Resources

Did you know that some insurance companies blatantly discriminate against the mentally ill? Many group disability policies limit the amount of benefit they will pay if the person’s disability is caused by, or related to, a mental illness. Amazingly, some Judges have decided that this type of discrimination against the mentally ill in long-term disability policies is okay. Just think about it – what usually happens to an individual who becomes ill and unable to work? You guessed it - they become depressed. The insurance company loves to see depression mentioned in the medical record. This way they can cut their losses. They also love to see cognitive impairments in your records as well. This can result from a brain…Read More

Most individuals understand that a Plaintiff who wins his or her lawsuit will be awarded attorney’s fees and costs incurred in prosecuting their claim. Unfortunately, attorney’s fees and costs are discretionary under ERISA. Another anomaly in ERISA law is that attorney’s fees and costs may be awarded against either a losing plaintiff or defendant. That’s right. A losing plaintiff may have to pay the insurance company’s attorney’s fees and cost. Some consider it only fair that the loser pays the fee, no matter which side. Others see it as having a chilling effect on the prosecution of the claim, since an individual may forego pursuing an otherwise valid claim out of fear that they would be saddled with the other…Read More

Some employers will offer a severance package providing for salary or medical benefit continuation, if you sign a general release, releasing them from all claims. If you decide to take such a package, you must be careful not to release your ability to apply for or continue to receive disability benefits under your company’s long-term disability plan. Remember, long term disability insurance only covers you if you become disabled while employed. If your employment is terminated or if you resign and then apply for disability benefits, it may be difficult to prove that you became disabled before your employment ended. If you are considering filing a disability insurance claim you should consult with an experienced ERISA lawyer before you leave…Read More

Is There a Conflict of Interest If the Party Paying Benefits Is The Same Party Who Decides Eligibility? On Thursday, the Supreme Court answered this question with a resounding YES! The Court found, what every plaintiff ERISA practitioner already knew, that when a company determines eligibility and pay benefits out of its own pocket there is an inherent conflict of interest. Recognizing this conflict of interest, the Court went on to state that a reviewing court should consider an insurance company's conflict of interest when reviewing the denial of an employee's health or disability benefits claim. While the court did not provide much guidance on how much weight should be given to the conflict, it provides that the reviewing court…Read More

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