New York Disability Lawyer Wins Appeal in Major Wall Street Broker Case Against GuardianFriday, February 8, 2008
The New York Mercantile Exchange (NYMEX) is right around the corner from our Wall Street office. Last July, a very successful Commodity Broker called our office for legal representation in his appeal of a denial of his ERISA long term disability claim against The Guardian Insurance Company. His long term disability policy was supposed to pay him $10,000.00 per month. He been out of work for 14 months prior to coming to our office and The Guardian, like most LTD insurance companies, was dragging their feet.
After the client retained our office, we quickly realized that the "stated" reason for The Guardian denial was based on a incorrect analysis of his prior occupation. An accurate description of the "material and substantial duties" of a long term disability client’s job is one of the most important, yet often overlooked, keys to winning individual disability income claims.
After obtaining the Guardian’s entire claims folder (to which all claimant’s are entitled under ERISA- see our Disability Law Library), we determined that The Guardian’s own vocational expert had incorrectly defined his "occupation" as involving primarily "electronic trading". In fact, he was the classic, active "floor trader" you might envision on the floor of any financial exchange. We immediately retained a well known vocational expert to write a 12 page report rebutting Guardian’s expert and detailing his actual job duties and work environment. Our expert even did a field visit to the Mercantile Exchange "trading pit" and interviewed our clients co-workers and boss. Finally, thinking outside the box and working together with our client, we obtained a key letter from a top Mercantile Exchange official backing up our occupational analysis.
After doing the necessary prep work and laying an unshakable foundation, we then wrote an extensive legal brief seeking a reversal of Guardian’s initial long term disability denial. To Guardian’s credit, their Appeal’s Committee issued a stunningly quick reversal within two weeks. Our client’s nearly 18 month odyssey without long term disability income was over. They immediately released a check to him for over $150,000 in retroactive benefits and he continues to collect his $10,000 per month benefit today. To avoid the stress of ongoing disability claim reviews in the future, we are now in the process of negotiating a complete "buy out" settlement of our client’s long term disability claim.
The key to winning this long term disability claim was not just writing a legal appeal (which many lawyers can do), but was developing evidence for our client which gave the Guardian a rational basis to reverse their prior decision. Smart lawyers don’t win appeals just by telling insurance companies "you are wrong, you made a mistake" (even when they did). After all, what human being wants to admit they were ‘wrong". You must give them additional evidence, like we did in this case, to reconsider their original decision.