The claimant, a small business owner in Maryland, came to us in December 2017 after being frustrated that an attorney he had paid a lot of money to had been unable to resolve a large “overpayment” claim that his disability insurance company was claiming was due from him.
The claimant has suffered two recurrences of rare brain cancer, and as a result, his seasonal landscaping design-build business began to lose money in 2015 and 2016. He kept the business going in spite of his diagnosis only because it was “all he had left to live for.”
The problem arose due to the way his accountant helped plan for and reported monthly revenue and expenses to the insurance company. In some months his business actually generated a profit for the month, even while it lost a lot of money on an annual basis. When annual tax filings were compared to the month to month reporting the insurance company claimed that even though the business lost money, it had overpaid the claim because the claimant “was only entitled to a benefit when he lost money in a month.” Since there were months that he did not lose money, the claim was that the insurance company had overpaid the claim.
To attempt to resolve the issue, the claimant hired a local (to him) attorney who was not experienced in handling long-term disability claims. This attorney billed many hours to get up to speed on the law, and then missed every significant argument and issue that could have been made. When the attorney almost missed a significant deadline (saved only by the claimant’s alert email to the attorney), the attorney was fired, and the claimant began an internet search for new counsel.
We were contacted, and because the claimant was in dire financial straights and in a bad place, medically, and had already paid a significant amount of money to the inexperienced attorney, we agreed to represent the claimant on a pro bono basis.Through discussions with the claims handler and an exchange of ideas with other very experienced national ERISA disability counsel, we were able to convince the insurance company to waive their overpayment claim, thus preventing an additional $27,742 loss to the claimant.