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Disabilities vary greatly, from permanent physical
injury to cognitive damage to drug or alcohol dependency.
In all cases, the disabling condition impairs a person’s
usual physical and/or mental function, preventing him
or her from earning a living as he or she previously
did. At that point, a disability insurance policy can
mean the difference between maintaining one’s
usual lifestyle and bankruptcy.
Unfortunately, disability insurers sometimes make it
difficult for insured people to recover the payouts
to which they are entitled and for which they have paid.
When that happens, expedient, successful resolution
is essential. The practice of Golomb & Honik’s
Mark F. Seltzer focuses exclusively on this area of
the law and has achieved national recognition. You can
read more about Golomb & Honik’s handling
of disability cases below:
- A surgeon who was insured against disability suffered multiple herniated discs resulting in multiple surgeries; he became totally and residually disabled in 2001. Although his condition was a serious one, he returned to work in a matter of months but was unable to perform some strenuous surgeries as before his injury. Once the waiting period on his policy expired, the surgeon made a claim on his own for residual disability benefits; the insurance company denied his claim. Golomb & Honik instituted suit on his behalf and included counts for breach of contract, bad faith, and violations of the Pennsylvania Unfair Trade Practices Act as well as other consumer laws. Golomb & Honik lawyers were able to establish bad faith on the part of the insurance company, including the way in which this individual case was handled. They also demonstrated a company-wide pattern and practice in misinterpreting their own policy language for the sole purpose of denying claims. The case settled shortly before trial for nearly ten times the compensatory claim for residual disability benefits.
A Philadelphia lawyer who was insured against disability, suffered from a chronic disease from which he ultimately became totally disabled as a trial attorney.
The victim-lawyer, through Golomb & Honik attorneys, brought an action against the defendant international insurance iompany for a breach of contract and the bad faith handling of the attorney's claim for disability benefits.
The attorney had a medical condition known as Crohn's Disease and, although diagnosed since early adulthood, worked continuously for several decades as a trial attorney. Beginning in November, 2000, he worked at his law firm on restricted basis and as a result collected a significantly reduced salary until the end of 2003 when his firm dissolved. At that time his conditioned worsened and he was unable to continue as a trial attorney or act as a litigation attorney in any form except to refer client matters to other attorneys.
The defendant insurance company denied his claim for disability benefits on the basis that his consultations with other attorneys referring matters, constituted a "new occupation" serving as a basis for the defendant international insurance company to deny disability benefits.
Golomb & Honik attorneys filed a complaint for breach of contract, unfair trade practices and consumer protection law, breach of fiduciary duty and bad faith. After exhaustive motion practice and pretrial discovery, the case settled for an amount which essentially represents the present rate of the total benefit the victim-attorney was otherwise entitled to until his 65th birthday. -
A 60-year old physician who maintained a full obstetrical and gynecological practice injured his dominant left hand leaving him unable to perform the substantial duties of his profession (i.e., surgery and child delivery).
After his injury, the physician made a claim for benefits under his group and individual policies with the defendant insurance company. While the insurance company initially paid the physician the benefits he was entitled to, for several years he was terminated benefits based on the results of a functional capacity evaluation and defense medical examination concluding that he was able to return to work. As a result, Golomb & Honik attorneys filed suit against the defendant insurance company claiming breach of contract, breach of fiduciary duty, bad faith and violations of Pennsylvania's consumer protection law.
During the course of discovery, and with the assistance of nationally recognized experts, it was determined that given the type of injury the physician suffered leading to his disability, the functional capacity evaluation and defense medical examination were both flawed. Each examination failed to analyze whether the physician could perform the specific duties of his profession and neither examiner bothered to review the relevant medical records. In fact, during the course of discovery the defendant insurance company admitted in writing that the functional capacity evaluation performed was conducted under improper protocol. Despite this allegation, the defendant insurance company continued to refuse the physician benefits. After extensive discovery and with the assistance of eminently qualified experts, the case settled for a confidential amount which was essentially equal to the present value of 100% of the benefits that the physician was entitled to plus an amount for bad faith and counsel fees.
A cardiologist, who was insured by a major insurer of individual disability benefits, suffered from ulcerative colitis for many years. In 1999 his condition exacerbated and he became unable to continue his clinical practice as a cardiologist and, ultimately, became disabled. Because he was unable to continue his duties as a clinical cardiologist he sought employment elsewhere and became an in-house medical director at a public company earning a fraction of what he had earned in private practice. In the meantime, the defendant insurer denied both residual and total disability benefits without so much as a peer review of the records in question - let alone an independent medical examination. As a result of the denial, Golomb & Honik attorneys instituted suit on behalf of the plaintiff cardiologist claiming a breach of contract and bad faith under New Jersey law. Despite the very stringent standard applied to bad faith cases in New Jersey, the claim survived a Motion to Dismiss and extensive and contentious discovery ensued. After multiple depositions; extensive written discovery; mediation; and, ultimately, a settlement conference with a federal magistrate, the claim settled just prior to trial.
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Beginning in December, 2002, the plaintiff physician suffered a seemingly endless succession of serious medical conditions leaving him totally disabled. He underwent multiple surgeries and his chosen career came to an end. After the onset of his disability, plaintiff physician presented a disability claim from the date of his December, 2002 disability onward. Initially, long term disability benefits were approved by the defendant insurance carrier and payments began as of July 22, 2003. From July, 2003 to June, 2005 plaintiff continued to receive benefits until, after 24 months, the defendant insurance carrier unilaterally terminated plaintiff physician’s benefits citing various provisions under the ERISA policy. Problem was, the policy under which plaintiff physician was receiving benefits was not an ERISA policy.
Golomb & Honik lawyers instituted litigation on plaintiff’s behalf for him to receive his benefits under the policy and for bad faith as a result of defendant insurance company’s attempt to deny plaintiff physician benefits under ERISA provisions which did not apply to this contract. After comprehensive discovery, defendant insurance company offered mediation in an attempt to resolve this case. At mediation, the claim was settled for a confidential amount which encompassed compensatory and bad faith damages.
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