Disability Insurance Lawyer Blog

Disability Insurance Claims and Your Physician

What happens when the long term disability insurance company asks for more medical records and your primary treating physician says no? During the decade plus that we have represented disability claimants, occasionally we do run into this situation. It often occurs when the claimant is a member of a large practice where they have been seen by many different physicians. It also occurs when, for whatever reason, sometimes valid, sometimes not, the claimant has a bad relationship with their physician (or even the physician’s staff). Whatever the reason for this situation, it is one that can be managed, but does require some skilled negotiating. Most important – this is not the time to change doctors. Insurance companies will notice and you will be accused of “diagnosis shopping” or “physician shopping.” It can be a red flag to an adjuster or a third party disability processing administrator and may be used to deny your...
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Chronic Fatigue Syndrome (CFS) Given A New Name and Diagnosis

For the estimated 836,000 and 2.5 million Americans who have long endured both the devastation and the stigma of Chronic Fatigue Syndrome, this week’s announcement by the Institute of Medicine (“IOM”), an independent organization that provides unbiased and authoritative advice to policymakers and the general public, was a huge milestone. The announcement is particularly important to us. Partner Jason Newfield recently completed a four year term on the Chronic Fatigue Syndrome Advisory Committee, a federal committee that advises the United States Department of Health and Human Services regarding Chronic Fatigue Syndrome. We are knowledgeable and experienced with ME/CFS, and take great pride in representing ME/CFS patients in disability insurance matters. IOM was tasked by a large number of federal agencies: The Department of Health and Human Services (HHS), the National Insti¬tutes of Health, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Food and Drug Administration,...
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Disability Claims and Stroke Victims

  This week, the American Heart Association and the American Stroke Association are presenting the International Stroke Conference 2015 in Nashville, Tennessee. It is a huge scientific conference, with experts in every aspect of cerebrovascular disease. The size of the conference is in direct proportion to the prevalence of strokes in the American population. According to the Centers for Disease Control, strokes kill almost 130,000 Americans every year and are the fourth leading cause of death for Americans. A stroke is caused by a blocked blood vessel or bleeding in the brain. It is sometimes called a “brain attack,” similar to a heart attack, when blood does not flow properly to the heart and sections of the heart tissues die. In the case of a stroke, portions of the brain are oxygen deprived and brain cells are destroyed or damaged. Strokes were once through of as something that only happened to the elderly,...
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Federal Court of Appeals Reverses Decision in Reliance Standard Life Case and Awards Benefits to Claimant

The Fifth Circuit Court of Appeals, on appeal from the Federal District Court in Texas (a very conservative Court), has reversed a decision in favor of an insurer, Reliance Standard Life Insurance Company, and has granted benefits to a claimant, where it determined that the claim decision was an abuse of discretion, as it was not supported by substantial evidence. Reliance Standard had determined that no further benefits were payable to claimant, on two separate grounds. First, it determined that the claimant had both a physical and mental impairment, and relying upon policy language which noted a limited pay period where a mental health impairment either caused or contributed to a disability, Reliance Standard ceased paying benefits. Reliance Standard claimed that it had paid the maximum benefit of 24 months for such conditions. Second, Reliance Standard determined that the claimant no longer met the definition of disability, as it determined the claimant...
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