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Did you know that in ERISA disability cases there are no real trials? That’s right, NO TRIAL. Once the insurance company denies your disability claim and your appeal is over, you get a chance to file a lawsuit. However, this suit isn’t tried before a jury of your peers. You cannot bring in witnesses to testify about how disabled you are. You cannot tell the Judge how your illness or injury prevents you from working. Not even your doctor can come in and testify on your behalf. When you file a lawsuit in an ERISA disability case, a Judge will decide your case. The only evidence he will review is what is already in the claim file when the insurance…Read More

Arch Surg. 2008 Mar;143(3):282-7; Prevalence of pain in patients 1 year after major trauma.Rivara FP, Mackenzie EJ, Jurkovich GJ, Nathens AB, Wang J, Scharfstein DO. Departments of Pediatrics and Epidemiology, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Box 359960, 325 Ninth Ave, Seattle, WA 98104, USA. fpr@u.washington.edu OBJECTIVES: To describe the prevalence of pain in a large cohort of trauma patients 1 year after injury and to examine personal, injury, and treatment factors that predict the presence of chronic pain in these patients. SETTING: Sixty-nine hospitals in 14 states in the United States. PATIENTS: There were 3047 patients (10 371 weighted) aged 18 to 84 years who were admitted to the hospital because of acute…Read More

After running a story in April about a breast cancer survivor’s battle to get disability insurance benefits from Cigna Group Insurance, Good Morning America said that they have received a flood of e-mails from viewers who were struggling with similar problems. According to GMA, U.S. House Rep. Debbie Wasserman Schultz, D-Fla., heard their report and says she wants to pursue legislation that would penalize insurance companies if they wrongly deny claims. They quoted her as saying “Right now there is no punishment. I’m going to make sure that we pursue these insurance companies and make sure that they are covering the claims that they are supposed to until we can get this law passed.” I often hear from clients who…Read More

I frequently get calls from long term disability claimants wanting to know if their disability insurance company can get all their social security back benefits. Often they recall some discussion with the insurance carrier about coordination of benefits, but fail to fully appreciate what it meant. In a nutshell, most group disability policies have a provision that allows the insurance company to offset other income benefits. This means they take credit for the income the disabled individual received from other sources of income such as social security disability, pension, retirement, worker’s compensation, or even settlement from an accident that resulted in the disability benefits. In some cases they can take credit for the social security income that their children receive…Read More

This past weekend, my single goal was to blog. Instead my husband surprised me with tickets to the Caribbean festival in Marion Oaks at Champaign’s farm. What an awesome weekend we had! It was great seeing old friends like Dr. Pam Lewin and Heather-Dawn, as well as meeting new friends and acquaintances. But who can talk about a Caribbean festival without talking about the food? Food was provided from morning until night. Breakfast included ackee & salt fish, green banana and fried dumplings. For lunch there was fish, jerk pork, chicken, run down and festival. Then there was dinner and supper with all the great island food including curried goat, gungu pea and red pea soup and much, much more.…Read More

Some Disability policies blatantly discriminate against the mentally ill. Many policies set limits on the amount of benefits they will pay if mental illness plays any part in a person’s disability. Some will even terminate benefits after 24 months if mental illness is the reason the person is unable to work. It should be no surprise that even our government discriminates against the mentally ill by the amount they pay for medical services for mental illness. Currently, Medicare recipients pay 50% co-pay for mental health services. Therefore, the Medicare Improvements for Patients and Providers Act of 2008 was a welcome reprieve for patients with mental illness. Under the new law, Medicare recipients will eventually pay the same 20 percent co-payment…Read More

Do you want to know a secret? Every day, millions of people pay good money for a disability policy that limits or terminates benefits for disability caused by pain, fatigue, or fibromyalgia. What is even more amazing is that the law allows it. This is OUTRAGEOUS! The insurance company will whine that there is no objective evidence that you are in pain, or that you are tired and fatigued. When you send them your medical records with these symptoms - which your doctor used to treat your condition- they say it’s based on your own reports of pain or fatigue. As a result, they will either not pay benefits, or will severely limit your benefits. You should know that there…Read More

Every year thousands of people are wrongfully denied long-term disability benefits from their insurance company. Often, these individuals will take early withdrawal from their retirement plan in order to meet basic living expenses while appealing the denial of benefits. As a result, they are left with nothing to fund their retirement and because of the disability, no means of ever earning that income again. To add insult to injury, once the disability carrier decides that they were wrong and should not have denied benefits, they also take credit for the income received from the individual’s pension, IRA or other retirement plan. The net result is that the insurance companies get a free ride. Not only do they get away with…Read More

Pain and depression are among the leading causes of long term disability. According to a literature review, on average 63 % of patients with depression experience one or more pain complaint and depression is present in 5% -85% (depending on the study setting) of patients with pain conditions. [Matthew J. Bair, MD, MS; Rebecca L Robinson, MS; Wayne Katon, MD and Kurt Kroenke, MD Arch Intern MED/Vol 163, Nov 10, 2003] Insurance carriers love to see these conditions in your medical records because those conditions allow them to limit or deny benefits caused by self reported symptoms. You should know there are ways to objectify your complaints. Therefore, you must seek legal representation should your insurance claim be denied based…Read More

Unfortunately, Congress did not offer this protection to individuals injured by their group disability insurance company. The insurance company can wrongly deny your claim; make you retain and pay a lawyer and if they lose in court, their only obligation is to pay you what they should have paid you if they didn’t wrongly deny your claim. That’s outrageous! My best advice is to do your homework. Know the reputation of the insurance company before you purchase your disability policy. If you already purchased a policy, become familiar with the terms before you file a claim. Get an experienced ERISA lawyer before filing your claim. They can help you understand what you need to do to establish entitlement to benefits…Read More