally disabled. Dow let him try, but Dan could not perform basic tasks due to shoulder pain. Within that 365-day window, his surgeon reaffirmed his total disability, and even the Social Security Administration declared Dan fully disabled. NUFIC, however, denied the claim. Their reasoning? The surgeon’s declaration of disability did not use the word “permanent.” Based on that technicality, NUFIC argued that Dan did not meet the plan’s requirement of being “permanently and totally” disabled within 365 days after the accident. Technicalities can make or break an ERISA case. On paper, NUFIC’s position looked defensible. Dan came to us after his own administrative appeal failed. Under ERISA, the court cannot consider any evidence outside the official administrative record, making it crucial to complete the record before a lawsuit is filed. We got with his surgeon to clarify the record. The surgeon issued a letter confirming that Dan had been “permanently and totally” disabled within the required 365 days. We submitted that letter to NUFIC before filing suit to make it part of the record. NUFIC still rejected it, so we filed suit seeking full benefits and attorney fees. NUFIC later saw the light and settled the case at mediation for a confidential sum. Dan had paid premiums for years for disability coverage. He never should have been forced to sue for the benefits he was entitled to. Thanks to persistence and the right legal strategy, he finally got justice. Justice After a Bogus Claim Denial OUR CLIENT FINALLY GETS THE BENEFITS HE EARNED
O TODAY
by magazine editor Sarah Josepha Hale, President Abraham Lincoln established the holiday in 1863, right in the middle of the Civil War. Hale had been pushing for an official day of thanks for decades, and both she and Lincoln believed it was the perfect time to give American families a reason to gather and feel united. Turkey was an early Thanksgiving tradition, but many other things associated with the holiday came much later. Macy’s held its first parade in 1924, and football became a regular part of the day in the mid- 1900s. Over time, television and advertising played a major role in creating the modern version of Thanksgiving we all know today. What began as a rough harvest gathering slowly turned into parades, football, and family traditions. But even with all the changes, sitting down to a meal together is still at the heart of Thanksgiving.
HAVE A LAUGH
We thank our referral counsel for the opportunity to help fight for Dan. Referral counsel received a fee of $16,550.
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