Our client was a senior-level executive at a large corporation whose role carried significant responsibility for government contracting. The client, who suffered from a serious mental health condition, reached the point where he was no longer able to perform the major duties of his profession due to the severity of his condition. He left his position and, after filing a claim with his long-term disability insurance company, began receiving disability benefits.
The Challenge
Long-term disability insurers often target claims involving mental health conditions because they are perceived as easier to terminate. Unlike physical injuries, conditions such as depression and post-traumatic stress disorder (PTSD) cannot be confirmed through objective testing like MRIs, EMGs or range-of-motion studies. This creates a golden opportunity for insurers to successfully challenge the claim.
A common tactic insurers employ to deny a legitimate claim is to demand that the claimant submit to a “neuropsychological evaluation.” These evaluations typically last for a day and are designed to assess cognitive functioning, including memory, executive function, reading comprehension and organizational skills. While neuropsychological testing can be highly appropriate for individuals suffering from dementia, stroke or traumatic brain injury, the scholarly literature is clear: for individuals with major psychiatric diagnoses, neuropsychological testing should never be used in isolation. Best practices require that the neuropsychological evaluation be used in conjunction with psychiatric evaluations, functional capacity evaluations, occupational analyses and symptom validity testing when making return-to-work or fitness-for-duty determinations.
In this case, the insurance company demanded that our client attend a neuropsychological evaluation without any accompanying psychiatric evaluation. Compounding the concern, the insurer selected a neuropsychologist who was a well-known “frequent flyer” for insurance carriers, with a documented history of pro-insurance company conclusions. That combination raised immediate red flags.
The Solution
The policyholder hired Schwartz, Conroy & Hack, PC, and we moved quickly. Using proprietary databases and publicly available resources, Partner Michail Hack and his team conducted an in-depth investigation into the insurer-appointed neuropsychologist’s background and documented a clear pattern of biased assessments. Michail then prepared a comprehensive submission to the insurance company demonstrating that our client could not receive a full and fair review of his claim if evaluated by the frequent-flyer neuropsychologist the insurer had chosen.
The Result
The insurer backed down. Months later, the company notified our client that he would be required to attend an independent medical examination with a different neuropsychologist, one whose history did not reflect the same history of troubling bias.
Our client attended the evaluation. This time, the results spoke for themselves. After reviewing the findings, the insurance company had no choice but to continue recognizing our client as disabled.
This outcome underscores a critical truth: when insurers rely on flawed processes and biased evaluators, vigilance and informed advocacy can make all the difference. Because of our expertise and tenacity, Schwartz, Conroy & Hack forced the insurance company to pay the full benefits that they owed to our client.
If your insurance claim has been denied or is being challenged, contact Schwartz, Conroy & Hack, PC. We have the expertise and tenacity to make insurance companies keep the promises they made to policyholders like you.
