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. 

We ain’t payin and we ain’t sayin why. Oh, you got a lawyer? Here’s your money. Take it. Take it

Melissa T. (Aetna) Melissa T. was admitted to the hospital with a diagnosis of Major Depression. One month before her admission, the hospital contacted Aetna, spoke to a person identified as Marsella G. and verified that plan benefits were payable at 80% "usual, reasonable & customary" (URC) charges, subject to a $400 deductible, up to a $2,000 out of pocket maximum, and then payable at 100% URC and a 45 day annual limit (lifetime max - $2,000,000). The type of coverage was verified to be a PPO. Daycare benefit, including “partial hospitalization” (PHP) were verified payable at the same rate. Two days before admission, the hospital called Aetna again to re-verify benefits. A person id

Featured Posts
Recent Posts
Archive

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.