Articles Posted in Long Term Disability

O’Ryan Law Firm, on behalf of Plaintiff, Melissa B., recently settled a lawsuit against American United Life Insurance Company (“AUL”) for the termination of Melissa’s disability insurance benefits after she was diagnosed with cardiomyopathy and congestive heart failure.

Melissa was a teacher with a local public school system and was forced to stop teaching when, shortly after giving birth to her son, she was found to have cardiomyopathy with reduced ejection fraction and chronic systolic congestive heart failure, confirmed by numerous echocardiograms, cardiac MRIs, and other testing procedures. After she was diagnosed with cardiomyopathy, Melissa began suffering from extreme fatigue, shortness of breath, and chest pain. Her cardiologist notified her employer that Melissa had severely reduced left-ventricular systolic function left her at an increased risk for mortality and precluded her from engaging in even light level activities on a full-time basis. Melissa’s treating physicians ordered her off work indefinitely, and AUL awarded her disability benefits under the policy beginning January 1, 2014.

Melissa was awarded Social Security Disability Benefits in September 2015, based on the Social Security Administration’s finding that she had been totally disabled since May 1, 2014.

O’Ryan Law Firm recently filed an appeal for Long Term Disability benefits against Cigna for wrongfully denying a participant’s benefits.  The client was a long-time employee of Toyota, working as a warehouse associate.  She was forced to stop working due to breast cancer, a bilateral mastectomy, and the residual effects of chemotherapy and treatment; including fatigue, migraines, bilateral lower extremity neuropathy and severe pain.

Despite the client’s treating physicians providing objective medical proof that she was unable to continue working due to her condition, Cigna hired a contracted physician to review her claim file.  The contracted physician contended the client could perform a sedentary occupation on a full-time basis even though the client’s own physicians stated she could not work at all.  The treating physicians reported to Cigna that she could not work and never released the client to return to work full-time.

Cigna originally approved the short-term disability and long-term disability claim in full until the time when the definition of Disabled changed to “performing the duties of any occupation.” As soon as this definition kicked in Cigna terminated her benefits.  Cigna’s hired contract physician even agreed with the treatment, limitations and restrictions placed on the client but in order to be hired for another claim file review the contracted doctor opined that the client was able to work a full-time job.  Cigna cited the following definition of “Disability within the long-term disability denial letter:

Human immunodeficiency virus, commonly known as HIV, is a virus that attacks the body’s immune system, specifically the CD4 cells, often called T cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. These special cells help the immune system fight off infections. Untreated, HIV reduces the number of CD4 cells in the body. This damage to the immune system makes it harder and harder for the body to fight off infections and some other diseases. Opportunistic infections or cancers take advantage of a very weak immune system and signal that the person has acquired immunodeficiency syndrome, commonly known as AIDS.[1]

Over the past three decades, revolutionary advances in treatment have dramatically improved the prognosis of individuals diagnosed with HIV/AIDS. Although no known cure for HIV/AIDS exists, modern treatments have rendered the disease highly manageable. However, while an HIV/AIDS diagnosis is no longer an almost certain death sentence, it still carries the risk of a number of severe, often disabling symptoms.

HIV/AIDS is most frequently treated with antiretroviral medications, which slow the growth of the virus in the patient’s bloodstream, allowing the patient’s immune system to recover and fight off the virus until it is undetectable in blood samples.[2] These medications are typically administered in the form of a single pill that contains a “cocktail” of multiple different antiretroviral drugs. Although these drug cocktails are highly effective in fighting HIV and can essentially eliminate it from a patient’s bloodstream, “reservoirs” of the virus remain in the patient’s body and allow the virus to return to dangerous levels if the patient ceases properly adhering to an antiretroviral treatment regimen.[3] This means that even after patients’ viral loads become undetectable in blood tests, they must continue to adhere to their antiretroviral treatment regimen for the rest of their lives. It is also common for HIV/AIDS patients to have to switch from one antiretroviral drug cocktail from another after the HIV virus in their bodies develop an immunity to one or more of the antiretroviral drugs in the cocktail, so HIV/AIDS patients are always at risk of contracting serious illnesses when their immune systems become compromised due to newly-developed resistances.[4]

O’Ryan Law Firm, on behalf of our client, Deborah P., recently filed a lawsuit against Madison National after they wrongfully terminated her disability benefits. Our client was employed as a Teacher with the Hanover Community School Corporation, which made her eligible for disability benefits offered through the Hanover Community School Corporation employee benefit plan.  Madison National is often times the insurance company for long term disability coverage offered to most teachers.

Deborah began her teaching career in 1984. After 30 years of teaching, Deborah was forced to stop working in December 2014 due to infiltrating ductal carcinoma, hypothyroid, chronic fatigue syndrome, GERD, neuropathy, knee pain, chest pain, shortness of breath, weakness, edema, nausea, palpations, cardiomyopathy, Hashimoto’s thyroiditis, migraines, and insomnia.

In October 2013, Deborah received a devastating diagnosis of invasive ductal carcinoma stage 2. Her life became overfilled with treatments, doctor visits, tests, decisions on treatments, etc. Since the tumor was almost 5cm, Deborah underwent chemotherapy first to see if the tumor would shrink and offer her more options. Deborah underwent extremely aggressive chemotherapy and continued to teach during treatments in hopes of beating the cancer and returning to teaching full time. Deborah began experiencing pain in her joints, profound fatigue, and was nauseous all the time. In March 2014, Deborah underwent a lumpectomy. Since 3 out of 5 lymph nodes were removed and tested positive, Deborah lives in daily fear that her cancer will return. In addition to chemotherapy and surgery, Deborah also underwent proton radiation. Deborah has tried to return to work, but became too profoundly fatigue to make it through a normal school day.

As a new employee to Ball State University, have you ever questioned whether your insurance carrier will “be there” when you are disabled from an injury or accident?  As a BSU employee, you may make monthly premium payments for long term disability coverage through payroll deduction, only to find out that when you need it, the insurance carrier is putting up road blocks to your rightful and deserved disability benefits.  The consequences of denials or early terminations in disability benefit claims can be devastating.

The O’Ryan Law Firm has represented numerous employees of several universities, including Ball State University, who have become disabled because of serious illnesses such as chronic pancreatitis, Lyme’s disease, fibromyalgia, degenerative disk disease, and cancer. A large number of those clients were employees who had worked for a university for many years, some even decades, before reaching the point where they were no longer able to work because of their medical conditions.

Ball State University’s Long-Term Disability Plan is an income replacement plan for BSU employees who become disabled due to an illness or accident.  The following is general information regarding long-term disability coverage provided to BSU employees:

Urinary incontinence is a surprisingly common problem that affects millions of Americans, and is described by the Mayo Clinic [1] as follows:

Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time.

Though it occurs more often as people get older, urinary incontinence isn’t an inevitable consequence of aging. If urinary incontinence affects your daily activities, don’t hesitate to see your doctor. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence.