The Story of Jim’s Battle Again
Dan Finally Gets Justice After a Bog
We thank our referral counsel for the opportunity to help fight for Dan on this one. (Referral counsel received a fee of $16,550.)
he was permanently and totally disabled. Dow agreed to let him try. Dan reported to work at Dow for a short period, but literally “just sat there.” He couldn’t even reach to type or use a keyboard due to severe shoulder pain. Still less than 365 days post-accident, his surgeon essentially said, “I told you so,” and declared him disabled from working in any capacity, as he knew he was all along. Even the Social Security Administration declared Dan totally disabled. NUFIC based its hair-splitting denial of benefits on the absence in the record of the word “permanently” in the surgeon’s declaration of total disability. Thus, said NUFIC, the record could not support the required “ permanently and totally” disabled within 365 days after the accident. Insurance companies know how to use ERISA law technicalities to deny claims. Claimants and their attorneys need to know as well! Technically, NUFIC was right. Dan came to us after administratively appealing the denial on his own. His appeal would have been his last chance to correct that technical shortfall in the record if an attorney had filed suit without curing the problem first. Under ERISA law, the court cannot consider any evidence that was not made a part of the official administrative record before the suit is filed.
Long-term disability insurers look for any opportunity to deny a claim. In a nutshell, National Union Fire Insurance Company (NUFIC) attempted to exploit our client Dan’s (not his real name) commendable attempt to return to work while totally disabled, even though that short attempt ended in failure. Dan, age 60, was a process technician at Dow Chemical Company. He fell while on a fishing trip and injured his arm and shoulder, leaving his arm useless after multiple surgeries. Dow had an ERISA-governed permanent and total disability plan insured by NUFIC. Benefits were payable if he was rendered “permanently and totally” disabled within 365 days of the date of the accident. Insurance companies will exploit best efforts to work, despite the efforts ending in failure. At Dan’s insistence, before the 365 days were up, his surgeon released him to attempt a return to “light duty” desk work, with special accommodations, although telling Dan it would never work and that
FINDING TIME TO DO THE REALLY IMPORTANT STUFF What Keeps You Up at Night?
In the last issue, I shared a nutshell version of my legal journey to the present and how owning my own law firm came with nagging fears:
small law firms from all different practice areas from all over the country that shared the common goal of living less stressful lives and running better and more profitable law practices without using mass advertising like TV ads or billboards. That event, and the friends I made there, led me to several other similar organizations. I was amazed to learn that communities of lawyers out there have already solved the business issues I’m currently struggling with and are willing to share everything they know. About the best technology, website vendors, answering services, phone services, case management software, intake software, graphic designers, video producers, and newsletter services. About hiring, staffing, firing (inevitable), planning, creating processes for efficiency, and identifying “things that need to be fixed” in your practice. About the best uses of your next hour and next dollar to improve your practice, given your unique current circumstances, with the overarching goal of improving your life. About how your law practice can serve your life instead of making you its slave.
1. Uncertainty whether I would always have enough business to sustain my family; and 2. Work-life balance, and the struggle to not let the practice consume me to the detriment of my family.
Maybe you can relate.
Then moving from my hometown of Metairie, where I was well- networked, to Baton Rouge after Hurricane Katrina destroyed our home and my office in 2005 (I can’t believe it’s almost 20 years!) put those fears into overdrive. It also drove me to learn what actions I could take to eliminate those fears. Hanging out with others who know more than you do is key … I attended a three-day event called Great Legal Marketing Summit in Fairfax, Virginia. The event gathered consumer-facing lawyers and
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