MetLife Sued for Termination of Disability Benefits

September 29, 2015

O'Ryan Law Firm, on behalf of Plaintiff, Jilian F., recently filed a federal lawsuit against Metropolitan Life Insurance Company ("MetLife") in an attempt to reinstate the Plaintiff's disability benefits claim. The Plaintiff was employed as a Marketing Communication Specialist with Landis + Gyr, which made her eligible for disability benefits under the Cellnet + Hunt Employee's Welfare Benefit Plan (the "Plan"). In Jilian F. v. Metropolitan Life Insurance Company and Cellnet + Hunt Employee's Welfare Benefit Plan, the Plaintiff filed a lawsuit to gain the long-term disability benefits she was entitled to under the terms of the MetLife policy.

Facts of the Case Against MetLife

Plaintiff was employed by Landis + Gyr until she became disabled in 2011 due to the disabling effects of Thoracic Outlet Syndrome, cervical degenerative disc disease and cervical radiculopathy, severe neck pain, fibromyalgia, carpal tunnel syndrome, and paresthesia.

Plaintiff filed an application for long term disability benefits and was paid disability benefits by MetLife from August 2013 to September 17, 2014.

MetLife Terminates Long-Term Disability Benefits

On September 17, 2014, MetLife wrongfully terminated the Plaintiff's long-term disability benefits. Plaintiff, represented by the O'Ryan Law Firm, then filed an administrative appeal with MetLife challenging the termination of her disability benefits. With this appeal, the Plaintiff included significant medical evidence to prove that she continued to meet the definition of Disabled under the MetLife policy. However, MetLife refused to overturn their decision to terminate the benefits. As a result, the Plaintiff was forced to file a lawsuit under ERISA in federal court against MetLife to obtain the benefits due her under the MetLife policy.

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Disabling Physical Ailments and Mental Impairments

September 3, 2015

Many of our clients suffer from depression as a result of their disabling physical conditions or they may have other disabling psychiatric conditions such as bipolar disorder. It is important to be aware that most disability policies cut-off disability benefits after 24 months of benefits if the disabling medical condition is considered a psychiatric condition otherwise known as a "mental impairment." Each policy contains different language on this issue. For instance, the Prudential policy provides

What Disabilities Have a Limited Pay period Under Your Plan?

Disabilities which, as determined by Prudential, are due in whole or part to Mental illness also have a limited pay period during your lifetime.

The limited pay period for self-reported symptoms and mental illness combined is 24 months during your lifetime.

Mental illness means a psychiatric or psychological condition regardless of cause. Mental illness includes but is not limited to schizophrenia, depression, manic depressive or bipolar illness, anxiety, somatization, substance related disorders and/or adjustment disorders or other conditions. These conditions are usually treated by a mental health provider...using psychotherapy or psychotropic drugs.

In the case of Deal v. Prudential:

 Deal saw a host of medical professionals for both physical and psychological conditions out of a knee injury and associated pain.
 Diagnosed with Moderate Major Depressive Order
 Two psychologists reports indicating Deal's disability caused, at least in part, by mental disorders
 The Court concluded--"Prudential has not shown that the mental disorder benefit limitation applies."

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Indiana State Teachers Association Insurance Trust Sued for Termination Of Disability Benefits

August 5, 2015

The O'Ryan Law Firm, on behalf of the Plaintiff, Doug. S., filed a lawsuit in Marion County Indiana against the Indiana State Teachers Association Insurance Trust ("ISTA") for unpaid disability benefits. The Plaintiff, Doug S., was employed as a shop teacher with the Michigan City Area Schools for many years, which made him eligible for disability benefits under the Long Term Disability Income Benefit Plan sponsored by ISTA.

In Douglas S. v. Indiana State Teachers Association Insurance Trust, the Plaintiff filed a lawsuit to gain the long-term disability benefits he deserved under the terms of the Plan.

Facts of the Case Against ISTA

Plaintiff was employed by the Michigan City Area Schools until he became disabled in 1993 due to the disabling effects of complications from hip fusion reversal, spinal stenosis, scoliosis of the lumbar spine, and cervical spondylosis. When he first became disabled, Doug S. filed an application for long term disability benefits and was paid disability benefits by the ISTA Insurance Trust for 20 years.

ISTA Terminates Long-Term Disability Benefits

On August 1, 2013, ISTA wrongfully terminated the Plaintiff's long-term disability benefits claiming that the Plaintiff had miraculously recovered from his degenerative issues after 20 years. The Plaintiff then filed an administrative appeal challenging this denial. With this appeal, Plaintiff included significant medical evidence to prove his condition and disability including a report from an Independent Medical Examination by a physician board certified in Occupational Medicine. This report confirmed that Doug S. was disabled. Despite this information, ISTA denied the appeal and the Plaintiff was forced to file a lawsuit to obtain the rest of his disability benefits.

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Life Insurance Company Of North America (Cigna) Sued by Purdue Employee For Denial Of Long Term Disability Benefits

July 8, 2015

O'Ryan Law Firm, on behalf of Plaintiff, Pamela H., recently filed a federal lawsuit against Life Insurance Company of North America (LINA) (a subsidiary of Cigna). The Plaintiff was employed by Purdue University, which made her eligible for Purdue's long-term disability plan, which was insured by LINA.

In Pamela H. v. Life Insurance Company of North America, the Plaintiff filed a disability lawsuit to gain the long-term disability benefits she deserved under the terms of the LINA policy.

Facts of the Case Against LINA

Plaintiff was employed by Purdue University from December 2004 until she became disabled on July 6, 2014 and unable to work. This was due to lumbar radiculopathy and rheumatoid arthritis. Plaintiff's treating physicians provided objective medical proof that the Plaintiff was unable to continue working due to these ailments.

Plaintiff filed an application for long-term disability benefits and LINA denied her claim on November 3, 2014.

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Disability Claims for Inflammatory Bowel Disease

April 15, 2015

Digestive disorders can cause a wide range of symptoms including abdominal pain, fatigue, diarrhea, vomiting, nausea, and weight loss. Inflammatory bowel disease ("IBD", not to be confused with Irritable Bowel Syndrome, IBS) may be responsible for such symptoms. IBD includes, but is not limited to, Crohn's disease and ulcerative colitis. When these conditions are not controlled, symptoms may become so frequent and severe that work is not possible.

Testing and Treatment

To assess IBD, the patient should seek treatment with a gastroenterologist. A gastroenterologist (GI) is the appropriate specialist to determine which testing is needed, and which treatment options are available. Available tests include endoscopy/colonoscopy, biopsy, blood tests, stool tests, and small intestine imaging. These tests may need to be repeated on occasion to determine how the disease is progressing.

Treatment options for Crohn's disease and ulcerative colitis vary patient to patient. Some GI specialists may present surgery as an option, although conservative treatment will be attempted first. Typically, adjustments to diet and medications will be offered first. Types of medication options are aminosalicylates, corticosteroids, immunomodulators, antibiotics, and biologic therapies. A high percentage of Crohn's disease patients will have surgery, although surgery does not cure Crohn's - it can only conserve portions of the gastrointestinal tract.

Maintaining Treatment and Recording Gastrointestinal Symptoms

Disabled patients should make sure they maintain treatment with GI specialists, follow their prescribed diet, and follow their doctors' treatment plans as best as possible. Often, patients will only see their GI specialist on a quarterly basis. Due to the chronic nature of IBD and the possibility that symptoms may wax and wane, it is not possible for patients to see their doctor every time there is a slight change in their condition. Therefore, it is advisable for disabled IBD patients to keep a log of their gastrointestinal symptoms. The log should indicate which days the patient is experiencing gastrointestinal symptoms, how long the symptoms last, and which symptoms are occurring. The patient may also want to note any other important data, such as abdominal pain level (rated on a scale of 1-10), what may have caused the symptoms (such as a stressful situation or a change in diet), and medication taken. For computer and smart phone users, there are options to easily record gastrointestinal symptoms such as GI Buddy App (available for iPhone and Android users). IBD patients should provide copies of their GI logs to treating doctors.

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Standard Insurance's Denial of Disability Benefits for Indiana University Employees

March 31, 2015

Founded in 1820, Indiana University has eight campuses in the State of Indiana and is a world leader in professional, medical and technological education. With over 17,000 employees state-wide, IU offers a generous benefit package which includes long term disability coverage through Standard Insurance. At the O'Ryan Law Firm, we have represented numerous IU employees who have become disabled and have been denied their long term disability benefits by Standard Insurance. We have represented professors, Human Resources professionals, and IT professionals, among others, employed at IU who applied for disability benefits with Standard, after their medical conditions made it impossible for them to continue working, and Standard Insurance denied those benefits.

"Disabled" or "Disability" is defined for IU employees in the Standard Insurance Policy as:

You are Disabled if you meet one of the following definitions during the period it applied: A. Own Occupation Definition of Disability; B. Any Occupation Definition of Disability; or Partial Disability Definition

A. Own Occupation Definition of Disability

During the Benefit Waiting Period and the Own Occupation Period you are required to be Disabled only from your Own Occupation. You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury or Pregnancy or Mental Disorder, you are unable to perform with reasonable continuity the Material Duties of your Own Occupation.

B. Any Occupation of Disability

During the Any Occupation Period you are required to be Disabled from all occupations.
You are Disabled from all occupations if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder, you are unable to perform with reasonable continuity the Material Duties of Any Occupation.

Any Occupation means any occupation or employment which you are able to perform, whether due to education, training or experience, which is available at one or more locations in the national economy and in which you can be expected to earn at least 80% of your Indexed Predisability earnings within twelve months following your return to work, regardless of whether you are working in that or any other occupation.
Material Duties means the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified or omitted. In no event will we consider working an average of more than 40 hours per week to be a Material Duty.

C. Partial Disability Definition
During the Benefit Waiting Period and the Own Occupation Period, you are Partially Disabled when you work in your Own Occupation, but as a result of Physical Disease, Injury, Pregnancy, or Mental Disorder, you are unable to earn 80% or more of your Indexed Predisability Earnings, in that occupation.

To deny these claims under the policy, Standard Insurance routinely utilizes their in-house physician, Dr. Richard Handelsman, to review the medical records and opine that the IU employee is not disabled. Dr. Handelsman is the Medical Director for Standard Insurance and a salaried employee of Standard. Dr. Handelsman never examines the claimant and bases his opinion solely on medical records; therefore, his opinion is limited to only a review of the medical records. Also, we have found that Dr. Handelsman's reports oftentimes fail to address important symptoms, like chronic pain, which are critical components to the disability claim.

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Disabilities Relating to Cancer

March 16, 2015

A diagnosis of cancer - even one that is treatable - cannot be taken lightly. Although significant progress has been made in the field of cancer research and treatment, cancer still takes the lives of millions of people worldwide every year. There are over 100 types of cancer and treatment can vary for individuals on a case-by-case basis. Often, cancer and the treatment of cancer (which may include surgery, chemotherapy, and/or radiation) can force individuals to stop working.

Some may assume that a cancer patient who applies for disability benefits will easily be approved for disability benefits. However, this is not always true. It is not enough to prove a diagnosis of cancer and expect to receive disability benefits. Rather, the individual must show that the cancer and/or cancer treatment is causing severe symptoms that would prevent the performance of work and that they meet the applicable definition of "Disability".

To improve the chances of being approved for disability benefits, the patient should have their doctor clearly document all of their symptoms, including pain, headaches, fatigue, nausea, numbness, dizziness, inability to concentrate, memory problems, difficulty walking or standing, emotional difficulty, and any other symptoms that affect functioning. This means that the patient must maintain treatment for all medical professionals they see, including oncologists, surgeons, family doctors, pain management specialists, and others.

The individual should also carefully track the symptoms they experience after surgery, chemotherapy, or radiation. Each of these forms of treatment may come with severe side effects. For example, chemotherapy may cause peripheral neuropathy. If a chemotherapy patient experiences neuropathy, they should have their doctor carefully document their symptoms of pain and numbness, and also undergo appropriate testing (EMG) to prove that the patient is experiencing neuropathy. Another possible side effect of chemotherapy is "chemo brain". If an individual experiences chemo brain, they should undergo a mental status examination to document their forgetfulness, trouble concentrating, trouble multi-tasking, taking longer to finish tasks, or other memory problems.

Radiation affects people differently, but it may cause skin changes, tiredness, diarrhea, or trouble eating, among other side effects. Again, it is important to have medical providers document each and every symptom experienced. If a disability claim is missing documentation about each symptom, then it may not accurately depict the severity of the individual's condition.

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Sedgwick's Administration of Eli Lilly Extended Disability Claims

March 9, 2015

As one of the largest employers in Indiana, Eli Lilly covers thousands of employees under their Extended Disability Plan ("Lilly EDL Plan"). The Lilly EDL Plan is self-insured, a rarity in the long term disability world. Just a few years ago, Anthem was the claims administrator for the Lilly EDL Plan but in the spring of 2012, Lilly hired Sedgwick to administer extended disability claims under the EDL Plan. Shortly after this time, our office began receiving calls from Lilly employees whose EDL benefits had been terminated or were under investigation by Sedgwick.

One of the calls we received was from the former Executive Director of Human Resources at Lilly who had worked for Lilly for over 25 years. Unfortunately, her diagnosis of Fibromyalgia worsened over the years until she was forced to leave Lilly and apply for short and long term disability benefits in December 2007. Fibromyalgia is a disease the Seventh Circuit has characterized as "common, but elusive and mysterious." Sarchet v. Charter, 78 F.3d 305, 306 (7th Cir. 1996). In evaluating fibromyalgia in the context of a disability claim, the court in Sarchet described the disease as:

Its cause or causes are unknown, there is no cure, and, of greatest importance to disability law, its symptoms are entirely subjective. There are no laboratory tests for the presence or severity of fibromyalgia. The principal symptoms are "pain all over," fatigue, disturbed sleep, stiffness, and--the only symptom that discriminates between it and other diseases of a rheumatic character--multiple tender spots, more precisely 18 fixed locations on the body (and the rule of thumb is that the patient must have at least 11 of them to be diagnosed as having fibromyalgia) that when pressed firmly cause the patient to flinch.

Based on the severity of her fibromyalgia condition, our client was approved for EDL benefits in May 2009 and she received those benefits for over 3½ until Sedgwick abruptly terminated those benefits.

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Discharge of Student Loans Due to Total Disability

February 16, 2015

More students than ever are graduating with student loan debt. Tuition has skyrocketed in the last few decades and it is now common for college graduates to owe tens of thousands of dollars by the time they earn their undergraduate diploma. If an individual becomes disabled before they pay back their federal student loan debt, they may face a very difficult situation.

If an individual took out student loans to finance their education, then these loans are currently not dischargable by bankruptcy unless that individual can prove that repaying the loan would cause an "undue hardship". Proving an "undue hardship" is an extremely high standard to show unless the individual has a severe disability. The U.S. Department of Education's website provides the reasons for which a student loan may be forgiven, cancelled, or discharged: Department of Education's website.

Federal student loans may be discharged if the borrower suffers a total and permanent disability. According to the U.S. Department of Education, there are three ways for an individual to prove that they are totally and permanently disabled:

1. If you are a veteran, you can submit documentation from the U.S. Department of Veterans Affairs (VA) showing that the VA has determined that you are unemployable due to a service-connected disability.
2. If you are receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, you can submit a Social Security Administration (SSA) notice of award for SSDI or SSI benefits stating that your next scheduled disability review will be within five to seven years from the date of your most recent SSA disability determination.
3. You can submit certification from a physician that you are totally and permanently disabled. Your physician must certify that you are unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment that
- Can be expected to result in death,
- Has lasted for a continuous period of not less than 60 months, or
- Can be expected to last for a continuous period of not less than 60 months.

The Department of Education allows individuals to apply for a "Total and Permanent Disability (TPD) Discharge" for federal loans online at the following website:

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Toyota Employee Disability Claims with Cigna

February 5, 2015

Toyota Motor Manufacturing Indiana, Inc. is an automobile manufacturing factory located in Gibson County, Indiana, in Princeton, Indiana. The closest biggest city is Evansville, Indiana. Toyota Indiana is owned by Toyota Motor Corporation of Japan.

The plants for Toyota Motor Manufacturing Indiana were built in 1996 in order to begin production of a full-size pickup truck solely for the U.S. Market. Toyota Indiana began production of the Tundrabegan in 1999 and Sequoia production began a year later for the 2001 model. Both the Tundra and the Sequoia were new to the market and have only been sold in North America. In 2009, Toyota Indiana began manufacturing the Highlander.

There are approximately 4500 employees of Toyota Indiana. At the O'Ryan Law Firm, we have represented numerous former Toyota employees who worked for many years at Toyota and then were forced to go out on disability when their medical conditions prevented them from working. The Toyota Motor Mfg. North America Long Term Disability Plan is an employee benefit plan administered in southern Indiana. The Long Term Disability Plan promises to provide Toyota Motor Manufacturing employees, as part of an employee compensation package, income replacement benefits in the event an employee becomes unable to work due to sickness or injury. All employees of Toyota are participants in the Long Term Disability Plan and therefore eligible to receive long term disability benefits if their doctor confirms that they are unable to work.

Cigna, or more specifically Life Insurance Company of North America ("LINA") insures the long term disability coverage to participants of the Toyota long term disability Plan. LINA is an insurance company incorporated and headquartered in Pennsylvania and doing business in the State of Indiana. The Cigna (LINA) policy promises to pay disability benefits to employees of Toyota if they are unable to work due to sickness or injury.

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Applying for Social Security Disability Benefits

January 15, 2015

If a disability is expected to last at least 12 months or end in death, then the disabled individual should apply for Social Security disability benefits. There are two types of Social Security disability benefits: Social Security Disability Insurance (SSDI, also known as Title II benefits) and Supplemental Security Income (SSI, also known as Title XVI benefits). To learn the eligibility requirements of each program, read O'Ryan Law Firm's article about Eligibility for SSDI and SSI benefits.

The process of applying for disability benefits from the Social Security Administration (SSA) may seem complex, but this article will explain what information is needed to apply and how to apply.

Information Needed to Apply

Before applying for Social Security disability benefits, the following materials should be gathered:

-Your Social Security number;

-An original or certified copy of your birth certificate and, if you were born in another country, proof of U.S. citizenship or legal residency;

-If you were in the military service, the original or certified copy of your military discharge papers (Form DD 214) for all periods of active duty;

-Your W-2 Form from last year or, if you were self-employed, your federal income tax return (IRS 1040 and Schedules C and SE);

-Direct deposit numbers (from a check, or ask your financial institution for the numbers) to have your monthly benefits deposited automatically;

-Information about any workers' compensation claim you have filed, including date of injury, claim number, and proof of any payments made to you;

-The name, address, and phone number of someone who knows about your condition and can help with your claim;

-Information about your illnesses, injuries, and conditions, including dates of treatment, and patient ID numbers; and the names, addresses, and phone numbers of the medical providers who treated you. It is best to provide all treatment information beginning 12 months prior to your disability onset;

-Names and dates of medical tests you have had and who requested the tests;

-Names of medicines you are taking and who prescribed them. You may also want to include side effects from medications;

-Medical records that you already have in your possession; and

-A list of up to five jobs and dates you worked during the last 15 years prior to your disability onset.

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Scleroderma as a Disabling Condition

December 22, 2014

At the O'Ryan Law Firm, we have represented several individuals in disability claims who suffer from a disabling disease called Scleroderma. According to the American College of Rheumatology:

Scleroderma (also known as systemic sclerosis) is a chronic disease that causes the skin to become thick and hard; a buildup of scar tissue; and damage to internal organs such as the heart and blood vessels, lungs, stomach and kidneys. The effects of scleroderma vary widely and range from minor to life-threatening, depending on how widespread the disease is and which parts of the body are affected.
The two main types of scleroderma are:

• Localized scleroderma, which usually affects only the skin, although it can spread to the muscles, joints and bones. It does not affect other organs. Symptoms include discolored patches on the skin (a condition called morphea); or streaks or bands of thick, hard skin on the arms and legs (called linear scleroderma). When linear scleroderma occurs on the face and forehead, it is called en coup de sabre.

• Systemic scleroderma, which is the most serious form of the disease, affects the skin, muscles, joints, blood vessels, lungs, kidneys, heart and other organs.

Diagnosis can be tricky because symptoms may be similar to those of other diseases. There is no one blood test or X-ray that can say for sure that you have scleroderma.
To make a diagnosis, a doctor will ask about the patient's medical history, do a physical exam and possibly order lab tests and X-rays. Some symptoms he or she will look for include:

• Raynaud's phenomenon. This term refers to color changes (blue, white and red) that occur in fingers (and sometimes toes), often after exposure to cold temperatures. It occurs when blood flow to the hands and fingers is temporarily reduced. This is one of the earliest signs of the disease; more than 90 percent of patients with scleroderma have Raynaud's. Raynaud's can lead to finger swelling, color changes, numbness, pain, skin ulcers and gangrene on the fingers and toes. People with other diseases can also have Raynaud's and some people with Raynaud's do not have any other disease.

• Skin thickening, swelling and tightening. This is the problem that leads to the name "scleroderma" ("Sclera" means hard and "derma" means skin). The skin may also become glossy or unusually dark or light in places. The disease can sometimes result in changes is personal appearance, especially in the face. When the skin becomes extremely tight, the function of the area affected can be reduced (for example, fingers).

• Enlarged red blood vessels on the hands, face and around nail beds (called "telangiectasias").

• Calcium deposits in the skin or other areas.

• High blood pressure from kidney problems.

• Heartburn; this is an extremely common problem in scleroderma.

• Other problems of the digestive tract such as difficulty swallowing food, bloating and constipation, or problems absorbing food leading to weight loss.

• Shortness of breath.

• Joint pain.

While some treatments are effective in treating some aspects of this disease, there is no drug that has been clearly proven to stop, or reverse, the key symptom of skin thickening and hardening. Medications that have proven helpful in treating other autoimmune diseases, such as rheumatoid arthritis and lupus, usually don't work for people with scleroderma. Doctors aim to curb individual symptoms and prevent further complications with a combination of drugs and self-care.

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Aetna Disability Claims

December 15, 2014

Many Indiana employees receive group disability insurance coverage through Aetna. Headquartered in Hartford, Connecticut, Aetna is a large disability insurance company that is currently in the Fortune 100. O'Ryan Law Firm has successfully represented many clients whose disability insurance benefits have been unfairly denied or terminated by Aetna.

Short Term Disability Benefits

Aetna's short term disability coverage pays benefits after a short elimination period (often a week long). Short term disability benefits usually last three to six months. During Aetna's investigation of the short term disability claim, it is common for Aetna to gather medical records, gather information about the claimant's job, require statements from treating providers about the claimant's ability to work and expected duration of disability, and have internal medical consultants review all medical evidence. If the individual is approved for short term disability benefits through the maximum duration of the policy, then they may apply for long term disability benefits.

Long Term Disability Benefits

After an elimination period that is typically the length of the short term disability period, the claimant may apply to Aetna for long term disability benefits. When a claimant receives long term disability insurance through a private employer, their claim is usually governed by the Employee Retirement Income Security Act ("ERISA").

In addition to information already gathered during the short term disability claim, Aetna will request updated medical records and statements from treating providers, may perform a vocational analysis, and may have internal medical consultants or external medical consultants review the medical evidence. It is very common for long term disability policies to require that the claimant prove disability from their own occupation for the first 24 months of long term disability benefits and then require that the claimant prove disability from any occupation after 24 months of long term disability benefits.

During the long term disability claim, it is more common for Aetna to utilize claim review tactics such as referring the claimant for an Independent Medical Examination ("IME"), contracting private investigators to perform surveillance of the claimant, contracting peer reviewing physicians to review evidence and call the claimant's doctors, and perform a Transferable Skills Analysis to see if the claimant can return to work in a different job. If a claimant is approved for long term disability benefits, it is likely that Aetna will urge the claimant to apply for Social Security disability benefits. Aetna may even refer the claimant to one of its vendors to represent them in their Social Security disability claim.

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Disabilities Relating to Cardiovascular Impairments

November 18, 2014

When a person has a medical problem affecting his heart or circulatory system, he may have work restrictions that prevent the ability to continue working. Depending on the severity of the heart condition, working may put a person at risk of suffering a heart attack or other life threatening cardiac event. In these situations, a person with cardiovascular impairments may qualify for short term disability benefits, long term disability benefits, and/or Social Security disability benefits.

Because a heart condition can be life threatening, it is crucial that a person with a cardiovascular problem seek immediate medical attention. When a patient presents with chest pain, palpitations, syncope, or other cardiovascular symptoms, it is common for physicians to order extensive testing. Testing for heart conditions may include echocardiograms (echo), electrocardiogram (ECG), exercise tests, drug-induced stress tests, Holter monitor tests, cardiac catheterization, cardiac computerized tomography (CT) scans, cardiac magnetic resonance imagings (MRI), chest x-rays, and blood tests.

Following the appropriate testing, treatment with a cardiologist is required to document the severity of the heart condition. If a person is required to undergo surgery, then she may have to see a surgeon specializing in heart operations. A cardiologist may only require a patient to follow-up on an annual basis, which means that it is important for the patient to also maintain treatment with her primary care provider and other doctors.

If a person undergoes a cardiovascular event such as a heart attack or surgery, but then is able to return to normal functioning, then he might only be eligible for short term disability benefits. However, if a heart condition requires the person to miss at least three months of work, then he may be eligible for long term disability benefits. To be eligible for Social Security disability benefits, the disability must last or be expected to last 12 months or longer.

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Prudential Disability Claim Denials

November 5, 2014

The Prudential Friendly Society was founded by insurance agent John Fairfield Dryden in a basement office in downtown Newark, N.J., in 1875. It was the first company in the U.S. to make life insurance available to the working class. In business for 137 years, it boast 48,000 employees worldwide.

At the O'Ryan Law Firm, we receive numerous calls a year from individuals who have become disabled, have disability coverage through Prudential, their doctor has reported to Prudential that they cannot work and Prudential denies the claim. One of Prudential's favorite reasons for denying claims is what they call a lack of "objective medical evidence." Many conditions, such as fibromyalgia or migraine headaches, result in symptoms, such as pain and fatigue, which are hard to prove objectively. There are no lab tests or diagnostic testing that are able to establish the severity of chronic pain or fatigue. Yet Prudential in these types of claims will insist on objective medical evidence to prove the disability thus making it nearly impossible to get the claim approved.

The courts have made clear in numerous cases that an insurer's refusal to honor a claim for lack of scientific data such as lab tests and x-rays is an abuse of discretion where no such data exists in medicine for the conditions at issue and where licensed physicians have provided professional opinions that the conditions are genuine and credibly disabling the claimant. See Holmstrom v. Metropolitan Life Insurance Company, 615 F.3d 758, 769-772 (7th Cir. 2010); Leger v. Tribune Company Long Term Disability Benefit Plan, 557, F.3d 823, 834-835 (7th Cir. 2009); Hawkins v. First Union Corporation Long-Term Disability Plan, 326 F.3d 914, 919 (7th Cir. 2003).

In Holmstrom, the claimant suffered from Complex Regional Pain Syndrome ("CPRS"), a condition recognized by the medical community but for which there is no specific diagnostic test. 615 F.3d 758, 768. In that case, the plan acknowledged "Holmstrom's claims of intractable pain, significant physical limitations, and cognitive deficiency as identified by [claimant and her treating physician]," but found "that the lack of objective findings to support ongoing total disability prevented [the plan] from determining whether [claimant's] disability was genuine." Id. at 764. In finding the Holmstrom plan's denial arbitrary and capricious, the court stated that the plan "gave undue weight to the absence of objective measurements for [claimant's] impairments," reasoning that:

Subjectively painful conditions like CPRS and fibromyalgia pose difficult problems for private disability insurance plan administrators and the Social Security Administration, who understandably seek to make decisions based on the most objective evidence available. But we have rejected as arbitrary an administrator's requirement that a claimant prove her condition with objective data where no definitive objective tests exist for the condition or its severity.

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