Disabled Man's Battle with MS and Standard Insurance Company Featured on Good Morning America

(MMD Newswire) March 3, 2009 - A man and his attorneys' successful struggle to obtain disability insurance benefits received national attention when Good Morning America featured his story and reported on the common delay and denial tactics employed by insurance companies.

Almost two years ago, Charles Tucker, an overachieving Certified Public Accountant ("CPA") and dedicated family man, began suffering from severe neurological symptoms, including debilitating headaches, constant fatigue, and eventually, uncontrollable hand tremors. It was when he lost his hearing in one ear that he first went to his physician. That is where his first battle began. Mr. Tucker underwent a brain MRI which revealed plaques consistent with Multiple Sclerosis ("MS"), a degenerative neurological condition. In shock and unwilling to accept this diagnosis he went to several other neurologists. However, eleven separate specialists and multiple MRIs confirmed the diagnosis of MS. Mr. Tucker was terrified about his family's future, but he was determined to remain functional for as long as possible. Unfortunately, his symptoms progressed and became accompanied by severe cognitive problems and the loss of hearing in his other ear. He struggled at work, but eventually became unable to perform the duties of a CPA. While Mr. Tucker was devastated, he found solace in the fact that years earlier he had secured disability insurance coverage through Standard Insurance Company ("Standard"), in case a sickness rendered him unable to work to support his family. This is where his second battle began.

With the help of his wife, Charles Tucker completed his application for disability benefits and supplied Standard with voluminous documentation of his diagnosis, severe symptoms, and his physicians' opinions that he was no longer able to work. He also provided the results of cognitive testing, which showed that Mr. Tucker, a once highly functioning accountant, now struggled with simple arithmetic. This was accompanied by multiple letters from his employer and clients explaining the progression of Mr. Tucker's symptoms and his struggle at work. Given the mountain of evidence provided, Mr. Tucker felt confident that Standard would quickly investigate and approve his claim. He was wrong. After forty-five days had elapsed, Mr. Tucker was informed that Standard required additional information and would be taking a thirty-day extension. Mr. Tucker learned that the information Standard was seeking was regarding an unrelated neck surgery. Despite their irrelevance, Mr. Tucker immediately provided the records hoping that this would expedite the process. In return, Standard asserted that it was taking its second and final thirty-day extension permitted under the law to obtain the raw data of the cognitive test results submitted three months earlier, despite not making a request for this data at that time. Mr. Tucker followed up with telephone calls to the Standard, pleading with them to contact his doctor and obtain the raw data.

Terrified about Standard's delay in making a decision and unable to obtain answers, Mr. Tucker sought the advice of an attorney at Disability Insurance Law Group, Alicia Paulino-Grisham. After reviewing the substantial information provided to Standard and the rationale for taking the two previous extensions, Attorney Paulino-Grisham informed Mr. Tucker that it appeared that the Standard was engaging in a common insurance company tactic - "slow walking." Insurance companies often delay rendering a determination on a claim because many people, distressed about their financial future, will simply abandon their claims and attempt to find alternative work. Attorney Paulino-Grisham explained that Mr. Tucker's claim was governed by the Employee Retirement Income Security Act ("ERISA"), which requires the insurance company to render a decision within forty-five days, and only allows the insurance company two thirty-day extensions if the insurance company asserts a need for the extension that is beyond its control. The intent behind these time limits is to prevent insurance companies from engaging in "slow walking." Attorney Paulino-Grisham further explained that despite the stringent regulations, many insurance companies continue to engage in "slow walking," because they know that many unrepresented claimants do not understand the law and that they will likely not pursue the violations in court.

Disability Insurance Law Group agreed to undertake representation of Mr. Tucker. Attorney Paulino-Grisham immediately contacted Standard and demanded Mr. Tucker's file, and subsequently sent Standard a lengthy correspondence clearly outlining Standard's unreasonable delay tactics and asserting that Standard had failed to assert a reasonable need for the extensions of time it had taken. Standard promptly provided Attorney Paulino-Grisham with Mr. Tucker's file, which included a medical records review conducted by a neurologist hired by the Standard. Based solely on the name of the physician retained by Standard, Attorney Paulino-Grisham immediately knew that the Standard would be challenging Mr. Tucker's diagnosis. The Standard regularly employs this particular physician who consistently challenges the diagnosis of neurological disorders. This was confirmed by the report included within Standard's file and a telephone conversation with the Standard. Attorney Paulino-Grisham pointed out to Standard that the physician it hired never even examined Mr. Tucker or saw his tremors. It was only then that the Standard requested that an Independent Medical Examination ("IME") be scheduled - mere weeks before its final deadline to render a determination. Attorney Paulino-Grisham advised that if the Standard failed to render a determination within its last deadline, it would be considered a de facto denial of the claim and Mr. Tucker would be free to file a lawsuit. In the meantime, Attorney Paulino-Grisham reviewed the consulting physician report which revealed several glaring and outrageous misrepresentations regarding Mr. Tucker's medical documentation, including the consulting physician's assertion that Mr. Tucker's hand tremors were the result of carpal tunnel syndrome. These inconsistencies were documented and sent to the Standard with a video statement from Mr. Tucker, showing his uncontrollable hand tremors. Despite this, the Standard chose to schedule the IME after the one hundred five days had elapsed. Standard was then advised by Disability Insurance Law Group that Mr. Tucker intended to seek legal action if a decision was not made immediately. Mr. Tucker attended the IME as scheduled and then Attorney Paulino-Grisham contacted Standard to inquire as to the status of the decision and to remind Standard of its unreasonable delay and violations of ERISA law. A few hours later, Attorney Paulino-Grisham received a telephone call that the Standard was finally approving Mr. Tucker's claim for benefits.

As the Good Morning America story showed, though Mr. Tucker and his attorneys ultimately obtained a favorable outcome, the process took a financial and emotional toll on Mr. Tucker and his family. Like many claimants, unaware of their rights, the unreasonable delay and lack of communication from the insurance carrier was not only frustrating, but terrifying. For months, Mr. Tucker simply did not know how his family would survive financially if Standard failed to pay his claim or denied his claim altogether. However, Mr. Tucker is one of the fortunate ones. When Disability Insurance Law Group obtained Standard's file, it was revealed that Standard was not just unreasonably delaying a claim decision, but also appeared to be preparing to deny his claim based solely on the medical records review of its hired physician. A denial would have certainly prolonged the outcome and caused Mr. Tucker and his family further emotional suffering and financial hardship, as he would have been required under ERISA to complete the administrative appeals process with Standard before ever being permitted to pursue a lawsuit. Since Mr. Tucker's story aired, Good Morning America has been inundated with stories from claimants who have endured similar insurance company tactics. Many have abandoned their claims, and others, unaware of how to navigate this complicated area of the law, have fatally damaged their claims and can no longer seek benefits.

Attorney Alicia Paulino-Grisham is a partner with Disability Insurance Law Group which focuses on individual and group disability insurance claims at all stages of the claims process. For more information please visit: www.dilawgroup.com

For more information contact:
Toni Rewets
Toll Free: (888) 644-2644
Tel: (561) 202-9170
Fax:(561) 202-9194
E-Mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

###