Tuesday, February 7th, 2023
  • HOME
  • FREE PHONE CONSULTATION
  • BLOG
  • CONTACT LAWYER

www.iwantmydisability.com

Nassau: 366 North Broadway Suite 410 Jericho, NY 11753
Suffolk: 445 Broad Hollow Road Suite 25 Melville, NY 11747
Call Us Toll-Free: (888) 572-0861   Email: jd@iwantmydisability.com

  • HOME
  • ABOUT
    • Disability Attorney
    • FREE PHONE CONSULTATION
  • RESOURCES
    • Useful Links
    • Docket Search
    • Court Decisions
    • Newsday Editorials
      • Editorial 8-25-11
      • Editorial 8-13-12
    • IMA CEs
    • McQuillin Oral Argument
  • DISABILITY CLAIM FAQ
  • SERVICES
    • Applying For Disability Benefits
    • Disability Appeals
    • Negotiation
    • Disability Claim Litigation
    • Post Approval Supervision
  • TESTIMONIALS
  • CONTACT

cc

Contact Us

Practice Areas

Social Security Disability

Disability Insurance Policies

Long Term Disability Plans

Union Disability Pension

NYS and NYC Disability Retirement

Federal Disability Retirement

Free Phone Consultation

Free Phone Consultation

 

Avvo - Rate your Lawyer. Get Free Legal Advice.

Bookmark and Share

Follow us on Facebook

Disability Claim Litigation

Our law firm will do everything to secure your disability benefits at the earliest possible time. However, in many instances, after a disability claim has been denied or terminated, it should be litigated. Some insurance companies and Administrative Law Judges force claimants to go to court in the hope that they will not pursue their disability claim. Our law firm has over a quarter century of litigation experience, and will not hesitate to file a lawsuit in order to get your disability benefits.

Litigation of many disability insurance claims and Social Security Disability claims are governed by federal law and take place in federal court. Disability claims that are not subject to ERISA are governed by state law and may proceed in either state or federal court. Regardless of the court in which you may need to litigate, we will explain the legal process to you in easily understandable language. At all stages of the litigation process, we will point out the issues to you and allow you to make the ultimate decision on important matters.

There is important news for New Yorkers whose disability benefits through their work or union were denied or terminated. When a court reviews a denial or termination of a New Yorker’s disability benefits, it usually has to uphold that decision unless it was “arbitrary and capricious.” That means even if the claimant has the better case, the insurance company or plan administrator could win. “Discretionary clauses” are what triggers the arbitrary and capricious standard of review.

Some federal district court from outside New York have been ruling that discretionary clauses are not enforceable. Disability insurance companies misuse discretionary clauses to deny benefits to claimants.

Discretionary clauses are contract provisions that grant an insurance company or administrator the unrestricted authority to determine eligibility for benefits and to interpret terms and provisions of the policy, contract or certificate. An example is: “the company has full, exclusive, and discretionary authority to determine all questions arising in connection with the policy, including its interpretation.” Most disability policies that employers buy to cover their workers include discretionary clauses.Over 20 States prohibit discretionary clauses in insurance policies because they have been found to be unjust, unfair and inequitable. New York once banned discretionary clauses, but the insurance lobby succeeded in having the insurance regulations banning those clauses withdrawn.

Discretionary clauses place the insured at a great disadvantage in any disagreement over the meaning of the insurance contract, usurp the role of the courts in deciding a matter of law, that is, the meaning of the contract, and exacerbate the insurer’s inherent conflict of interest in being both the entity that pays and decides what does or does not need to be paid. In other words, the insurance company profits increase when it denies and terminates claims. As noted by the Supreme Court in Metlife v. Glenn, 554 U.S. 105, 128 S.Ct. 2343 (2008), where an insurer both determines whether an employee is eligible for benefits and pays those benefits out of its own pocket, there is a conflict of interest. This conflict would be mitigated by prohibiting discretionary clauses and lessening the insurer’s discretion to decide what the contract means.
Discretionary clauses are also unjust and contrary to the laws of this State because the deferential standard of review is opposed to the common law doctrine that ambiguities in insurance contracts should be construed in favor of the insured. Moreover, discretionary clauses in insurance contracts are misleading because policyholders probably do not understand when reading these clauses that they are giving up the right to a neutral, merits-based review of the insurer’s decisions and the meaning of the policy, and that the insurer as a practical matter could proceed with essentially absolute discretion as to what the policy means. Disability insurers always argue that they have the discretion to deny or terminate benefits by relying exclusively on the opinions of their doctors, who reject the opinions of the treating doctors, regardless of what the evidence reveals.

A disability or health insurance policy is a contract. The interpretation of a contract is a matter of law and ordinarily questions of law are for the judiciary to decide. In a lawsuit on a contract, such as when an insured sues an insurer, a court looks at the question of law de novo, i.e., without regard for how the contract might have been initially interpreted by the insurer. However, when a discretionary clause is present, it usurps the role of the courts because they are required to give deference to the insurer’s interpretation of the contract, and will only overturn the insurer’s view if the court finds the insurer’s decision was arbitrary and capricious. This leads insurers to deny and terminate claims that they know should be approved.

A client that I am currently representing illustrates a concrete example of what is at stake. She is covered by two disability policies that were issued by First Unum. One policy grants discretionary authority, while the other does not. First Unum found that my client can perform her own occupation, and has denied benefits, under the policy that it mistakenly thinks grants it discretionary authority. At the same time, based upon the same, and actually less, evidence, First Unum found my client was disabled from any occupation under the policy that does not grant discretionary authority.

Insurance companies’ widespread abuse due to discretionary clauses prompted some regulatory authorities to take action. In 2002, the National Association of Insurance Commissioners (the “NAIC”) issued a model act entitled “Prohibition on the Use of Discretionary Clauses” (the “Model Act”). When an insurance company issues a group disability policy, a discretionary clause grants the insurer or administrator the authority to determine eligibility for benefits and to interpret terms and provisions of the policy. The purpose of the Model Act is to prohibit clauses that purport to reserve discretion to the insurer to interpret the terms of a disability insurance policy.

The abuse of discretionary authority by the insurance became so widespread that the media covered the issue. On October 13, 2002, NBC Dateline did an expose called “Benefit of the Doubt”. The story described how Unum, the largest disability insurance provider, had systematically manipulated and created evidence in order to create excuses to deny and terminate disability claims. On November 20, 2002, CBS 60 Minutes also did an expose on Unum called “Did Insurer Cheat Disabled Clients?” The 60 Minutes piece detailed how Unum forced doctors to manufacture evidence as a means to deny and terminate disability claims.

The abuses by Unum resulted in the U.S. Department of Labor and 49 State Insurance Departments bringing an action against Unum that resulted in a regulatory settlement agreement. Among other things, Unum was forced to reassess hundreds of thousands of disability claims that it had denied or terminated. Although Unum continues to engage in the same tactics that led to the agreement, no further action has been taken, and other disability insurers are now following Unum’s lead. Perhaps no further regulatory action has been taken because many states have now banned discretionary authority.

On March 27, 2006, New York State Insurance Department issued Circular Letter No. 8 that adopted the NAIC Model Act. The letter stated that “discretionary clause provisions in accident and health insurance policies and in subscriber contracts will no longer be approved by the Department” because “The Department has determined that the use of discretionary clauses violates Sections 3201(c) and 4308(a) of the Insurance Law in that the provisions ‘encourage misrepresentation or are unjust, unfair, inequitable, misleading, deceptive, or contrary to law or to the public policy of this state.’ Additionally, the Department believes that the use of discretionary clauses is an unfair or deceptive act or practice, within the meaning of Article 24 of the Insurance Law.”

In what is already a contract of adhesion, i.e., one that a consumer has no choice but to accept, discretionary clauses skew the balance of power even further in favor of the insurer. In other words, when a disability policy in New York grants the insurer discretionary authority, New Yorkers are at a severe disadvantage in any contest over questions of coverage, eligibility and interpretations and applications of the provisions of the contract for the simple reason that the insurer included a discretionary clause in the contract. If discretionary clauses are prohibited, then the courts apply the de novo standard of review, and are free to substitute their own judgment for that of the insurer. If a matter comes to court, the consumer faces a level playing field, and is better protected.

What is perhaps most affected by the differing standards of review is the mindset of the insurer – its confidence that whatever it decides is sacrosanct under the “arbitrary and capricious” standard, as opposed to the more cautious approach it would take knowing that its decisions would be reviewed de novo. My experience has shown that whenever a court rules that a de novo standard of review applies, the insurer immediately seeks to settle the case, which is a tacit admission that the insurer knew its decision was wrong.

Recognizing that a level playing field would require insurers to stop denying and terminating claims, the insurance lobby prevailed upon the Insurance Department to withdraw the Model Act just three months after it was adopted. On June 29, 2006, the Insurance Department issued Circular Letter No. 14, which withdrew the ban. The Letter stated that discretionary clauses that require courts to review disability and medical insurance claims under an arbitrary and capricious standard of review rather than de novo review negate essential features of the policies, as well as statutorily required appeal rights, which nullifies the insurer’s responsibility to pay. The Insurance Department found that discretionary clauses were likely to mislead the policyholder, contract holder or certificate holder; were “unjust, unfair or inequitable; and were an “unfair or deceptive act or trade practice.” While no longer banning discretionary clauses, the Insurance Department stated that it was “drafting regulations that would prohibit the use of discretionary clauses” in insurance policies. That was a long time ago.

In April 2010, the Insurance Department asked for comments about proposed regulations to ban discretionary clauses, but no regulations were enacted. In 2014, I spoke with Insurance Department-Department of Financial Services representatives, and they said that it was highly unlikely that anyone would be drafting any regulations to ban discretionary clauses now.

Over twenty States have enacted legislation to ban discretionary clauses, and the list includes “Red” States such as Texas and “Blue States” such as Illinois and California. Adopting the Model Act levels the playing field when the disabled are forced to sue insurance companies to receive their benefits. Having a fair claim review process is not a Democratic or Republican issue. How long must New Yorkers wait for similar protection?

The New York State Assemblymember, who is the Chair of the Committee on Insurance, is probably unaware of the problem with discretionary clauses. He/she needs to be made aware of the problems that New Yorkers have experienced when insurance companies have denied or terminated their disability benefits. Unbeknownst to many if not most employees, their benefits were denied or terminated under a policy that granted the insurance company discretionary authority. If you or anyone you know has experienced a problem receiving disability benefits under a disability plan through work, let your Assemblymemberl know about your problem.

Disability Law Blog

ALJ Carlton Reversed Again

Administrative Law Judge (“ALJ”) John Carlton  denies most cases Social Security Disability (“SSD”) cases because he bases his decisions on...

Hartford Breached Its Fiduciary Duty

Hartford Life, as claims administrator of a long term disability (“LTD”) plan, relies on claim procedures, which the Second Circuit...

Excuses Excuses

By Susan Golden The number one question we get everyday is, “How long will it take to get a decision on...

Testimonials

I wanted to express my gratitude to you, for winning my Social Security Disability Insurance (SSD) claim. Though my words will never truly match the abundant respect and appreciation I have for your firm’s skill and careful handling of my SSD case, I thought I should, at the very least, begin with this letter. I originally hired another SSD attorney to represent me on my claim; my claim was mishandled by that attorney’s office and consequently denied. At that point I was already out of… Read more
S.M.
I really don’t know what I would have done if I didn’t have Mr. Delott and Susan Golden.  I’m so happy to be receiving my SSD benefits and have money.  I never met such honest people who work in a law firm.  They truly care and help.  I would say if you need a SSD lawyer please call this office ASAP.
D. Z.
Just wanted to thank you again for helping me with my case. With me being very impatient with the whole SS process, you always talked me off the ledge and reassured me that everything was going to be fine. I know I can never thank you enough. I wanted you to know how appreciative my wife and I am for all the hard work that you guys did for me. I do now and always will continue to recommend Mr. Delott to anyone needing help. Have a nice day.
M. A.
Jeffrey Delott’s Law office was dedicated to getting my S.S.D. benefits. They were always patient and eager to help me. I was treated kindly and honestly and highly recommend using Jeffrey Delott to win your case. “From the moment I had my first conversation I knew I was in very good hands, and felt confident that I would have a favorable outcome. Whenever I had a question or concern it was answered right away. I highly recommend Jeffrey Delott and his staff to represent you for any disabil… Read more
R.D.
I’m not the type of person that sits and sends letters out to people, but everyone at The Law Offices of Jeffrey Delott Law was professional and responsive to me. I’m still amazed at the speed and efficiency in which my disability case was handled from start to finish. I can’t thank you enough.
B.T.
I want to express our extreme appreciation for all your hard work and determination you put into winning my disability case and the settlement from The Standard.  We couldn’t have done any of this without you, your knowledge, and expertise.  I am now able to concentrate on my health.
S.H.
It has taken me time to think about what to say to you for all the compassion and hard work you have done for me. You called me to appraise me of every step I needed to take and at what point my case was at. Whenever I had a question or concern I would call you, If you were unavailable you did call me back ASAP. You heard me cry, you listened when I was at financial brink, you knew my pain was real. You did not treat me like I was a piece of paper coming across your desk and another case to… Read more
P.C.
“Thank you for all of the excellent work you did on my behalf to help me win my appeal for long term disability benefits. Throughout that difficult time my comfort was knowing that I had the best attorney on the job. Your foresight of all possible contingencies and your proactive approach really helped me to get a handle on the many documents and doctor’s visits required to put forth the best possible case. You put your incredibly thorough knowledge of this area of law to its best use every… Read more
B. K.
“Jeffrey Delott has been considerably successful in obtaining my disability far beyond my achievement and I TRULY THANK him for his gallant efforts.”
L. W.
“Mr. Delott was extremely knowledgeable, supportive, patient and professional. He helped me every step off the way- never giving up and always available for questions and advice. I was able to secure an award quicker than anyone thought thanks to his detailed service and determination! Highly Recommended!”
L. S.
“When my friend referred me to your firm, he mentioned how pleased he was with how you and your staff handled his case. I agree. It is so important that you have the proper representation when you become disabled.”
C. W.
“I strongly suggest that people who are in need of SSI or SSD benefits get in contact with you guys. I did not think I would be approved in such a short period of time. Mr. Delott was very professional, he knew his job and the system very well, and he kept me informed at all times. He and his staff will take care of everything. I am very, very, very happy with the results. I am a disabled veteran, and this was the best thing that could happen to me. I recommend and suggest that you give Mr.… Read more
R. S.
Jeffrey came highly recommended by a friend of mine who had used his services and been approved. Not only did Jeffrey help me with my SSD claim he also helped me with my LTD and pension disability. He dealt with me personally and always kept me informed. he is extremely knowledgeable and responds immediately to an questions i had. His staff is extremely helpful and I know I will always get a return phone call very quickly. I would highly recommend him – he really knows his stuff and i appre… Read more
The best disabiity attorney
I cannot begin to thank Mr. Delott for his outstanding commitment to securing Social Security Disability for my husband, Andrew. When my husband was first diagnosed with early onset Alzheimer’s, I was not only overcome with the grief of his disease but facing the reality of financial disaster due to his inability to work. My husband was only 59 at the time of his diagnosis. It was through sharing my situation with my co-workers that Mr. Delott’s name was given to me as a referral, and the… Read more
M.C.
“I could not believe how quickly my case was approved. If it were not for all your hard work and dedication I know I would not have had this quick and favorable outcome. I truly appreciate you walking me through this complicated process, and taking the time to answer all of my many questions.”
N. D.
Thank you for your help and support in attaining the benefits my husband was due. We will be able to pay our bills and expenses, and will definitely be able to sleep better at night. We will definitely recommend you for legal matters.
W. R.
Thank you for winning my SSD case! I was at a major crossroads in my life after I was no longer able to work. I did not know where to turn or what to do and the stress was taking its toll on my self and my wife. I was both overwhelmed and scared to death with the thought of having no income and no hope of ever earning a living again because of my illness. I would recommend Jeffrey Delott to any person who needs a disability attorney and wants to win. Jeff and his staff always “kept me in th… Read more
D.V.
“Jeff Delott really knows his stuff. His professional advice and guidance were extremely valuable in helping me to navigate through the overwhelming amount of red tape involved in obtaining SSD.”
A. N.
“I can’t say enough about Jeffrey Delott . His knowledge and aggressiveness helped me get my LTD benefits started in a matter of days after weeks of unsuccessful attempts alone. Thank You!.”
K. M.
“Jeffrey Delott has the utmost ethical standards of any lawyer that I have dealt with. He possesses all of the assets necessary for success — honor, dignity, and sincerity. I will continue to refer him to friends and family. He took the time to explain the particulars of my case, was always available to take my calls, always returned my calls and was always available to answer my questions no matter how silly they might have been.”
S. F.
“I was certain I made the right choice hiring Jeff Delott from the very beginning, and my certainty was consistently validated every step of the way. Jeff kept me informed, always responded personally to my concerns within 24 hours, and was a relentless warrior on my behalf. Jeff understands why you need his services, and he treats you with respect while aggressively and expertly handling your situation.”
M.C.
Thank you for all your hard work and dedication. Your knowledge and guidance helped bring comfort to me and my family during a difficult time. You were always available to answer my questions and offer your advice and support. In my mind, there is only one disability lawyer and that is Jeffrey Delott.
G. G.
Hands down he is the best Disability Attorney around. He is extraordinarily knowledgeable and successful and gives you personal attention unlike you would get from a large firm like Binder and Binder.
Best Disability Attorney
I applied for disability on my own and was denied. I was referred to Mr. Delott and couldn’t be happier with the outcome of my case which was approved. Mr. Delott is the most knowledgeable, efficient attorney who gave his undivided personal attention and guided me every step of the way. You won’t find a better disability attorney.
Highly recommended Disability Attorney
“I have recommended you in the past and I will continue to do so!”
L. Z.
“From the moment I hobbled into his office, Jeffrey was quite clear on how he would attack the inaccuracies and inconsistencies of several reports of Hartford people. I couldn’t help crying when Jeff told me my benefits were being reinstated because I was so overwhelmed with joy and shock. I never win anything. I know this could never have happened without the aggressive skills of Jeff.”
A. B.
“I contacted Jeff Delott over the internet and within 24 hours he contacted me by phone. Mr. Delott was extremely knowledgeable and upfront about what records I would need to produce to win the case. I had filed for SSD by myself and was denied twice. With his expertise he had it overturned with a fully favorable decision within a few months and I did not have to go in front of an ALJ. He was very responsive throughout my case and he did not give up! I would highly recommend Jeff Delott to … Read more
D. G.
I haven’t gotten a chance to thank you for everything you and your staff did for me and my family.   I can’t thank you enough.  It really means a lot to me.  I know you and Susan Golden worked countless hours on my case with numerous emails and phone calls.  In the beginning I was a little skeptical and nervous going through the social security process but in the end we prevailed and this really separates you from other attorneys that are in it just for the business.  Your compassi… Read more
A.D.
“I will never forget when I was originally denied benefits for Fybromyalgia,Jeffrey Delott told me not to worry, he assured me that I will be approved, he said it might take some time but I will get my benefits. Thank you so much, your aggressiveness and knowledge make you the best at what you do.”
L. J.
I want to thank you for the sensational work you did in winning my disability appeal. Your professionalism, and that of your staff, were notable throughout your representation of me.
S.P.
Thank you so for taking my case when nobody else would. Thank you for seeing that I had a case when no other lawyer would touch me. Only you saw that there was hope. I can’t thank you enough for taking all my calls through all my doubts. You are indeed a great savior. I will recommend you to anyone who asks.
B.L.
I am an attorney who suffered a permanent disability. Once disabled I had to decide whether to represent myself in a petition against the Social Security Administration or to retain another attorney to pursue the claim on my behalf. As an attorney I had access to the court system. As a result I was familiar with administrative judges, court clerks, attorneys and other persons employed in the field of disability law. If you want to know who are the best and brightest attorneys in any fiel… Read more
A.C.
Jeffrey Delott did an amazing job for me. Mr Delott applied for SSD and for my private LTD for me. There was continual communication between Mr Delott or his assistant Susan with me almost on a daily basis via email, telephone, or regular mail. Then after only five months into the process I received a call from Mr Delott saying that I was approved for both SSD and my LTD on the same day. After speaking with friends and reading horror stories online about how the process can take up to 2 yea… Read more
H.D.
“From my initial consultation with Jeffrey Delott, I was immediately impressed with his knowledge of Social Security Disability. From day one he always answered my questions or concerns I had and always explained what to expect in detail. I did receive my benefit and was glad that I used him as my attorney.”
I. F.
“I found Jeff to be relentless in his determination to get my case settled quickly. He succeeded in a matter of months. When I had spoken to other lawyers they would tell me it could take two years. I recommend him to anyone who wants a lawyer who will go all out for you and be there every step of the way.”
T. B.
“I want to thank you for being so professional, compassionate, thorough and knowledgeable about your field. I cannot express my gratitude enough. You are the best.”
U. P.
Thank you very much for all your help. You were very kind. I recommended my neighbor to you. I’m sure you’ll help him too! Thanks again!
M.B.
I just wanted to thank you again for helping me with getting my disability. I was vacillating with my decision to apply knowing that I needed to, but kept wavering as i felt I must be able to work at something. Left to my own devices I would probably still, be working on the application. With your help we progressed in a timely manner and I should be receiving my first check this month. Thank you again.
M.J.M.
From the onset of working with Jeffrey Delott, I found him to be efficient and knowledgeable. He was very understanding about my situation and easy to talk to.. I am extremely satisfied with the results I acheived working with Jeffrey Delott’s firm.
N. R.

DISCLAIMER
This website provides general information on disability law topics as a public service. Information is intended to be as accurate and current as possible, but should not be relied on as legal advice. No attorney/client relationship is created by viewing or using the content on this website. Each legal problem is different, and past performance does not guarantee future results. You should not act on any of the information contained in this site without first consulting legal counsel, which is why readers are advised to seek experienced legal representation in connection with disability related issues. Our Internet links are not associated with us, and we do not guarantee the accuracy of, any information contained in any link. Past performance doesn’t guarantee future results.

  • HOME
  • ABOUT
  • RESOURCES
  • DISABILITY CLAIM FAQ
  • SERVICES
  • CIGNA
  • TESTIMONIALS
  • CONTACT
  • CLIENT RIGHTS

Attorney Advertising
Copyright © 2023, Law Offices of Jeffrey Delott

Site Powered By: WebDesignYou