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.

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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" »

Over the years, we have represented numerous employees of Indiana colleges and universities who have become disabled because of serious illnesses such as diabetic neuropathy, lyme disease, degenerative disk disease, multiple sclerosis and lymphoma. A large number of those clients were disabled Purdue employees who had worked for Purdue University for many years, some even decades, before reaching the point where they were no longer able to work because of their medical conditions. Purdue has a very generous employee benefit package so our clients were very surprised and extremely disappointed when their disability claims were either denied outright or prematurely terminated by the insurance company.

Prudential Insurance Company previously insured Purdue's long term disability program and now Cigna is the insurance carrier for the Purdue long term disability program, or more specifically Cigna's subsidiary Life Insurance Company of North America. Many Purdue employees have contacted our office after Cigna denied their claim upon their initial application or when Cigna terminated the benefits before the individual was truly able to return to work.

Cigna typically hires consulting physicians, who never examine our clients, to review the person's medical records and conclude, contrary to the treating physicians, that the client does not have any restrictions or functional impairments. Cigna then relies upon the conclusions of the consulting physicians to deny legitimate disability claims.

The consequences of Cigna denying a Purdue employee's claim for disability benefits are severe. Under the Purdue employee benefit program, disabled Purdue employees continue to receive medical coverage, life insurance coverage, tuition reimbursement for their kids that attend Purdue and retirement annuity deposits. When Cigna wrongfully denies a Purdue employee's disability claim, all of those benefits immediately disappear. The disabled Purdue employee will no longer have the medical coverage they need for treatment, they will lose their life insurance coverage, be required to pay full tuition for their kids and lose retirement contributions. As a result, Cigna's denial can have a dramatic impact on the life of a disabled Purdue employee.

The O'Ryan Law Firm has successfully handled the appeals and lawsuits of Purdue employees against Cigna when Cigna has wrongfully denied their disability benefits. If you have received a denial letter from Cigna, or Life Insurance Company of North America, please contact us so that we may discuss your best strategy for moving forward with your disability claim.

The application process is generally quite simple. First, you must notify your insurance company or your Human Resources department of your claim. You will then be asked to complete a claim form and to sign a medical authorization form so that the insurance carrier may request copies of your medical records directly from any doctors who have treated you for your conditions. Your doctor will also need to fill out a form certifying that you are unable to return to work because of your medical conditions. Lastly, your employer must complete a form providing the insurance company with your position and salary information so that they may properly calculate your monthly benefit payment.

As part of their investigation, the insurance company may also send you to one of their doctors to examine you in order to determine if you are able to return to work or send you to a functional capacity evaluation to assess your physical capabilities.

If your claim is approved, your long term disability policy typically will pay you 60% of your wages while you are disabled, depending on the specific terms of your policy. Your insurance company will require periodic updates on your condition, from both you and your physicians, to verify that your disabling condition is ongoing. In some instances, the insurance company may hire an investigator to conduct surveillance of your activities while you are away from your job and possibly conduct an internet search to uncover your volunteer or social activities.

If your claim for benefits is denied, there are options available to you if you do not agree with the insurance company's decision. This will depend on your policy, but typically you will have the opportunity to file an appeal, usually within 180 days of the denial. During the appeal process, you will be able to submit further medical evidence of your disability. This is one reason why it is important to continue treating with your doctor while you are off of work.

In a perfect world, your long term disability insurance carrier will pay your claim until you are well enough to return to work or until your maximum coverage age of 65 if you are deemed totally disabled and cannot return to work. However, if your claim is denied, please contact the O'Ryan Law Firm to see if we can assist you in convincing the insurance company to properly pay your disability benefits.

Fibromyalgia is a condition that may prevent someone from working. In these situations, the person may be able to apply for short term disability benefits, long term disability benefits, or Social Security disability benefits. When it comes to filing a claim for disability benefits, it can be challenging for claimants to prove that their fibromyalgia is disabling. These challenges appear in claims to both insurance companies and the Social Security Administration ("SSA").

Those who suffer from fibromyalgia experience chronic, widespread pain and fatigue, but the objective test results may not show this. Unlike conditions such as Multiple Sclerosis or degenerative disc disease, fibromyalgia does not appear in MRIs or x-rays. Because fibromyalgia is a disorder which does not appear in medical imaging or blood tests, it can be a difficult condition to diagnose. If a fibromyalgia patient is applying for disability benefits, they should follow these steps to document proof of their disability:

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The most basic answer is that the insurance company or claims administrator contends that you do not meet the definition of "disabled" or "disability" under the disability policy or plan. There are numerous technical reasons why claims are denied such as you are ineligible for benefits or you have not provided the information requested by the insurance company. As far as being ineligible, many disability policies require that you work so many months for your employer before you become eligible for the short or long term disability coverage. Also, you may no longer be eligible if your employment has been terminated and you have not already applied for the benefits. We encourage our clients to contact the Human Resources department immediately to obtain an application for short term and long term disability benefits when they know that they are no longer able to function at their job. Additionally, make sure that you send the insurance company all of the information and documents that they are requesting so that your claim is not tossed out because they didn't receive a specific form or medical record. We know that at times it is frustrating dealing with their seemingly endless requests, but you don't want to be denied because you "weren't cooperating" with them, which is a requirement in the policy.

Once you have made it over the eligibility hurdle, the insurance companies find all sorts of reasons to deny disability claims: your medical records don't support impairment, your doctor's statement of disability doesn't comport with the medical records, you worked for a long time after you were diagnosed, surveillance shows that you remain active, if you can work on a computer at home then you aren't disabled, if you can shop at Wal-Mart then you can go back to work, you quit because you didn't like your boss and their absolute favorite: our doctors (who never speak to you or examine you) say you can work. All of the insurance companies, including Cigna, Prudential, Hartford, MetLife, and Lincoln Financial, like to use their doctors to review and deny claims.

This is why the appeal process is so important and why an experienced lawyer can make all of the difference. This is no game to the insurance companies. They know that if they successfully deny your claim, they keep every penny of your disability payments. As a result, they are very aggressive at denying claims and making sure the denial sticks. We take the appeals process very seriously because this most likely is your last chance to respond to and rebut all of the bad information that the insurance company has stuffed into your file, some of which you may have never seen.

Continue reading "Why was my claim denied?" »

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.

Many of our clients suffer from psychiatric impairments that keep them from being able to work on a regular basis. As we see in most all of our disability cases, at some point in time the insurance company hires a psychologist or psychiatrist to review the medical records of our clients to manufacture a report finding that our client is not impaired or disabled. Significant authority provides that when dealing with psychiatric claims, the opinions of psychiatrists or psychologists who merely review written records are inherently unreliable as compared to the opinions of physicians and other health care providers who examine and treat the patient at issue. The American Psychiatric Association has instructed that the primary assessment tool for a psychiatrist evaluating an individual's medical condition and treating those conditions is the face-to-face interview with the patient and "evaluations based solely on review of records ... are inherently limited." Westphal v. Eastman Kodak Co., 2006 WL 1720380, *5 (W.D.N.Y., June 21, 2006). The American Psychiatric Association further stated that it is "unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination..." Id., citing "The Principals of Medical Ethics" Section 7, Paragraph 3, 2006 Edition. In Zoller v. INA Life Ins. Co. of New York and Lucent Technologies, Inc. Long Term Disability Plan for Mgmt. Employees, 2008 WL 3927462 (S.D.N.Y. 2008), the court held that "the practice [of relying on second-hand opinions of psychiatrists] seriously undermines a reviewing court's confidence in such opinions where they appear to be, as in the instant case, unsupported and arbitrary rejections of the opinions of treating physicians." Id. at * 14; see also Winkler v. Metropolitan Life Ins. Co., 170 Fed. Appx. 167, 168-69 (2nd Cir. 2006) (First-hand observation is especially important in the context of assessing psychiatric disabilities).

It has been noted that in disability cases involving mental illness, these cases "may be uniquely suited for diagnosis by personal examination." Scotti v. The Prudential Welfare Benefits Plan, 2009 U.S. Dist. LEXIS 64559, at *16 (D.N.J. July 23, 2009). Courts discount the opinions of psychiatrists who have never seen the patient because unlike other medical doctors who can formulate medical opinions based upon objective clinical tests, the psychiatrist typically treats the patient's subjective symptoms. Schwarzwaelder v. Merrill Lynch & Co., Inc., 606 F. Supp. 2d 546 (W.D. Pa. 2009), rev'd on other grounds, Merrill Lynch, Pierce, Fenner & Smith, Inc. v. Schwarzwaelder, 2012 U.S. App. LEXIS 16845 (3d Cir. Pa. Aug. 13, 2012). When a psychiatrist evaluates a patient's mental condition, "a lot of this depends on interviewing the patient and spending time with the patient, . . . a methodology essential to understanding and treating the fears, anxieties, depression, and other subjective symptoms the patient describes." Sheehan v. Metropolitan Life Ins. Co., 368 F. Supp. 2d 228, 254-55 (S.D.N.Y. 2005). A subjective evaluation is a requisite when a doctor is diagnosing the psychiatric state of a patient. Glunt v. Life Ins. Co. of N. Amer., 2012 U.S. Dist. LEXIS 8027 (E.D. Pa. January 24, 2012). As held by the court in Morse v. The Corning Inc. Pension Plan for Hourly Employees, U.S. Dist. LEXIS 12645 *26 (W.D.N.Y., Feb. 23, 2007):

Subtleties in the patient's mannerisms, the nuances that are derived from her speech and gestures cannot be observed and evaluated by the non-examining physician. This is all necessary in the evaluation process and cannot be done in absentia nor by merely evaluating the treating physicians' notes and opinions. Accordingly, it was error for MCMC to rely upon the opinions of two non-treating, non-examining doctors to the exclusion of the remaining substantial evidence in the record in finding that Morse was not disabled.

Oftentimes, disability claims are denied based on the opinion of a psychologist, psychiatrist or therapist who never examined or interviewed the person applying for disability benefits. Without the opportunity to observe an individual's mannerisms, or the nuances derived from speech patterns or gestures, we believe the opinions of these record reviewing psychiatrists are unreliable and should not be used by the insurance companies to deny claims.

The O'Ryan Law firm has successfully represented numerous clients who suffer from psychiatric disabilities such as bipolar disorder, severe depression, and schizophrenia in proving to the insurance companies that these conditions are truly disabling. Please contact the O'Ryan Law firm if you believe that you are unable to return to work based on a psychiatric impairment.

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 " »

If you have been denied short term or long term disability benefits, you may have noticed information in your denial letter about The Employee Retirement Income Security Act of 1974, or "ERISA." ERISA includes regulations for all employee benefits that are offered by private employers, including your group health and disability insurance.

Which Employee Benefit Plans are Covered by ERISA?
ERISA governs most private employee benefit plans, including disability and health insurance plans.

Which Employee Benefit Plans are Exempt from ERISA?
ERISA usually does not cover employee benefit plans offered through public or church employers. If you're an employee of a public school or a church owned hospital, your employee benefit plan may be exempt from ERISA. Additionally, "salary continuation plans" may also be exempt from ERISA.

My ERISA Claim Has Been Denied. Now What?
If your ERISA claim has been denied, you must first file an appeal. ERISA allows the claimant to seek legal representation during the appeals process and O'Ryan Law Firm may be able to help you.

Appeal
ERISA describes the number of days allowed to appeal and also the number of days in which the insurer has to make a decision. During the appeal process, the claimant has the right to request the administrative claim file that the insurance company has created. ERISA law specifies that the employee's claim file must be sent within 30 days of a request.

ERISA law states that a claimant must appeal a denial within 180 days. If a claimant fails to appeal by this deadline, they could forfeit their claim for disability benefits. The appeals process is very important and must contain relevant medical and vocational evidence.

Once the claimant has appealed, the insurance company has a maximum of 90 days to make a determination. If the insurance company's review will take longer than 45 days, then the insurer is to notify the claimant in writing that more time is needed.

Lawsuit
In most situations, the claimant must exhaust the appeals process before they are permitted to file a law suit in court. Because ERISA claims are governed by a federal act, the claimant must file a lawsuit in federal court. The deadline to file a lawsuit is usually included in the employee benefit plan.

Unfortunately, the judge's review of the ERISA claim is generally limited to the evidence that was supplied during the claim review process and appeal. That means that the claimant does not have the chance to submit supportive medical information after their last appeal has been denied. Therefore, the appeal phase is extremely important to a claimant's chances of success.

Additionally, ERISA cases are not entitled to a jury trial. Rather, the judge is the sole determiner of the lawsuit. The judge usually makes his or her determination by reviewing extensive legal briefs by both the Plaintiff and Defendant.

Contact O'Ryan Law Firm
Because the rules of ERISA are complicated and O'Ryan Law Firm has a wealth of experience handling every step of the ERISA claims process, we may be able to help you if you have been denied disability insurance benefits.

In disability insurance cases that are governed by the Employee Retirement Income Security Act ("ERISA"), courts have found that a disability insurance company's failure to consider an important aspect of a claimant's disability is evidence of an arbitrary and capricious decision.

For example, the court in Powers v. Nat'l Rural Letter Carriers' Ass'n Long-Term Disability Income Plan found that it was arbitrary and capricious for the disability plan to ignore completely the Plaintiff's contemporaneous statement that she had one or two bad days a week where she could not leave the couch. 2009 WL 1259378 (S.D. Ind. May 5, 2009).

In Powers, the Plaintiff's treating physician recommended that a functional capacity evaluation be performed to assess the Plaintiff's physical restrictions and limitations. However, the disability plan opted to make a denial without a functional capacity evaluation and instead relied upon surveillance video of the Plaintiff.

Another factor considered in determining the insurer's arbitrary and capricious decisionmaking was the disability plan's failure to show that there were jobs in Indiana that the Plaintiff could perform. Although the disability plan found jobs that are "prevalent in the national economy", the disability plan did not provide actual numbers and locations of jobs that the Plaintiff could perform. Id. at 5. Moreover, the jobs provided by the disability plan did not meet the accommodations that the Plaintiff requires as a result of her physical restrictions and limitations. Specifically, the disability plan did not find any jobs that would allow the Plaintiff to miss more than one day of work per month because of her health condition. As a result, the court in Powers determined that the Plaintiff met the requirements to continue to receive long term disability benefits and the disability plan was arbitrary and capricious in terminating her benefits.

Continue reading "Evidence of an Insurer's Arbitrary and Capricious Decision in Disability Insurance Cases" »