reverse. When stretched under high tension, the vines usually strip loose from the branches and fall to the ground. Then, you can just cut them and push them out of the trail. But this time, while I inched backward and watched the vine pull tighter and tighter on the bucket (in hindsight, not smart at all), it popped instead of stripping out of the branches. In a blur, it whipped into my opened left eye so hard I thought it was now jelly. To tell you the truth, I was scared. As lawyers, we read a lot on most days of the week. Was that even feasible now with one working eye? Google told me that one-eyed people can move the book instead of the good eye to conserve eye-muscle energy. That didn’t sound promising for all-day reading.
How We Win Against Phony Doctors Hired to Support Insurers THIS WOULD NEVER FLY WITH A JURY
Would I need to call my disability insurer?
I’d never considered these things before. It gave me a glimpse of the fear my long-term disability insurance clients face when an illness or injury ruins their ability to work and a claim denial wrecks them financially.
We’re seeing this more and more: long-term disability insurers will approve benefits for incurable conditions, then, without rational explanation, terminate benefits, effectively declaring their insured suddenly cured. Our recent client, “Bob,” is a perfect example. Bob, married and a proud father, was a software engineer living in Atlanta. He was in his mid-40s, loved his work, and earned well over $100,000 annually when he was diagnosed at Mayo Clinic with a rare sleep disorder called idiopathic hypersomnia (IH) that caused excessive daytime sleepiness (EDS). Patients with IH can’t fight the unpredictable need to sleep several times a day, and suffer constant brain fog and fatigue. It’s like narcolepsy, except patients don’t feel rested regardless of how long they sleep. Symptoms can mimic drunkenness and having the flu. Reliance Insurance Company, based on its own doctors’ opinions, approved Bob for employment-based ERISA long-term disability benefits in early 2016 after he began regularly missing work and was unable to keep up with deliverables. But five years later, and despite IH having no known cure, Reliance randomly had a doctor “take another look” at his medical records to declare him capable of any work without limitation. Bob’s benefits were terminated based on only a records review, despite Reliance’s right to an actual IME. This would never fly with a jury, right? As ridiculous as it may seem for Reliance to hire a new doctor (of unimpressive credentials) to disagree with its first doctor and Bob’s credentialed treating physicians, long-term disability insurers do it all the time when the claim is governed by federal ERISA law. Why? Because under ERISA, Bob can’t get a jury trial, and no bad-faith penalties are available under state law. So, insurers terminate benefits and hope Bob files his mandatory ERISA administrative appeal without counsel, and like most claimants, without properly building evidence into the administrative record. They know that if Bob takes that route, he’ll probably lose his federal court trial because the judge can’t consider any new evidence that wasn’t made part of that record. Our firm added a ton of supportive evidence into the record on appeal, Reliance approved Bob’s benefits, and thankfully, we didn’t have to go to court. Though it was a just outcome, Reliance should never have put Bob and his family through financial and emotional turmoil.
I am legally blind in my left eye now, and I wear shatterproof glasses all day to protect the right. Thankfully, reading and all other activities are unhindered using my good eye, and I never had to make a disability insurance claim. But believe me, it’s comforting to know you have that coverage, just in case. And now, I never do anything eye-risky without proper protection!
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Unplug. Try to stay off your phone when you’re finally away on vacation. You’ve set up guidelines and a chain of command, so trust the exceptional employees you’ve left behind. Now, I would be lying if I said I don’t check my phone now and again when I’m off. However, to combat working your
vacation away, I recommend picking designated times of the day that you allow yourself to check in with the firm. Let your staff know when you’ll be available and only work during these established time frames. Since Hurricane Ida, I’ve taken multiple relaxing vacations. My family went on a wonderful ski trip in Jackson Hole, and my wife and I even impulsively traveled to Denver to sightsee. Before establishing these procedures, I wouldn’t have been able
to go anywhere impulsively. So learn from me, don’t wait for a disaster to go on vacation. Be proactive, plan, and take some time off just because; you deserve it!
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