"standard insurance" - The case discussed here highlights one of the ways in which an insurance company attempts to justify the cancellation of benefits after they have begun to pay them.
George Nevitt was a practicing lawyer who fell down the stairs on June 19, 2001. His injuries were so severe that he began receiving disability benefits long term from Standard Insurance Company (Standard), the company that provided your company's employee welfare benefit plan. In April 2007, Standard ended Nevitt coverage claiming that no longer qualified due to the limitation of mental disorder of the plan.
Nevitt exhausted all administrative remedies and filed a complaint with the U.S. District Court for the Northern District of Georgia, Atlanta Division. Requested summary trial. Norma responded by moving for summary judgment on their behalf. Nevitt responded by filing a cross motion for summary conviction, so standard showed an additional motion for summary judgment. Nevitt then moved to strike additional motion Standard. (This is typical.)
Let's look at the facts presented by the administrative record. After his fall, Nevitt began experiencing frequent migraine headaches, pain in the neck and both arms. His cognitive skills were also damaged. In August, he saw his primary care physician, a neurologist and a physiotherapist. He was forced to reduce the number of hours worked and finally underwent an MRI in September. The MRI showed I had hernias on both the C-4-C-5 and C-6-Disk C-7, as well as a deformation of the spine. Other damage was also evident on MRI.
On November 15, 2001, Nevitt filed a claim for partial disability benefits. He had not been with the firm a year yet, so make sure that Standard Nevitt has no pre-existing condition. They had an internal medicine consultant to review their medical records. No pre-existing condition was found. This doctor said Nevitt's condition should improve in time.
When Nevitt condition did not improve, his neurologist recommended that he see a neurosurgeon. He did so in May 2002. The neurosurgeon suggested that he needed surgery to repair hernias and stimulate spondylitic appears on MRI. Nevitt was reluctant to undergo surgery, so the neurosurgeon regarding a board certified pain management and rehabilitation specialist.
"standard insurance" - In December 2003, Nevitt stopped working altogether. An independent medical examiner will check your workers' compensation claim. The doctor who performed the test said he could return to work if the duties of his job have changed. Nevitt returned to her neurosurgeon again recommended surgery, but Nevitt referred to a neuropsychologist who was diagnosed with post-concussive injury, concluding that cognitive impairment Nevitt has affected their ability to practice law. Nevitt said that was emotionally distraught that was affecting his cognitive abilities. As a result, it is recommended drug treatment for depression.
Nine months later, in August 2004, Norma ordered an independent medical examination. This physician concluded that Nevitt had neuropsychological problems limit their ability to work. Her doctor disagreed and continued to restrict his work.
Another year passed. In August 2005, Standard asked a neurologist to review the records of Nevitt. Nevitt neurologist concluded that this was not disabled from the practice of law. We recommend monitoring of treatment for migraines is Nevitt. At the same time, Standard asked a psychiatrist to review the records of Nevitt. She concluded that he suffered from major depression at times, but could return to work with emotional support. Her physician did not agree, and it continued to restrict the return to work.
In October 2006, Standard ordered an independent medical examination. The neurologist, after seeing Nevitt, came to the conclusion that Nevitt complaints were out of proportion to the injury. There was no reason why he could not perform a sedentary desk job without any restrictions.
Standard Nevitt finished the long-term disability benefits in April 2007. They said their benefits were limited to 24 months due to anxiety and depression contributed to his disability. He called the October 12, 2007, citing his neck pain, migraine headaches and brain damage. These were off independently and were not subject to the limitation of mental disorder. Submitted affidavits from its physicians, a detailed account of his fall, a functional capacity evaluation and work simulation test as evidence of your disability is not related to mental illness. The same expert said that it had determined that they no longer qualified for long-term disability reviewed the additional material and upheld the decision.
"standard insurance" - The case was sent to the Administrative Review Unit Standard for an independent review. Nevitt submitted additional documentation. A report from a neurologist said his migraine can be expected to cause him to lose 5 to 7 working days each month. A second report by a professional consultant Nevitt said it was no longer able to practice law because of its limitations. Standard also presented the report of a neurologist who disagreed, stating that migraine should only affect Nevitt for one or two days per occurrence. I could not see how you turn the practice of law.
"standard insurance" - The Administrative Review Unit confirmed the resolution of standard benefits. Nevitt gave copies of medical records were used to reach its conclusions. In response, Nevitt underwent additional tests to address concerns that physicians have expressed consulting standard. The results of these tests were sent to the Claims Specialist for consideration. The specialist said that the evidence sent any new information. The initial decision to end the confirmed.
To resolve this issue, the Court considered several things. First, the Court of Justice to evaluate the reasonableness of the determination of Norma, in light of material recorded in the administrative record. For that reason the Court had to determine whether the Court agreed with the claims administrator's decision of denial of benefits.
The Court considered the language policy. What standard promised in the policy? First, the policy that they covered the result of physical illness, injury, pregnancy or mental disorder, if the insured could not work on their "own occupation." The declared policy of long-term benefits are limited to 24 months so that "each period of permanent disability caused or contributed to a mental disorder. "Things, including mental disorders such as depression or depression" and "anxiety and anxiety disorders."
Nevitt argued that his condition was not included in the provision of mental disorder because it was off quite apart from mental problems you may have. The Court agreed. When the Court reviewed the administrative record used at the time of the decision to terminate Nevitt long-term disability policy, the Court reached a different decision. It was determined that the administrative record demonstrated at least three conditions, which is not a mental disorder that contributed to the disability Nevitt. The clinical history justified the probability of continued work missing Nevitt of at least 5 to 7 days per month, which is unacceptable in the practice of law.
Nevitt motion of summary proceedings was granted December 3, 2009. Standard coverage must restore its long-term disability. "standard insurance"
George Nevitt was a practicing lawyer who fell down the stairs on June 19, 2001. His injuries were so severe that he began receiving disability benefits long term from Standard Insurance Company (Standard), the company that provided your company's employee welfare benefit plan. In April 2007, Standard ended Nevitt coverage claiming that no longer qualified due to the limitation of mental disorder of the plan.
Nevitt exhausted all administrative remedies and filed a complaint with the U.S. District Court for the Northern District of Georgia, Atlanta Division. Requested summary trial. Norma responded by moving for summary judgment on their behalf. Nevitt responded by filing a cross motion for summary conviction, so standard showed an additional motion for summary judgment. Nevitt then moved to strike additional motion Standard. (This is typical.)
Let's look at the facts presented by the administrative record. After his fall, Nevitt began experiencing frequent migraine headaches, pain in the neck and both arms. His cognitive skills were also damaged. In August, he saw his primary care physician, a neurologist and a physiotherapist. He was forced to reduce the number of hours worked and finally underwent an MRI in September. The MRI showed I had hernias on both the C-4-C-5 and C-6-Disk C-7, as well as a deformation of the spine. Other damage was also evident on MRI.
On November 15, 2001, Nevitt filed a claim for partial disability benefits. He had not been with the firm a year yet, so make sure that Standard Nevitt has no pre-existing condition. They had an internal medicine consultant to review their medical records. No pre-existing condition was found. This doctor said Nevitt's condition should improve in time.
When Nevitt condition did not improve, his neurologist recommended that he see a neurosurgeon. He did so in May 2002. The neurosurgeon suggested that he needed surgery to repair hernias and stimulate spondylitic appears on MRI. Nevitt was reluctant to undergo surgery, so the neurosurgeon regarding a board certified pain management and rehabilitation specialist.
"standard insurance" - In December 2003, Nevitt stopped working altogether. An independent medical examiner will check your workers' compensation claim. The doctor who performed the test said he could return to work if the duties of his job have changed. Nevitt returned to her neurosurgeon again recommended surgery, but Nevitt referred to a neuropsychologist who was diagnosed with post-concussive injury, concluding that cognitive impairment Nevitt has affected their ability to practice law. Nevitt said that was emotionally distraught that was affecting his cognitive abilities. As a result, it is recommended drug treatment for depression.
Nine months later, in August 2004, Norma ordered an independent medical examination. This physician concluded that Nevitt had neuropsychological problems limit their ability to work. Her doctor disagreed and continued to restrict his work.
Another year passed. In August 2005, Standard asked a neurologist to review the records of Nevitt. Nevitt neurologist concluded that this was not disabled from the practice of law. We recommend monitoring of treatment for migraines is Nevitt. At the same time, Standard asked a psychiatrist to review the records of Nevitt. She concluded that he suffered from major depression at times, but could return to work with emotional support. Her physician did not agree, and it continued to restrict the return to work.
In October 2006, Standard ordered an independent medical examination. The neurologist, after seeing Nevitt, came to the conclusion that Nevitt complaints were out of proportion to the injury. There was no reason why he could not perform a sedentary desk job without any restrictions.
Standard Nevitt finished the long-term disability benefits in April 2007. They said their benefits were limited to 24 months due to anxiety and depression contributed to his disability. He called the October 12, 2007, citing his neck pain, migraine headaches and brain damage. These were off independently and were not subject to the limitation of mental disorder. Submitted affidavits from its physicians, a detailed account of his fall, a functional capacity evaluation and work simulation test as evidence of your disability is not related to mental illness. The same expert said that it had determined that they no longer qualified for long-term disability reviewed the additional material and upheld the decision.
"standard insurance" - The case was sent to the Administrative Review Unit Standard for an independent review. Nevitt submitted additional documentation. A report from a neurologist said his migraine can be expected to cause him to lose 5 to 7 working days each month. A second report by a professional consultant Nevitt said it was no longer able to practice law because of its limitations. Standard also presented the report of a neurologist who disagreed, stating that migraine should only affect Nevitt for one or two days per occurrence. I could not see how you turn the practice of law.
"standard insurance" - The Administrative Review Unit confirmed the resolution of standard benefits. Nevitt gave copies of medical records were used to reach its conclusions. In response, Nevitt underwent additional tests to address concerns that physicians have expressed consulting standard. The results of these tests were sent to the Claims Specialist for consideration. The specialist said that the evidence sent any new information. The initial decision to end the confirmed.
To resolve this issue, the Court considered several things. First, the Court of Justice to evaluate the reasonableness of the determination of Norma, in light of material recorded in the administrative record. For that reason the Court had to determine whether the Court agreed with the claims administrator's decision of denial of benefits.
The Court considered the language policy. What standard promised in the policy? First, the policy that they covered the result of physical illness, injury, pregnancy or mental disorder, if the insured could not work on their "own occupation." The declared policy of long-term benefits are limited to 24 months so that "each period of permanent disability caused or contributed to a mental disorder. "Things, including mental disorders such as depression or depression" and "anxiety and anxiety disorders."
Nevitt argued that his condition was not included in the provision of mental disorder because it was off quite apart from mental problems you may have. The Court agreed. When the Court reviewed the administrative record used at the time of the decision to terminate Nevitt long-term disability policy, the Court reached a different decision. It was determined that the administrative record demonstrated at least three conditions, which is not a mental disorder that contributed to the disability Nevitt. The clinical history justified the probability of continued work missing Nevitt of at least 5 to 7 days per month, which is unacceptable in the practice of law.
Nevitt motion of summary proceedings was granted December 3, 2009. Standard coverage must restore its long-term disability. "standard insurance"
