Articles Tagged with “Multiple Sclerosis”

O’Ryan Law Firm, on behalf of client Stacy K., recently filed a federal lawsuit against Reliance Standard Life Insurance Company after Reliance Standard wrongfully terminated her disability benefits after paying the benefits for three years. Stacy was employed as a Case Manager with Southern Hills Counseling Center which made her eligible for disability benefits under her employee benefit plan.

Stacy was forced to stop working in May 2014 due to the disabling effects of Multiple Sclerosis and severe migraine headaches.  Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body.  MS is a type of autoimmune disorder. It isn’t known what causes Multiple Sclerosis, although environmental factors and genetics are believed to play a role.  Common symptoms include problems with balance and sensation, difficulty walking, leg or arm movement, fatigue, muscle spasms, tingling, numbness, and bladder control.  The symptoms, severity, and duration can vary from person to person.  Tremors can occur during precise movements, in the hands, or limbs.

Currently, multiple sclerosis is not a curable disease. Treatment strategies can help slow or modify the course of the disease, including treatment of relapses, and make the patient more comfortable.

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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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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