Articles Tagged with Lupus

O’Ryan Law Firm, on behalf of Plaintiff, Denise D., recently filed a lawsuit against The Prudential Insurance Company of America (“Prudential”).   Plaintiff was employed by Advance/Newhouse Partnership, which made her eligible for the Advance/Newhouse Partnership Short Term and Long Term Disability Plans, which were administered and insured by Prudential.

Facts of the Case Against Prudential

Plaintiff was employed by Advance/Newhouse Partnership from 2012 until she became disabled in February 2016 and was unable to work due to lupus, fibromyalgia, migraines, spondylosis and radiculopathy. Plaintiff’s treating physicians provided objective medical proof that the Plaintiff was unable to continue working due to these serious illnesses.  Her physicians also confirmed that she was unable to perform the material duties of her job thus meeting the definition of “Disabled” under the Prudential policy.

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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