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. 

Sometimes it just takes persistence.

“David W.” (Central Reserve Life Insurance Company) This was a strange and convoluted case from the beginning. David W. was admitted to a residential treatment facility for cocaine, amphetamine and cannabis dependence. Upon admission, his health plan coverage was verified as providing payment at the rate of 50% of “Usual, Reasonable & Customary” (URC) charges, after a $500 deductible. Unlike my “normal” ERISA cases, this was not an ERISA plan. It was presumably governed by Colorado law. Unbeknownst to David. his employment (and hence his coverage) was terminated two weeks before his admission. However, he didn’t learn of this termination until three weeks after he was admitted as an inpa

The impossible disability dilemma – choosing between insufferable pain or impairment from medication

John S. (CIGNA) John was a competitive swimmer in high school and college, competing in a "Master’s program", and setting 7 county records. He also enjoyed mountain biking, and playing bridge at a high level. He was employed by a major telecommunications company, where he worked for many years, first as a Senior Software Engineer, then promoted to Principal Engineer and ultimately promoted to Engineering Manager. His occupation required a high level of cognitive ability and application of analytical skills. One day when John was at a hotel swimming pool with his wife, a young boy jumped into the pool landing squarely on John’s neck and back. Since that day he suffered chronic pain, incr

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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.