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Benefits Law Blog

Post-Traumatic Stress Disorder and LTD Benefits

In recent years, there has been greater recognition of post-traumatic stress disorder, commonly referred to as PTSD. Many veterans returning from overseas conflicts experience PTSD, but the condition is not limited to former military. PTSD may occur following a significant injury or psychological shock and results in persistent mental or emotional distress. According to the Sidran Traumatic Stress Institute, 20 percent of Americans will cope with PTSD in their lifetime with 13 million people experiencing it at any given time.

If you have experienced a severe injury or traumatic event in your life, the effects of PTSD are very real and may affect your ability to work. Despite increased awareness of PTSD, though, disability claims resulting from that condition are often complex and difficult to prove.

How You Talk To Your Doctor Matters

After you experience an injury or sickness that affects your ability to work, obtaining disability benefits can be as difficult as trying to recover physically. Even if you have purchased disability insurance or have long-term disability insurance (LTD) coverage through your employer, you may not fully understand how to tap into those benefits when the time comes. What steps can you take along the way to ease this process?

As is often the case, the first steps you take are often the most important. The first visit you make will be to your doctor’s office. You trust your doctor to make the right decisions and give you the right advice about your medical condition, but how that translates from the doctor’s office to the insurance company may not always be to your benefit.

What Are Pre-Existing Conditions?

In a recent Ohio federal court ruling, Linda Hines successfully challenged Unum's invocation of its pre-existing condition exclusion when she became disabled due to anisometropia, a neurologic condition where the brain is unable to coordinate the separate images generated by each eye.   Unum maintained that the cataract surgery Hines underwent during the 3-month lookback period prior to the effective date of her coverage related to the anisometropia.  In Hines v. Unum Life Ins. Co. of Am., 2018 WL 6599404 (N.D. Ohio December 17, 2018), the court overruled Unum's determination.  

Based on the language of the policy, the court had to determine whether the treatment Hines received during the three months prior to her coverage date constituted the receipt of "medical treatment, consultation, care or services, including diagnostic measures," that caused, contributed to, or resulted in her disabling condition. The court concluded that a treatment, which triggers a later condition is not a pre-existing condition regardless of the chain of causation.

Disability Claims And Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy (RSD) is a chronic pain syndrome that can occur after an injury, and its persistence is often significantly worse than the original injury. It is a difficult condition to diagnose and common for disability insurance companies to refute or deny as a compensable disability claim. The Social Security Administration, however, has published a guidance memorandum that describes the condition and offers instructive guidance to Social Security personnel, including administrative law judges, as to how disability claims involving CRPS should be assessed.

If an insurance company has denied your disability claim related to CRPS, you should not give up pursuing your claim. This disease can significantly affect your life for years to come, and you will need compensation to replace lost wages and medical bills. The insurance company should not treat your claim any differently than another claimant, and an attorney experienced in and knowledgeable about CRPS claims can assist you.

The Problem With Pain

According to the National Institutes of Health, approximately one in 10 Americans experience severe pain every day. This pain could be the result of any number of conditions. Because pain is a subjective experience, not every condition that causes pain is known -- but what is known is that pain can drastically affect your quality of life and ability to work.

Chronic pain can affect your ability to both sit for long periods of time and remain standing, interfering with your capacity to remain comfortable at home and on the job. As a result, individuals who suffer from chronic pain may need to apply for disability insurance benefits if the level of pain reaches a level of severity to precludes the continuation of work on a consistent and reliable basis.  For those who have reached that point, it is important to understand the process of applying for disability insurance and the common issues that arise in applying for these benefits.

Review Your Employee Benefits Every Three Years

We have all seen the letters in the mail. Your employer is updating their benefits policies, and by law, you are required to receive notification summarizing the changes. These notices contain a lot of legal jargon and fine print, and you probably threw them away without much more than a cursory glance. Although these updates are often difficult to understand, they can go far in explaining how your benefits are changing, and small changes can add up. How can you stay on top of these changes to ensure your benefits are optimized for the future?

Failing to account for changes in your employer benefits could mean that you lose out on the full value of your plan, putting you in a potentially tough position when you need your benefits the most. You can conduct this check whether you are currently employed, formerly employed or now a retiree anticipating payout.

401(k) Litigation Is Rising. What Could Change?

According to USA Today, the stock market gained 20 percent last year, making 2017 one of the best years for stocks since Y2K. A natural result of these gains was a rise in the value of 401(k) or 403(b) investments for consumers around the country. While the money in 401(k) and 403(b) accounts grew, so did the litigation surrounding the fiduciary duties of their providers to limit excessive fees charged to plan participants. What could change as the result of the litigation and how does it affect you as the beneficiary of a 401(k) or 403(b) account?

The potential for changes due to 401(k) litigation is important to everyone saving for retirement because new rulings can affect the way your company's plan is managed. Under the Employee Retirement Income Security Act of 1974, also known as ERISA, companies receive guidance on how to operate retirement accounts. The law establishes that employers and benefits managers are subject to fiduciary duties that require them to manage retirement plans with the best interests of their beneficiaries in mind.

Obtaining LTD Benefits For Multiple Sclerosis Can Be Complex

Multiple Sclerosis is a serious neurological disorder that is often disabling.  The Multiple Sclerosis Foundation estimates that more than 400,000 people in the United States suffer some level of symptoms from the condition. Not all cases lead to disability. However, the condition can progress to the point that continuing to work is no longer an option for some people. Unfortunately, a diagnosis alone does not automatically lead to a long term disability benefit approval and insurers may resist paying benefits if they deem the evidence of functional impairment inadequate. 

The disease does not follow a linear direction, and progression of the condition can vary widely. Symptoms are often episodic, with exacerbations and relapses. Because symptoms wax and wane, this often presents a potential pitfall for individuals seeking LTD benefits.

Is Death Resulting from Autoerotic Asphyxiation "Accidental"?

Anecdotally, the most litigated accidental death insurance claims involve drunk driving. The next most prevalent type of litigated accidental death claim are cases involving autoerotic asphyxiation. The recent ruling in Tran v. Minnesota Life Ins. Co., 2018 WL 1156326 (N.D. Ill. March 5, 2018) was one such case.

The plaintiff was the widow of an individual who hung himself while engaging in an act of autoerotic asphyxiation. Although the police were called to the decedent's home "for suicide by hanging," the medical examiner determined the cause of death was "[a]sphyxia due to hanging, autoerotic in nature" and further deemed the manner of death was an "accident." The defendant's consulting physician also concluded that the decedent's death was due to autoerotic asphyxiation; however, the claim for accidental death insurance was denied on the ground that it fell within an exception in the policy for "suicide or attempted suicide or other self-inflicted injures." The insurer deemed the death the result of a self-inflicted injury and therefore excluded. The denial was upheld following the plaintiff's appeal. The court reversed

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