ERISA Disability and Health Case Histories and Random Musings by an ERISA Disability Lawyer

Mark Twain said, "Write what you know."   Over the past 25 years, I have handled just about every kind of long term disability claim denial case there is, everything from heart attacks, strokes, cancer, diabetes, fibromyalgia, degenerative disc disease, accidental injury, IBS, headache syndromes, broken eardrums, diabetes  to somatoform disorder.  I have also handled numerous health benefit claim denials for medical providers.


All ERISA claims have two things in common: (1) The facts of each case are unique; and (2) the law is always the same (until it changes).  So I thought it might be interesting to take some histories from the cases I know best, my own, and write a short blog post for each one.  Although each one is different, the same issues surface again and again. It seems insurance companies can only come up with so many ways to screw over claimants.   After a couple of decades, a lawyer can get pretty good at identifying the pattern.  Read through the posts that interest you.  And you too may see the patterns I see every day.  I have only included full client names in those cases that were litigated; and thus, are a matter of public record.


Also, from time to time, I may throw in some commentary about the practice of law in general and some perspectives about the life of a sole practitioner ERISA lawyer. 

Law? What law? Rigged data? What rigged data?

Krista C. (Self-Funded Plan administered by Pinnacle Claims Management / The Holman Group) Krista C. was admitted to the hospital for treatment. Prior to admission, the hospital contacted the Holman Group and verified that inpatient benefits were payable at 80% of "usual, customary and reasonable" (UCR) charges, subject to a $2,000,000 lifetime maximum. The hospital was advised that pre-authorization was required for inpatient care. Thereafter the hospital obtained all necessary authorizations, in writing, for the treatment rendered. This consisted of a series of seven separate authorization letters. Therefore all treatment was meticulously case-managed and approved. Total charges excee

Denial of Long Term Disability claim based on an incomplete review of the medical record.

Margaret C., M.D. (The Hartford) At the time her claim arose, Margaret was a 45-year old radiologist, employed by a very well-known hospital. She had a 35-year history of scoliosis. However, this condition did not cause any disability or otherwise affect her ability to work, until she delivered her first child. She originally left work, on maternity leave, with the intention returning to work, after the birth of her child; however, following the delivery she experienced severe, disabling back pain, as a result of which she was not able to work. She did return to work on a trial basis, working part time, but found that she was unable to perform the assigned duties of her job, even workin

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© 2014 by Michael A. McKuin

Attorney at Law

Post Office Box 10577

Palm Desert, CA 92255

(California State Bar No. 103328)


The information provided at this website is intended for educational and promotional purposes only. It is strictly general in nature and under no circumstance should it be considered legal advice.  Every case is unique and a competent, qualified lawyer must be consulted for legal advice regarding any specific case.