IN SOCIAL SECURITY DISABILITY CASES AN ADMINISTRATIVE LAW JUDGE MAY NOT SUBSTITUTE HIS OR HER OWN JUDGMENT IN PLACE OF A MEDICAL EXPERT

In a Social Security Disability hearing, an Administrative Law Judge (“ALJ”) cannot replace a treating physician’s opinion with his or her own lay opinion. In other words, it is inappropriate for an ALJ to ignore or reject a medical opinion based only on his or her own medical understanding. That is, an ALJ cannot substitute his or her judgment for that of the medical and vocational experts.

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WHEN AN INSURANCE COMPANY TRIES TO REDEFINE A PHYSICAL ILLNESS AS A MENTAL ILLNESS TO LIMIT THE BENEFIT DURATION IT IS THE INSURANCE COMPANY THAT BEARS THE BURDEN OF PROOF

Sometimes insurance companies deny claims on grounds other than by arguing that their insured is not disabled. Indeed, it is not unusual for insurance companies to initially agree that an insured is disabled under the terms of the policy not only from her own occupation, but from any occupation, but then to claim that the benefits are limited to a relatively short period of time, like 24 months, due to a policy’s limitations on paying for disabilities caused by mental and nervous impairments.

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FEDERAL COURTS HAVE FOUND THAT STANDARD INSURANCE COMPANY ABUSES ITS DISCRETION IN ERISA LONG-TERM DISABILITY CASES BECAUSE OF ITS BIASED CLAIMS ADMINISTRATION

Standard Insurance Company has a history of biased claims administration as illustrated by recent federal court decisions.

In Oster v. Standard, 759 F.Supp.2d 1172 (N.D. California, Jan. 5, 2011), Standard abused its discretion, among other things, because “[It] did not comply with its obligation as an ERISA fiduciary to adhere to ‘higher-than-marketplace quality standards on insurers’ or ‘discharge [its] duties’ in respect to discretionary claims processing ‘solely in the interests’ of Oster, its claimant,” referencing Metropolitan Life Ins. Co. v. Glenn, 128 S.Ct. 2343, 2345 (2008), citing 29 U.S.C. 1104(a)(1), and instead, treated claimant “as an adversary during the claims process [casting] doubt on the credibility of its decision on appeal.”)

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