Articles Tagged with “social security claim”

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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ERISA was enacted to promote the interests of employees and their beneficiaries in employee benefit plans and to protect contractually defined benefits. Black & Decker Disability Plan v. Nord, 538 U.S. 822, 829 (2003). An ERISA plan is a “special kind of contract,” in which there exists a “presumption of full judicial review at the behest of the [plan participants or beneficiaries].”Fritcher v. Health Care Service Corp., 301 F.3d 811, 816 (7th Cir. 2002). Full disclosure of important rights and responsibilities under ERISA plans was a primary goal in the enactment of ERISA. In endorsing ERISA, the Congressional Committee on Education and Labor considered fiduciary duty and disclosure an “essential element” of employee plans. H.R. Rep. 93-533, p. 4645-4646 (October 2, 1973). The Committee specifically stated that disclosure requirements under the prior Welfare and Pension Plans Disclosure Act were insufficient and had not accomplished Congressional intent:

Experience has . . . demonstrated a need for a more particularized form of reporting so that the individual participant knows exactly where he stands with respect to the plan– what benefits he may be entitled to, what circumstances may preclude him from obtaining benefits, what procedures he must follow to obtain benefits, and who are the persons to whom the management and investment of his plan funds have been entrusted.

Id. at 4649. In order to strengthen and improve the protection of participants in employee welfare benefit plans, ERISA was passed in 1974. Congress specifically recognized the importance of disclosure of information and transparency in welfare benefit plans, which includes providing plan participants with clear information regarding whether third party administrators have been given discretionary authority to make claims determinations.

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