Indiana Long Term Disability Lawyer Blog

Multiple Sclerosis is an autoimmune disease that affects the brain and spinal cord. The symptoms and severity of Multiple Sclerosis (MS) can vary among those afflicted with the disease, but it is not uncommon for the condition to prevent a person from working. Symptoms can include fatigue, loss of balance, muscle spasms, numbness, weakness, tremors, problems with coordination, difficulty walking, vision problems, bowel/bladder difficulties, inability to concentrate, memory problems, and speech impairments.

When MS prevents a person from working and they file a disability claim with their insurance company or the Social Security Administration, there are a few things that can help prove that MS is disabling. The first step is to make sure that the patient has been diagnosed properly. That includes undergoing exams like MRIs of the brain and spine, nerve function studies, and lumbar punctures. These objective test results are essential to ruling out other conditions and determining whether a patient has MS. Moreover, these test results can also indicate the severity level of a patient's MS.

Continue reading "Multiple Sclerosis Disability Claims" »

The Northern District of Illinois recently ruled in favor of the Plaintiff's summary judgment motion in a long term disability lawsuit. In Krupp v. Liberty Life Assurance Company of Boston, the court found that Liberty Life's termination of Ms. Krupp's long term disability benefits was arbitrary and capricious. Krupp's long term disability benefits were provided through her employee benefit plan and accordingly, the case was examined under the rules and regulations of the Employee Retirement Income Security Act ("ERISA"). To read the full opinion, see the link here.

Continue reading "Northern District of Illinois Finds that Liberty Life's Termination of Disability Benefits was Arbitrary and Capricious" »

Attending your child's recital or having dinner with friends, taking a trip, even picking flowers from your garden may seem like innocent activities, and it may be all you feel like doing when you're disabled; however to an insurance company, this sometimes translates into "if they feel well enough to do that, they can go back to work." When you're disabled and unable to work, it's understandable that you might spend more time on the computer updating your status and posting pictures on various social networks like Twitter, Instagram, and Facebook to stay in touch with family and keep them up to date on your condition. However, posting about your activities, volunteer work, social events or travel can cause serious harm to your disability claim.

Recently we have seen a dramatic increase in insurance companies' interest in our clients' Facebook pages. We are receiving requests for access to our clients' Facebook accounts and copies of all postings, pictures, events and even personal messages on Facebook, dating back to the date the account was established. This can add up to hundreds of images and multiple pages of information, much of which may not be revealing, but is personal to you and is information that you would not want shared with everyone. Insurance companies will try to use this information against you to argue that you are not disabled or no longer disabled, and either deny or terminate your disability benefits. Therefore, when you file a disability claim, it's prudent to stop all postings on social networks immediately in the event that the insurance company has plans to conduct a background check or surveillance. This will minimize the insurer's access to your private life and information that could lead to your disability claim being denied.

The process of applying for disability insurance benefits is not easy. After becoming injured or sick, the claimant must then complete stacks of paperwork in order to file a claim for disability insurance benefits. Among the forms that the claimant must complete is an authorization form that allows the insurer to contact medical sources. But what some claimants do not realize is that the insurer may look beyond the claimant's medical records when making a determination of disability.

The insurance company may utilize a private investigator to surveillance the claimant. This usually means that an investigator will observe the claimant's house or apartment for hours at a time and wait for the claimant to leave the house. The investigator will then follow the claimant to wherever it is they travel and document the activity. Insurance companies may take this evidence and present it to a peer reviewing physician for comment. If a claimant is observed walking in a store for 45 minutes, a doctor can review the surveillance video and opine that the claimant is capable of returning to work.

Continue reading "Non-Medical Evidence that Disability Insurers Can Use to Deny Benefits" »

Unfortunately, there is a common surprise for claimants who have been approved for long term disability ("LTD") benefits through an employee group benefit plan. LTD benefits are usually subject to a list of offsets that will reduce the amount that a claimant receives in disability insurance benefits.

One of the most frequent offsets is when a claimant is approved for Social Security Disability Insurance ("SSDI") benefits. When a claimant receives both LTD insurance benefits and SSDI benefits, the claimant's LTD benefits will be reduced by the amount that they receive from the Social Security Administration.

For example: assume a claimant has been approved for LTD benefits and receives $2000 per month. If that claimant has also been approved for SSDI benefits at $1500 per month, then the claimant's LTD benefits will be reduced to $500 per month. The net effect is that the claimant still receives $2000 per month - the amount they were owed under the long term disability policy - however, the monthly long term disability benefit is now much lower.

The most significant result of this offset occurs when a claimant has been approved long term disability benefits soon after they stop working, but then has to wait for a hearing with the Social Security Administration to determine whether or not they will receive SSDI benefits. In some cases, a claimant can wait two years or longer for a hearing with the Social Security Administration. If a claimant is approved for SSDI benefits at the hearing level, they will likely owe the long term disability insurer for "overpayment" due to the offset provision in their long term disability policy.

Continue reading "Overpayment in Long Term Disability Insurance Cases " »

In cases where the insurance company acts as both the payer and administrator of claims, courts have recognized that a conflict of interest may influence insurance companies to wrongly deny insurance benefits.  In Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), the Supreme Court held that a fiduciary's conflict of interest "must be weighed as a factor in determining whether there is an abuse of discretion." Although the presence of a conflict does not change the standard of adjudication, the Court in MetLife v. Glenn held:

Trust law continues to apply a deferential standard of review to the discretionary decisionmaking of a conflicted trustee, while at the same time requiring the reviewing judge to take account of the conflict when determining whether the trustee, substantively or procedurally has abused his discretion.

128 S.Ct. at 2350. The weight the court assigns to the conflict factor depends on the facts and circumstances of each particular case. Id.  A conflict of interest should prove more important where circumstances suggest a higher likelihood that it affected the benefits decision.  Id. at 2351.  Specifically, the Glenn court held:

The conflict of interest at issue here, for example should prove more important (perhaps of great importance) where circumstances suggest a higher likelihood that it affected the benefits decision, including, but not limited to, cases where an insurance company administrator has a history of biased claims administration [cite omitted]. It should prove less important (perhaps to the vanishing point) where the administrator has taken active steps to reduce potential bias and to promote accuracy, for example, by walling off claims administrators from those interested in firm finances, or by imposing management checks that penalize inaccurate decisionmaking irrespective of whom the inaccuracy benefits.

 Id. at 2351.  In analyzing the Glenn case, the Seventh Circuit held "[T]he gravity of the conflict, and thus the likelihood that the conflict influenced the plan administrator's decision should be inferred from the circumstances of the case, including the reasonableness of the procedures by which the plan administrator decided the claim, any safeguards the plan administrator has erected to minimize the conflict of interest, and the terms of employment of the plan administrator's staff that decides benefit claims." Majeski, 590 F.3d at 482.