21 November

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Loeys-Dietz Syndrome and Your ERISA Short-Term or Long-Term Disability Insurance Claim

Loeys-Dietz syndrome is a genetic disorder that affects the connective tissue in your body that provide not only strength but flexibility to bones, ligaments, muscles, and blood vessels. It affects multiple body systems and can result in a disability insurance claim if you are no longer able to work. Common problems include: 1. enlargement of the aorta, which can result in aneurysms or dissections of blood vessels, 2. skeletal problems that include a premature fusion of the skull, scoliosis of the spine, a sunken or protruding chest, and joint deformities, 3. spontaneous collapse of the lungs, and 4. hernias. The two most disabling problems are cardiac...

08 July

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The Ten Mistakes You Can Make That Can Destroy Your ERISA Disability Claim

Posted by Nancy Cavey

in ERISA

Short and long-term disability insurance claims are often made because of chronic heart problems. But if you have chronic heart issues and were thinking about leaving work and applying for disability benefits, there are some common problems you should be aware of before you do that. The case of Adams-Runion v. UNUM Life Ins. Co. of Am., 2022 WL 1050097 (E.D. Cal. Apr. 7, 2022) illustrates these problems. Adams-Runion was the Director of Laboratory Services at Doctors’ Hospital of Manteca, California, which required her to sit at least six hours per day. Her job was very stressful. She had undergone heart surgery in...

07 July

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“Limited Disability Benefits” Clauses in Chronic Fatigue Syndrome Disability Insurance Claims

Posted by Nancy Cavey

in Chronic Fatigue Syndrome

Chronic Fatigue Syndrome Disability Claims Clause

Many disability policies or plans have subjective medical condition or limited disability benefit clauses that will limit the payment of disability benefits to just 24 months. There is often a fight about the terms of these limited disability clauses and whether a particular medical condition falls within the limited disability benefits clause. That is exactly what happened in the case of Tucker v. Express Scripts Health & Welfare Benefits Plan, 2022 WL 88143 (E.D. Mo. Mar. 25, 2022). Mr. Tucker was covered under a disability plan that had a “Limited Disability Benefits” clause that limited the payment of disability benefits after...

03 May

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Vertebral Compression Fracture and Wedging Claim Denial by UNUM Overturned by Federal Judge

Posted by Nancy Cavey

in UNUM Insurance Company

Vertebral Compression Fracture Disability Claim

One of the most painful back injuries is a compression fracture of the spine that results in wedging and a loss of height of the vertebral body. The bone of the spine can collapse and, as it heals, wedge. The spinal bone can also fracture and fragment. That is known as a Retropulsed fragments. The fracture fragment is displaced into the spinal canal, potentially causing a spinal cord injury. Common Causes and Symptoms of Vertebral Compression Fracture The common causes are due to trauma, like ejection from a car or ejection seat, or something as “simple” as osteoporosis, lytic lesions, tumors, or infection. Symptoms...

02 May

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UNUM’s Claim that Policy Holder’s Back Pain was Out of Proportion to the Evidence of Radiculopathy on Exam Reversed by Federal Judge

Posted by Nancy Cavey

in UNUM Insurance Company

Radiculopathy ERISA UNUM Disability Attorney

One of the common reasons disability carriers like UNUM deny or terminate benefits is the argument that the policy holder’s pain is out of proportion to examination findings and, therefore, the policy holder isn’t disabled by the terms of the disability plan or policy. Many times, disability carriers can get away with this argument because the disability plan or policy has “get out jail free” language that grants the plan or policy the discretion to determine whether the policy holder is disabled. It can be extremely hard to legally prove that a disability carrier has abused its discretion in denying a...

06 January

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First Circuit Clarifies What a “Full and Fair Review” Means to a Denied ERISA Disability Claim

Posted by Nancy Cavey

in ERISA

The Employee Retirement Income Security Act, which governs employer sponsored benefits like disability insurance, is not friendly to the very people it is designed to benefit – you! However, one of the saving graces in ERISA are the ERISA claim regulations which require that a denied policy holder or plan beneficiary be given a “full and fair review” during the claim review process. Let me tell you a typical story so you understand the games the disability plans or carriers play. Ms. Jette was a legal assistant who had back problems for which she underwent back surgery. Jette was paid short and...

24 June

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Are You a Salesperson Whose Disability Insurance Policy or Plan Has Occupational Classes That Can Impact Your Disability Insurance Benefits?

Posted by Nancy Cavey

in Occupations, Sales

Salesperson misclassification of occupational class and disability insurance

A disability insurance company can offer to an employer disability insurance benefits for its employees that lumps occupations into classes. Why? Disability carriers will lump jobs into specific occupational classes based on risk. These classes take into consideration the hazards of the job, the length one may be disabled and the odds that a disabled policy holder won’t return to work. In other words, the disability carrier will use an occupational class to determine the premium you will have to pay, what benefits the policy will provide and the maximum benefit you can get. It is common for sales-based employers to offer a...

08 April

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My Long-Term Disability Claim Has Been Denied Do I Have to Exhaust All Levels of Appeal Even If My Appeal Won’t Matter?

Posted by Nancy Cavey

in Appeals

Long Term Disability Appeal Court Claims

You paid your premiums, filed your claim when you were no longer able to work, and waited for your check. But instead of a check, you got a letter denying your claim. A long-term disability claim denial can be devastating. Alternatively, your claim might have been accepted, but now you’ve gotten a letter from the disability carrier terminating your benefits. The denial or termination letter should explain the basis of the denial or termination, your rights, and your obligation to file an appeal of the denial or termination. Do I have to Exhaust All Levels of Appeal before Going to Court? The short answer...

Author: Nancy Cavey