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. 

Frequent Flying Results in Disability

Janine M. Gualderon vs. Long Term Disability Plan of Guild, Inc. CV 04-1049 PA "'People. Not just policies.' best describes the way we feel about our relationship with you. Responding to your needs in a caring and assuring way is of prime importance to us." These were the words of Standard Insurance Company's President and CEO in his welcoming letter to Guild, Inc., when Standard agreed to accept the company's premium dollars. It was a sentiment that wasn't quite realized in Ms. Gualderon's case. Instead, after submission of her LTD claim, an investigation began that expanded again and again, growing increasingly intrusive and adversarial. Ultimately, it delved into every aspect o

“We know we said we’d pay you, but surely you didn’t think we meant it.”

“Marvin D.” (Plan administered and insured by Aetna Life Insurance Company) Oasis Treatment Center is a residential treatment facility that provides treatment for alcoholism and drug dependency. Marvin D. was an employee of a major life insurance company, whose health plan was insured by Aetna. At the time of his admission to Oasis, Marvin D. had a serious problem with alcohol and cocaine addiction. He had been drinking and using cocaine, daily, for more than six years. It is clear that he met the diagnostic criteria for Psychoactive Substance Dependence, as outlined in the Diagnostic Statistical Manual of Mental Disorders (DSM) and it was the admitting physician’s professional opinion

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ERISA Disability Lawyer

© 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.