Articles Tagged with “long term disability”

It’s never too early or too late to hire an attorney to represent you in your disability case. You do not have to wait to be denied by your insurance company before talking to an attorney. We offer several services that can protect your interests. Here are some examples of how we can help:

  • Assist you with your initial application for Long Term or Short Term Disability benefits.
  • Help manage your monthly Long Term Disability benefits.

O’Ryan Law Firm, on behalf of Plaintiff Dee Ann Miller recently filed a federal lawsuit against The Hartford Life and Accident Insurance Company (“Hartford”) for payment of disability benefits. The Plaintiff was employed as a Senior Collector with Springleaf Finance, Inc., which made her eligible for disability benefits under the Springleaf Finance Disability Plan and Hartford policy who insures the Plan.  In Miller v .The Hartford Life and Accident Insurance Company, the Plaintiff filed a lawsuit to gain the long term disability benefits she was entitled to under the terms of the Hartford policy and promised to her by her former employer.

Facts of the Case

Ms. Miller was employed by Springleaf Finance for over 15 years until she became disabled in 2014 due to the disabling effects of Fibromyalgia, psoriatic arthritis, osteoarthritis, and chronic pain.  Ms. Miller submitted a claim to Hartford and was paid disability benefits by Hartford. from September 2014 to April 2015.  Her condition did not improve and her medical records showed that she continued to actively seek treatment for her multiple medical conditions.  The last report from her rheumatologist showed that she had 18 of 18 tender points.  She also has difficulty grasping with her hands because of her arthritis.

O’Ryan Law Firm, on behalf of Plaintiff Shane C., recently filed a federal lawsuit against The Prudential Insurance Company of America (“Prudential”). The Plaintiff was employed as Senior Vice President Regional Manager with Custard Insurance Adjusters, Inc. which made him eligible for disability benefits under the Custard Insurance Adjusters, Inc. Long Term Disability Plan (the “Plan”).  As a Regional Manager, Shane was required to travel to 9 different offices throughout the Midwest to oversee and supervise these 9 offices.

In Shane C. v. The Prudential Insurance Company of America and Custard Insurance Adjuster, Inc. Long Term Disability Plan, the Plaintiff filed a lawsuit under ERISA to gain the long-term disability benefits he was entitled to under the terms of the Prudential policy.

Facts of the Case Against Prudential

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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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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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: http://www.disabilitydischarge.com/home/
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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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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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Most long term disability benefit plans or policies require claimants to apply for Social Security Disability benefits in addition to applying for long term disability benefits. The reason being that the insurance is able to offset any SSDI award against any monthly long term disability amount that is owed to the claimant under the policy. The SSDI monthly benefit is a dollar-for-dollar offset against what your insurance company pays you in terms of a monthly long term disability benefit payment. For example, if you are receiving $2,000 a month in long term disability and you are subsequently awarded an SSDI benefit of $1,000 then your long term disability benefit payment is reduced to $1,000 according to the terms of the disability policy. Because this offset is so valuable to the insurance companies, they will be persistent in their demands that you pursue your claim for SSDI benefits.

Unfortunately, we see many individuals who are receiving long term disability benefits, are then awarded SSDI and subsequently their insurance company terminates the long term disability benefit claim. This happens despite the fact that the insurer may have hired a company, such as Allsup or the Advocator Group, to represent the claimant in the SSDI process. It seems unfair that the insurance company can represent to the Social Security Administration that you are totally disabled but then terminate your benefits claiming you are no longer disabled for purposes of the disability policy.

When we have clients in this position, we first of all point out to the insurance company that the definition of disabled for purposes of SSDI is more stringent than the definition of Disabled under the terms of the policy. The SSA defines “disability” as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. 42 U.S.C. §423(d)(1)(A).

Oftentimes, the insurance company will ignore the SSDI findings of total disability or fail to analyze or distinguish the SSA’s fully favorable decision in any of its denial letters. The courts have held that it is improper for the insurer to ignore the SSA’s decision of total disability given the fact that it is important proof that the claimant meets the definition of Disabled under the policy. “This definition is a stringent one, and an administrator’s failure to address a claimant’s SSA disability finding is thus especially questionable when the ERISA plan’s disability definition is less exacting.” Holzmeyer v. Walgreen Income Protection Plan for Pharmacists and Registered Nurses, 2014 WL 4388625, *18 (S.D. Ind. Sept. 4, 2014).
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Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that can affect the skin, joints, kidneys, brain, and other organs. Symptoms can vary in severity, but SLE may be severely disabling. If SLE causes disability, then it is essential for the proper documentation to be gathered in order to support a disability claim.

SLE almost always causes joint pain and swelling. Other symptoms may include chest pain, fatigue, fever, malaise, hair loss, mouth sores, sensitivity to sunlight, skin rash, swollen lymph nodes, headaches, numbness, tingling, seizures, vision problems, personality changes, abdominal pain, nausea, vomiting, abnormal heart rhythms, coughing up blood and difficulty breathing, Raynaud’s phenomenon, swelling in the legs, and weight gain. If a patient only has skin symptoms, then this is called discoid lupus; not systemic lupus erythematosus.

Because of the wide range of symptoms, autoimmune disorders can be very challenging to diagnose. For a clinical diagnosis of SLE, a patient must have 4 out of 11 common signs of the disease. 11 of the common signs of the disease are malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, pleuritis or pericarditis, kidney disorder, neurological disorder, blood disorder, immunologic disorder, and positive antinuclear antibody (ANA) testing. Objective testing is available to diagnose lupus, although no single test can diagnose lupus. Testing includes antibody tests (such as ANA panel), complete blood count, chest x-ray, echocardiogram, kidney biopsy, and urinalysis. About 95% of patients with lupus test positive for ANA, although ANA testing is not conclusive to diagnose lupus.

If SLE is causing a disability, a claimant needs to see the appropriate specialist and undergo all relevant testing. Rheumatologists are the appropriate specialists to diagnose and treat lupus. If a claimant suffering from SLE applies for disability and has not treated with a rheumatologist, then it will be challenging for them to prove a disability. Even though there is no cure for SLE, regular treatment is necessary to control symptoms. If a claimant does not maintain regular treatment, then their claim may fail to show the severity of their symptoms. Therefore, it is critical for a claimant with SLE to regularly see their doctors, including a rheumatologist.
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