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. 

Just because we said so, you thought it was true? What kind of a sucker does that make you?

David A. (Self-funded plan self-administered by Blue Cross Blue Shield of Mississippi.) David A. was admitted to a residential treatment facility, with a primary diagnosis of Alcohol Dependence. At the time of his admission, he was a 39 year-old single truck driver, with a 20 year history of drinking. He reported that his alcohol use had increased over the past 8 to 10 years and that he consumed 1 to 1 1/2 pints of whiskey per day. He also reported experiencing occasional blackouts. He stated that in the two-weeks prior to admission, he had started drinking in the morning. He also stated that he had recently been arrested for driving under the influence, which had resulted in a suspensi

Your claim is denied because you don't meet our definition of "necessity".

Denise B. (Self-Funded Plan administered by American Medical Security Insurance) Denise B. was admitted to a residential treatment facility for cocaine dependency, where she spent 30 days as an inpatient, with one week of follow-up outpatient treatment. She had a 15 year history of cocaine use, but in the three years prior to her admission, her use of powder cocaine accelerated to daily use. She also reported regular use of crack cocaine in the previous one and a half years before her admission. At the time of admission, she was using 1 gram of cocaine a day and she had lost 8 pounds of body weight, in the month preceding her admission. Her admission sheet indicated that she had used a

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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.