Articles Tagged with “short term disability”

Navigating through the process of obtaining or keeping your short-term or long-term disability includes obtaining supportive statements from your treating physicians.  Not only is it important to collect medical records for your claim but also it is imperative that you garner an attending physician statement that will support your disability.

Prior to filing for short-term or long-term insurance benefits, you should make an appointment with your doctor to discuss your decision to leave work. Once you arrive at your appointment, be sure to take the time to explain why you need their help in the claims process.  If you need a form or letter written, make sure that the doctor explains in as much detail as possible the severity of the symptoms you experience and how they impact your ability to work.

One of the most common reasons for a disability claim denial by an insurance company is due to lack of proof of disability.  Starting the process with your physician should happen prior to submitting a disability claim.  Waiting to file a disability claim until after confirming first that your physician will be willing to provide support will help ensure a positive outcome.

Michael P is a Gulf War veteran who served in special forces with the US Marines during Operation Desert Storm. During his time in combat, Michael was exposed to hazardous chemicals from burning oil wells and experienced firsthand the horrors of war.

After returning home and receiving an honorable discharge from the Marine Corps, Michael went to work as an electrician in a heavy industrial manufacturing facility in northwest Indiana. As part of his role, Michael was frequently required to work on cranes and other heavy industrial equipment high above a foundry floor in a facility in which molten steel was transported and poured. According to his job description, he was required to keep electrical equipment such as wiring motors, switches, and electrical mechanisms in good repair and operating condition; install a variety of complicated electrical and some mechanical equipment; and diagnose and remedy trouble quickly to avoid shutdowns.

In June of 2017, Michael was diagnosed with very severe post-traumatic stress disorder (“PTSD”) as a result of his combat experience. He also suffered from severe headaches, frequently lasting hours at a time. When he presented for an MRI to evaluate the cause of his headaches, his doctors noted atrophy in the cerebral cortex, a common feature of many brain diseases that is frequently associated with dementia, seizures, and impaired comprehension, often resulting from underlying traumatic brain injury.

Narcolepsy is a chronic neurological disorder affecting the brain’s ability to direct sleep/wake cycles and if left undiagnosed, may interfere with psychological, social and cognitive function inhibiting academics, social interaction and work.  People with narcolepsy may experience broken sleep patterns throughout the night or an inability to sleep.  They may awaken in the morning refreshed only to experience extreme sleepiness during the day.

Nearly all individuals with narcolepsy with cataplexy have extremely low levels of naturally occurring chemical hypocretin.  Hypocretin regulates your REM sleep and wakefulness.  While the causes of narcolepsy are not totally understood, much of the research shows that it may result from a combination of factors such as autoimmune disorders, family history and brain injuries

Narcolepsy is diagnosed by clinical examination as well as a detailed medical history.  A physical exam is important to rule out other conditions that may be causing the symptoms but there are two specialized tests, Polysomnogram and Multiple Sleep Latency Test, performed to diagnose Narcolepsy.  Although there is no cure for narcolepsy, some of the symptoms can be treated with medications such as Modafinil, antidepressants, sodium oxybate, and life style changes.  Taking short naps, maintaining a regular sleep schedule, avoiding caffeine or alcohol prior to bedtime, avoiding smoking and exercising daily are just some of the things you can do to reduce the symptoms of narcolepsy.

Lois M was a factory worker for a large manufacturing company. By June of 2017, decades of working in very heavy duty manufacturing jobs had taken their toll on her body, leaving her unable to continue working due to severe and debilitating degenerative joint disease in her left hip, mild scoliosis, severe multilevel degenerative disc disease, bulging discs, facet arthrosis of the lower spine, and osteoporosis.

When she was unable to continue working, Lois filed a claim for short term disability (“STD”) benefits under a disability benefits plan provided by her employer and administered by Life Insurance Company of North America (“LINA”), a subsidiary of Cigna. Despite significant supportive medical records and strong statements from her treating physicians in support of her claim, LINA denied Lois’ claim based on a review by a nurse case manager.

After her claim was denied, Lois hired O’Ryan Law Firm to represent her to appeal the denial of her STD claim and assist her in filing a claim for long term disability (“LTD”) insurance benefits. We helped Lois gather substantial additional supportive medical evidence, including strong supportive statements from multiple treating physicians, and compiled an appeal of LINA’s denial of her STD benefits. Unfortunately, Lois’ employer continued to refuse to pay her STD benefits despite overwhelming evidence that she was truly disabled from performing her heavy duty manufacturing occupation.

Christine W. is 54 years old and worked in marketing for a large network of hospitals and healthcare facilities until she was forced to stop working in early 2018 due to severe back and leg pain resulting from severe scoliosis and flat back syndrome subsequent to Harrington rod surgery. Since that time, she has also undergone major spinal reconstructive surgery and is currently in the process of recovering from that surgery.

When Christine was forced to stop working, she applied for short term disability (STD) benefits through her employer’s disability plan, which was insured by The Hartford. Under the terms of the Hartford policy, Christine was entitled to receive STD benefits for up to 6 months if she was unable to perform the material duties of her own occupation. Because Christine’s medical conditions prevented her from working in her own occupation, The Hartford awarded her STD benefits, which it paid until March of 2018.

In March of 2018, Christine received an epidural steroid injection to treat her back pain, and it provided her with limited relief for 1-2 weeks. Unfortunately, because her treating physician’s records noted that her back pain had improved as of mid-March, The Hartford latched onto this statement and used it to terminate her STD benefits, claiming that she was able to return to work as a result of her improved condition.

O’Ryan Law firm has extensive experience representing clients in appeals and litigation under the Employee Retirement Income Security Act of 1974 (ERISA), which governs most claims for benefits under employer-sponsored insurance plans. Earlier this year, the US Department of Labor amended its regulations under ERISA, providing claimants with some additional rights during the process of appealing denials of benefits under plans governed by ERISA.

One important additional right granted under the new ERISA regulation is the opportunity to review and respond to any additional evidence considered by an insurance company during an appeal of a benefits claim denial. This means that if a claimant appeals a denial or termination of benefits and the insurance company sends the file to a reviewing physician, the claimant has a right to read and respond to the report of that reviewing physician before the insurance company can make its final decision on the appeal. O’Ryan Law firm recently took advantage of this new protection to obtain short term disability (STD) benefits for a client who had previously had her STD benefits terminated.

Kim M was a Repair Service Attendant at a large telecom company and was forced to stop working in early 2017[1] as a result of failed back syndrome, multilevel degenerative disc disease, lumbar facet arthritis, and spondylopathy. After she was unable to return to work, she was awarded STD benefits under her employer’s disability plan, which was administered by Sedgwick. However, Sedgwick terminated Kim’s STD benefits several months later, claiming there was no longer sufficient medical evidence to support her claim. In the letter explaining its termination of Kim’s benefits, Sedgwick relied on the opinions of two reviewing physicians who asserted that Kim was not disabled.

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.

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.

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.

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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