Recently in Short Term Disability Category

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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Applying for Disability Benefits Without Health Insurance

October 15, 2014

Maintaining or obtaining health insurance coverage is a common problem for those applying for disability benefits. Many Americans receive health insurance coverage through their employer. When a disability forces the employee to stop working, they are at risk of losing their health insurance coverage unless they timely pay the hefty premiums pursuant to the Consolidated Omnibus Budget Reconciliation Act (COBRA). Unfortunately, not having health insurance can be very problematic for those applying for disability benefits.

If the disabled individual is able to afford the premiums for continued health insurance coverage under COBRA, then it is probably in her best interest to pay the monthly premiums and maintain her current health insurance coverage. However, many individuals are unable to afford the monthly premiums without the regular income from a job. When a disabled person cannot make these required payments, they will be forced to find new health insurance coverage or forego health insurance at all.

First of all, applying for disability benefits without health insurance coverage is challenging. Without health insurance coverage, the individual is usually unable to afford the out-of-pocket expenses required for regular medical treatment. The individual may miss out on important testing, medications, and regular examinations. Of course, if the patient is not seeing their doctor, there will be a lack of current medical records to document the patient's disability. For both long term disability claims and Social Security disability claims, a lack of ongoing medical treatment can make it much more likely that their disability claim will be denied.

Second, the claimant should do everything in his power to obtain health insurance. This includes looking for private health insurance via the federal health insurance marketplace: https://www.healthcare.gov/ If the individual cannot afford private health insurance options, they should investigate whether they are eligible for their state's Medicaid program. For Indiana residents, information about applying for Medicaid can be found at the following website: http://member.indianamedicaid.com/apply-for-medicaid.aspx. Even if an Indiana resident is not eligible for Medicaid, they may still be eligible for another state program, such as Care Select, Healthy Indiana Plan, or Hoosier Healthwise. If the individual already receives Social Security disability benefits, then they should eventually be eligible for Medicare, although there is a two year wait to qualify for Medicare.

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Improper Insistence on "Objective Evidence" to Prove Fibromyalgia

September 8, 2014

The O'Ryan Law Firm has represented numerous clients suffering from fibromyalgia in the disability claims process. Usually, the client contacts our office after their disability claim has been denied and all too often the insurance company or claims administrator has denied the claim because there is "insufficient objective medical evidence" to support the claim. It is improper for your disability insurance company to insist that you produce objective medical evidence to prove that you have fibromyalgia because it is impossible to supply the insurance company with objective evidence that doesn't exist.

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 an 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.

According to the American College of Rheumatology:

Fibromyalgia is a chronic health problem that causes pain all over the body and other symptoms. Other symptoms that patients most often have are:

• Tenderness to touch or pressure affecting joints and muscles
• Fatigue
• Sleep problems (waking up unrefreshed)
• Problems with memory or thinking clearly

Some patients also may have:

• Depression or anxiety
• Migraine or tension headaches
• Digestive problems: irritable bowel syndrome (commonly IBS) or gastroesophageal reflux disease (often referred to as GERD)

• Irritable or overactive bladder
• Pelvic pain
• Temporomandibular disorder--often called TMJ (a set of symptoms including face or jaw pain, jaw clicking and ringing in the ears)

Symptoms of fibromyalgia and related problems can vary in intensity, and will wax and wane over time. Stress often worsens the symptoms.

The American College of Rheumatology provides the following criteria for evaluating of fibromyalgia:
Criteria Needed for a Fibromyalgia Diagnosis

1. Pain and symptoms over the past week, based on the total of:

Number of painful areas out of 18 parts of the body
Plus level of severity of these symptoms:
• Fatigue
• Waking unrefreshed
• Cognitive (memory or thought) problems
Plus number of other general physical symptoms
2. Symptoms lasting at least three months at a similar level
3. No other health problem that would explain the pain and other symptoms.

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Disability Claims Denied by Sedgwick CMS

August 16, 2014

Sedgwick Claims Management Services ("CMS") is a third party claims administrator hired by insurance companies and employee benefit plans to manage disability claims. If your employee benefit plan uses Sedgwick CMS as a claims administrator, then Sedgwick CMS is responsible for deciding whether your disability claim is approved or denied. As well as processing and adjudicating disability claims, Sedgwick holds itself out as providing the following services:

The company specializes in workers' compensation; disability, FMLA, and other employee absence; managed care; general, automobile, and professional liability; warranty and credit card claims services; fraud and investigation; structured settlements; and Medicare compliance solutions (website last visited August 16, 2014).

Sedgwick CMS is headquartered in Memphis, Tennessee and is one of the largest third party administrators in the nation. Many Indiana employers hire Sedgwick CMS to serve as their claims administrator for employee benefits. Employee benefit plans that currently use or previously used Sedgwick CMS include Eli Lilly & Company, AT&T, Comcast, Walgreens, Franciscan Alliance Inc., SPX Corporation, Ascension Health, Hewlett-Packard, PepsiCo Inc., International Paper, UnitedHealth Group, and many others. If employees of these companies apply for short term or long term disability benefits, Sedgwick CMS is responsible for processing the claims and deciding whether benefits should be paid. As a third party administrator, Sedgwick CMS does not actually pay the disability benefits. Rather, the employee benefit plan or insurance company pays disability benefits if Sedgwick CMS approves the claim. Often, the employee benefit plan has little involvement in the disability claims process, if any.

Like disability insurance companies, Sedgwick initially reviews a disability claim by obtaining medical records, requiring the claimant's treating physician to complete questionnaires, and having in-house staff (nurses, doctors, vocational analysts, claims analysts) review the claimant's file. If the claim is denied and the claimant appeals, then Sedgwick's review of the appeal will likely include the use of contracted record reviewing physicians. If the claim is approved, Sedgwick may call or write to the claimant frequently in efforts to obtain more information. Sedgwick may also require the claimant to undergo an "Independent Medical Examination" or "Functional Capacity Evaluation."

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Proper Contents of a Denial Letter

August 7, 2014

The Employee Retirement and Income Security Act ("ERISA") mandates that insurance companies and claims administrators provide claimants with the specific reasons for the denial or termination of employee benefits and the reasons for the denial must be in writing. See Militello v. Cent. States, Se. and Sw. Areas Pension Fund, 360 F.3d 681, 688 (7th Cir. 2004), cert. denied, 543 U.S. 869 (2004). The Department of Labor has promulgated regulations under ERISA which require certain information to be contained in a denial or termination of benefits letter. Specifically, 29 C.F.R. §2560.503(g) states:

Manner and content of notification of benefit determination.

(1)....The notification shall set forth, in a manner of calculated to be understood by the claimant -

(I) Reference to the specific plan provisions on which the determination is based;

(II) A description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary;

These requirements ensure that when a claimant appeals a denial to the plan administrator, he or she will be able to address the determinative issues and have a fair chance to present his case. Halpin v. W.W. Granger, 962 F.2d 685 (7th Cir. 1992). Describing the additional information needed, as required by this section, enables a claimant to gain a better understanding of the inadequacy of his claim and to gain a meaningful review by knowing with what to supplement the record. Wolfe v. J.C. Penney Co., 710 F.2d 388 (7th Cir. 1983).

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Cigna Disability Claims

July 16, 2014

Cigna, headquartered in Bloomfield, Connecticut, is a global health services organization and its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups. CIGNA is one of the top health insurers in North America, with medical plans covering nearly 12 million people. Cigna operates in 30 countries, has approximately 40,000 employees and manages around $54 billion in assets.

CIGNA is the parent company of Life Insurance Company of North America. Life Insurance Company of North America ("LINA") offers group life, accident, and disability insurance to employers. LINA was formed in 1956 by Insurance Company of North America (INA), a CIGNA predecessor company. LINA provides group disability insurance to many employers across Indiana including Toyota, the University of Notre Dame, State Farm, Sony Electronics, Covance and many others. Employees of these companies are provided short and long term disability benefits if they become unable to work due to injury or illness. LINA is responsible for processing the claims and making monthly benefit payments if the claimant proves that they are disabled and unable to return to their own occupation.

During the claims process, LINA will have a Nurse Case Manager review the medical records to determine whether an individual meets the definition of Disabled under the terms of the policy. If necessary, the Nurse Case Manager will escalate the review to a Cigna Medical Director who is an employee of Cigna. The Medical Director will also review the medical records and reports to determine whether the restrictions and limitations listed by the claimant's treating physician are supported by the medical records. It is not uncommon for the Nurse Case Manager and Cigna Medical Director to disagree with the treating physician and to find that the claimant is able to return to work despite the medical evidence supporting the claim.

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Disability Due to Spinal Injuries and Disorders

July 15, 2014

Spinal injuries or disorders may cause a great deal of pain or limit a person's movement. There are many causes of spinal conditions, including infections, injuries, degenerative bone changes, spondylitis, scoliosis, and tumors. Some of these disorders can be disabling in nature. Spinal injuries or disorders are relatively common. In fact, spinal conditions and back pain are one of the leading causes of disability.

When a back condition forces someone to miss work, it is necessary to carefully document how the back condition is disabling. First of all, objective testing is required to make a correct diagnosis and reveal the severity of the condition. Objective testing may include x-rays, MRIs, and CT scans, among other tests. One overlooked form of objective evidence is a list of signs observed by the treating physicians. Observable signs may include an abnormal gait when ambulating, pain with movement, and noted areas of the spine which are tender or painful on palpation. Range of motion testing is another type of evidence that is helpful to demonstrate disability. A range of motion test shows the degree to which a person can move each of their joints.

After objective evidence has been used to make a diagnosis, all treatment options must be considered. In most cases, conservative treatment is attempted prior to surgical intervention. Conservative treatment usually means rest, heat or ice therapy, physical therapy or home exercises, pain medications (NSAIDS and/or steroids), injections (nerve blocks and steroids), and non-traditional treatment such as massages, chiropractic adjustments, and acupuncture. If a spinal condition remains severe after conservative treatment and surgery is a possibility, a referral may be made to an orthopedic surgeon or neurosurgeon. Available surgical procedures include laminectomy, discectomy, or a spinal fusion. If surgery is not an option for the patient, then they may be referred to a specialist in pain management.

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Persistent Lyme Disease Symptoms May Cause Disability

June 30, 2014

The Center for Disease Control (www.CDC.gov) reported 17,730 cases of Lyme Disease in the year 2000 and as of 2012, over 100,000 cases have been reported. Lyme Disease is a growing epidemic in America and was first recognized in 1975 in Lyme, Connecticut, where the first outbreak occurred. Lyme Disease is the illness that results from the bite of an infected tick and it is the most common tick-born infectious disease in the United States.

Several related species of Borrelia cause Lyme Disease (Lyme Borrelia). Virtually all patients in the United States are infected with a single species called Borrelia burgdorferi, the spirochete that infects the deer tick and causes Lyme Disease. Worldwide, there are about 850 tick species and 30 major tick-borne diseases.

The infection usually starts with a painless, spreading "bull's eye" rash where the tick had attached itself to the skin. If you notice your tick bite right away and you are treated with antibiotics, this infection can be cleared fairly easily. If the cause is not found until later, people with Lyme Disease are more likely to feel fatigued, suffer from poor sleep, and muscle and joint pain, even after treatment. Other symptoms might be an acute fever, rash, Bells' palsy (paralysis of the face), headache, and joint and muscle pain. Some patients may complain of sensory symptoms such as burning, shooting pain or numbness. Your doctor may administer blood tests to determine if Lyme Disease is causing your symptoms and to rule out other diagnoses.

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Functional Capacity Evaluations in Disability Claims

May 14, 2014

Functional Capacity Evaluations ("FCEs") are a type of test used to determine the severity of someone's physical impairments. FCEs are common in disability insurance claims, workers compensation claims, and other contexts where the level of a claimant's injury or sickness needs to be evaluated.

FCEs are usually administered by a physical therapist or physician who specializes in occupational medicine. Common measurements during an FCE include how much the claimant can lift, how much they can push and pull, how long they can walk and stand, how long they can sit, the ability to reach in all directions, the ability to grasp and manipulate with each hand, the degree to which a claimant can move all joints, the ability to squat and bend, and the ability to stoop and balance. FCEs can vary in duration: some FCEs are very brief - only a couple of hours - and some FCEs are actually performed over the course of two days.

In long term disability insurance cases, many insurance policies allow the insurance company to request that a claimant undergo an FCE at a facility of their choosing. A claimant's refusal to undergo such testing may give the insurance company grounds to deny disability benefits. Therefore, it is likely that the claimant will have to comply with the insurance company's request for an FCE. However, a claimant may want to consider the following tips before attending an FCE:

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Disabling Neuropathy

April 15, 2014

As type II diabetes becomes more and more common, many people suffer from peripheral neuropathy, which is a result of nerve damage. Neuropathy may cause weakness, pain, or numbness in the hands and feet, although it may occur in other parts of the body. Sometimes this nerve damage becomes so severe that it prevents people from maintaining their normal lifestyle, including the ability to work.

If neuropathy forces someone to stop working and they apply for disability benefits, there are some important tips to help document the disability. First, establishing treatment with a neurologist is very important. A Neurologist is the appropriate specialist to diagnose and treat neuropathy. If a person does not properly document their neuropathy, they will face a tough challenge in having their disability claim approved. Diagnosis requires considering full medical history, neurological examination (such as checking reflexes, sensation, and coordination), physical examination, and appropriate testing. The testing most commonly used for diagnosing neuropathy includes electromyography, nerve conduction tests, nerve biopsy or skin biopsy, blood tests, MRIs or other medical imaging tests, and lumbar puncture (or spinal tap).

Second, it is necessary for the disability claimant to maintain regular treatment with their neurologist and other medical care providers. If it is shown that the disabled person has not complied with recommended treatment, then disability benefits may be denied.

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The Impact of Surveillance on Disability Claims

March 19, 2014

Disability insurance companies may look to more than just medical records and reports when determining whether a claimant qualifies for disability insurance benefits. Insurers have long used private investigators to perform surveillance of claimants in order to obtain additional information regarding the claimant's restrictions and limitations. Oftentimes, the private investigators are asked to document their observations with video to provide tangible evidence of the claimant's daily activities and abilities. Depending on the information gathered, reports from the investigators' surveillance and the associated video evidence can lead to a denial of disability benefits. Generally, when courts review video evidence they look at whether the observations in the surveillance video are consistent with the claimant's reported restrictions and limitations.

A common strategy for disability insurers is to schedule surveillance at a time when the claimant has a scheduled appointment with their doctor or a previously scheduled medical examination. This provides the private investigators with a known opportunity to observe the claimant outside of their home. Inevitably, this allows the surveillance team to observe the claimant driving or riding in a vehicle. In Mote v. Aetna Life Insurance Co., 502 F.3d 601 (7th Cir.2007), Aetna's decision to deny the plaintiff's disability benefits was upheld by the court. Aetna based their decision in part on video surveillance showing the plaintiff running errands, driving to medical appointments, and loading groceries into her car. This evidence was used to establish that the plaintiff could work in "any occupation." However, video surveillance in Gessling v. Grp. Long Term Disability Plan for Employees of Sprint/United Mgmt. Co., 693 F. Supp. 2d 856, 864 (S.D. Ind. 2010) only showed that the claimant was capable of driving a little longer than the fifteen minutes he reported to a Hartford Life representative. The court in Gessling found that this video evidence "says nothing useful about (the claimant's) ability to work in his own occupation."

Similarly, the Northern District of California found that surveillance evidence depicting a plaintiff "walking, driving and doing errands ... for a couple of hours ... does not mean that [that p]laintiff is able to work an eight-hour a day job." Thivierge v. Hartford Life & Accident Ins. Co., 2006 WL 823751, at *11 (N.D.Cal. March 28, 2006). The Eastern District of California reached the same conclusion in a case where Hartford procured surveillance video of the plaintiff driving to the store, visiting a friend, carrying a small bag, and sitting through an interview while taking numerous breaks. Leick v. Hartford Life & Acc. Ins. Co., 2008 WL 1882850 (E.D. Cal. Apr. 24, 2008). The court determined that the plaintiff's documented activity on a "good day" did not contradict that the plaintiff was unable to perform a full-time sedentary job. Id. See also Hunter v. Life Ins. Co. of N. Am., 437 F. App'x 372, 378-79 (6th Cir. 2011) (surveillance of a plaintiff driving to her functional capacity evaluation, as well as other activities of daily living, did not indicate that Hunter can perform all the physical duties of her former occupation).

Key considerations when reviewing surveillance evidence of driving include how long the claimant is operating the vehicle and where they are driving to during the surveillance. Courts seem to understand that driving only 15 or 20 minutes does not reveal much about a person's ability to work in a full-time job. Moreover, if the claimant is driving to a place where they are required to attend, like a doctor's appointment or a trip to the grocery store, then courts have often found this type of activity to be reasonable unless the claimant has reported that they are unable to drive at all.

There have been occasions where a court reviews surveillance evidence of a claimant engaging in activity that is physical in nature. One such case is Holoubek v. Unum Life Ins. Co. of Am., 2006 WL 2434991 (W.D. Wis. Aug. 22, 2006). In Holoubek, Unum obtained surveillance showing the plaintiff engaging in activity including (1) driving an automobile, (2) operating a forklift at a construction site, (3) lifting various objects, (4) walking and bending forward at the waist; and (5) leaving his apartment on four continuous days. In this case, Unum was determining whether the plaintiff could return to his job as a materials manager. Unum terminated the plaintiff's benefits and in the district court's decision, the judge found that Unum's four days of surveillance "is of little value because it fails to demonstrate that plaintiff could sustain such a level of activity on a continuous basis." While relying on the case of Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914, 918 (7th Cir.2003), the Holoubek court found that the plaintiff was in a desperate situation and forced "himself to work despite an illness that everyone agree[s] [is] totally disabling." While the court in Holoubek admitted that the surveillance video showed activity inconsistent with the plaintiff's claimed restrictions and limitations, the court ruled that Unum's termination was arbitrary and capricious because Unum failed to explain how plaintiff's observed surveillance activities established that he could perform the material and substantial duties of a materials manager.

Another case examining surveillance footage showing physical activity is Cross v. Metro. Life Ins. Co., 292 F. App'x 888 (11th Cir. 2008). The surveillance footage showed the plaintiff occasionally bending at the waist, squatting, carrying equipment of an unknown weight, and coaching baseball. MetLife characterized the plaintiff's observed activity as "pitch[ing] baseballs to a player in the batting net", although the court's review found that the plaintiff was merely "sitting on a bucket next to a batter and tossing baseballs a few feet up in the air for the batter to hit." MetLife also attempted to bolster its argument by pointing out what the plaintiff was not doing in the video, namely not using braces or supports, not limping, and not exhibiting signs of impairments or pain. Id. The court decided that the surveillance footage is only a "snapshot of Cross's activities throughout the day" and "these snapshots do nothing to disprove Cross's reports of pain." The court noted that the plaintiff increased his dosages of pain medication during his coaching activities since these activities caused him more pain. Even considering MetLife's surveillance video, the Eleventh Circuit held that MetLife's determination that plaintiff is capable of performing his prior occupation is not supported by reasonable grounds.

One case involving Liberty Mutual included three occasions of surveillance video over a four year period. Minix v. Liberty Life Assur. Co., 2005 U.S. Dist. LEXIS 15309 (N.D.Ind.. July 22, 2005). In 1999, the plaintiff, who suffered from ulcerative colitis, was observed performing activity at a horse farm. The surveillance showed Minix enjoyed riding and showing horses on good days. In 1999, Liberty Life did not change its determination that Minix was totally disabled. Id. Again in 2000, the Liberty Life performed surveillance of the plaintiff and he "was observed driving his truck, moving hay, unloading his truck, and sitting in a parking lot for two hours and forty minutes." Id. Still, Liberty Life did not change its opinion that Minix was totally disabled. Yet again in 2002, Liberty performed surveillance and observed Minix riding a "horse for approximately one hour and twenty minutes, walking around, bending at a 90 degree angle to pick up sticks, and sitting on the porch for approximately forty minutes." Id. After the third surveillance period, Liberty terminated Minix's disability benefits claiming that he could return to work in an occupation other than his regular occupation. The court found that the surveillance video did not prove that Minix can return to work and reasoned:

Minix's ability to bend over and pick up sticks, however, is not determinative of whether he is able to perform any occupation. Simply put, ulcerative colitis does not affect these capabilities. Rather, it is Minix's sudden pain and urgent need to use the bathroom which cause interruptions of his work.

In another case involving Hartford Insurance Company, the court reviewed video surveillance of the claimant, among other things, walking for about a mile on five occasions for approximately half an hour. Hanusik v. Hartford Life Ins. Co., 2008 WL 283714 (E.D. Mich. Jan. 31, 2008). Hartford terminated the plaintiff's disability benefits based on this level of activity. The court pointed out that the activities performed by the plaintiff were not ones the Plaintiff alleged she was disabled from performing. The court in Hanusik recognized that the surveillance did not reveal that the plaintiff could perform any single or combination of activities for an eight or four hour period, or strenuously exert herself in consecutive days. The court also did not find the surveillance video reasonably reliable to determine the extent of the plaintiff's fatigue symptoms. Further, the court did not find the surveillance video as credible factual support for Hartford's decision to terminate benefits and therefore the court ruled that the Hartford's determination was wrong.

If your disability claim has been denied in whole or part due to surveillance captured by the insurance company, contact the O'Ryan Law Firm toll free at (855) 778-5055.

Disability Coverage through Liberty Mutual

March 6, 2014

Based in Boston, Massachusetts, Liberty Mutual employs over 50,000 people in more than 900 locations throughout the world. As of December 31, 2012, Liberty Mutual Insurance had $120.1 billion in consolidated assets, $101.5 billion in consolidated liabilities, and $36.9 billion in annual consolidated revenue. The company, founded in 1912, offers a wide range of insurance products and services, including personal automobile, homeowners, workers compensation, commercial multiple peril, commercial automobile, general liability, global specialty, group disability, fire and surety.

Liberty Mutual Group Benefits department provides mid-sized and large businesses with short- and long-term disability insurance products and group life insurance. Many Indiana employers, such as Dow Chemical and Subaru, have purchased short term disability group coverage and long term disability group coverage through Liberty Mutual. Although, oftentimes Liberty Mutual is only the claims administrator for the short term disability coverage and does not insure the short term disability benefits. By issuing the short term and long term disability policies, Liberty Mutual agrees to pay income replacement benefits to employees who become disabled due to injury or illness.

On their website Liberty Mutual notes that as far as Long-Term Disability:

• Between ages 35 and 65 seven in ten employees will be disabled for five weeks or longer.
• Only 15% of LTD claims last longer than five years.
• 98% of Liberty Mutual Insurance's eligible claimants were approved for Social Security Disability Insurance benefits in 2010.

The O'Ryan Law firm has represented numerous clients in short term and long term disability claims which are insured by Liberty Mutual. If you have submitted a claim to Liberty Mutual for disability benefits, it is important to collect all of your medical records and submit them to Liberty Mutual to insure that Liberty Mutual has all of the critical documentation of your disability. Also, it is extremely helpful to have your physician, therapist, or nurse practitioner write a detailed letter to Liberty Mutual explaining how your medical conditions prevent you from returning to work. Letters from friends, co-workers and supervisors can also be helpful in establishing the extent of your restrictions and limitations due to your impairing medical conditions. If Liberty Mutual insists on denying your disability claim, please contact the O'Ryan Law Firm toll free at (855) 778-5055 to further discuss your disability claim with Liberty Mutual. We represent individuals throughout the State of Indiana in Liberty Mutual disability claims including all of the major cities such as Indianapolis, Bloomington, South Bend, Fort Wayne, and West Lafayette.

Disability and the Family Medical Leave Act

February 19, 2014

When a disability causes someone to stop working, they may be unsure of their rights to employee protections or insurance benefits. One common question for disabled employees is whether or not the employer can terminate the employee's job due to a disability. For some employees, they may have limited protection under the Family and Medical Leave Act (FMLA).

Under FMLA, eligible employees can take up to 12 workweeks of unpaid leave a year. FMLA also requires group health benefits to be maintained during the leave as if employees continued to work instead of taking leave. After the employee has exhausted 12 workweeks in one year, they are entitled to their same or an equivalent job if they are able to return to work. Unfortunately, if the disabled employee is still unable to return to work after exhausting their leave of absence under the FMLA, the employer may legally terminate his or her employment. More details can be found on the Department of Labor's website.

It is very important to recognize that not all employers are required to provide FMLA protection. FMLA applies to all public agencies (including local, state, and federal employers, and local education agencies) and private sector employers who employ 50 or more employees for at least 20 workweeks in the current or preceding calendar year. Therefore, if your workplace includes less than 50 employees and your employer is private, you may not receive FMLA protection.

Additionally, employees must satisfy several requirements in order to take an unpaid leave under the FMLA. First, they must work for a covered employer as explained above. Second, they must have worked 1,250 hours during the 12 months prior to the start of leave (with special hours of service rules for airline flight crew members). Third, they must work at a location where the employer has 50 or more employees within 75 miles. And fourth, they must have worked for the employer for 12 months.

If a disabled employee is eligible for FMLA protection, they can apply for an unpaid leave of absence due to a "serious health condition." The FMLA defines a "serious health condition" at Title 29 of the Code of Federal Regulations §825.113 as a condition involving inpatient care or continuing treatment by a health care provider. In addition, the Department of Labor commented on the meaning of a "serious health condition" in a 1996 opinion letter and stated that "'eligible employees' may take leave for, among other reasons, their own serious health conditions that make them unable to perform the essential functions of their position.

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Madison National Disability Claims

January 29, 2014

The O'Ryan Law Firm has represented several clients in disability claims against Madison National Life Insurance Company. Most of these clients have been teachers or other former employees of school corporations located in Indiana. Madison National has issued disability coverage to numerous school corporations across the State of Indiana committing to provide income replacement benefits to Indiana teachers who have become disabled due to an injury or illness. We have represented several teachers who have had a stroke, suffer from bipolar disorder, or who have been diagnosed with fibromyalgia, among other medical conditions, in disability claims denied by Madison National.

Madison National has been headquartered in Madison, Wisconsin since
1961. They are a wholly-owned subsidiary of Independence Holding Company, a NYSE listed corporation with principal interests in the life and health insurance business. Madison National is involved in several lines of life, health and disability business including Group Life, Short-Term Disability and Long-Term Disability for both public and private sector employers across the country.

Madison National's Group Long Term Disability Plans typically provide the following:

Income replacement from as low as 40% to as high as 70% of pre-disability earnings;
A range of replacement options to help tailor a plan to fit an employee benefit budget;
A wide variety of elimination periods are available;
Benefit waiting periods can be as short as fourteen days to as long as one year and can be designed to coordinate with an existing sick leave and/or Short-Term Disability plan;
Benefits are most commonly paid until retirement age, but can also be shortened for a more economical plan;
Various definitions of disability are available;
Partial or Residual definitions allow an employee to return to work on a part-time basis and still continue to receive a benefit;
Limited durations are available for more economical plans;
Benefits for disabilities due to drug/alcohol, mental/nervous, and/or self-reported conditions can be limited to reduce the cost of the plan;
Many optional plan provisions are available.

In claims with Madison National, it is important to make sure you submit all of your medical records to Madison National and that you have your physician clearly and adequately explain your restrictions and limitations to Madison National. It is important to maintain a regular treatment plan with your treating physicians and to diligently pursue your treatment plan. Otherwise, Madison National may find that your disability claim is not supported and they will readily deny the claim. If your disability claim has been denied by Madison National, please contact the O'Ryan Law Firm at (855) 778-5055.