Treating Doctor v. Insurance Company’s Doctor

Long-term disability claims primarily involve gathering the right information from your doctors in order to show an accurate picture of your limitations and inability to work based on the definitions in your policy.  Many times the insurance company will attempt to contradict the opinions of your doctor by sending your medical records to an “independent” (peer review/insurance company) doctor.  The insurance company doctor does not know you and has never even seen you, yet often times, will support the insurance company’s decision to deny benefits.  At Cody Allison & Associates, PLLC, our attorneys can effectively argue against the insurance company doctor’s review based on the credentials of the doctor, their bias, as well as the quality of the review itself.

The case law in the Sixth Circuit of the United States Court of Appeals shows that in an ERISA long-term disability decision, the treating doctor of the claimant should be given adequate weight to insure a fair decision is being made.  The courts are looking to see if the insurance company acted arbitrarily and capriciously in denying benefits. They are prohibited from relying solely on their “hired guns” when making a decision.

Every case is different.  Just like you are a unique individual, your case is unique as well.

At Cody Allison & Associates, PLLC we fight denied long-term disability claims everyday.  It’s what we do.  If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation.  You can reach Cody Allison & Associates, PLLC at (615) 234-6000.  We are based in Nashville, TN; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few).  We will be happy to talk to you no matter where you live.  You can also e-mail our office at cody@codyallison.com.   Put our experience to work for you.  For more information go to www.LTDanswers.com.

 

Understanding The Definitions in Your Long-Term Disability Policy for Own Occupation to Any Occupation

Most ERISA Group Long-Term Disability Policies pay disability benefits for the first two years you may qualify for disability benefits under your policy’s definition of “own occupation”.   It is important to know what your long-term disability policy’s definition of “own occupation” is defined as.  The definition in these group policies can vary with many different versions of a definition for “own occupation”.  Certain policies may use the term “regular occupation” instead of “own occupation”.  It is extremely important to understand not only the definition of your “own occupation”, but all the definitions in your long-term disability policy.  In most ERISA Group policies, after two years of benefits have been paid for your “own occupation” period, the definition then changes to “any occupation”.   If you do not have a copy of your long-term disability policy, we would recommend you request the policy and review the definitions so you know what you need to do in order to qualify to receive these benefits.  Just because you have the policy in place, does not automatically mean you will receive the long-term disability benefits because your doctor says you can’t work.  There are many definitions and variations of definitions that you need to be aware of.   We will be happy to review your long-term disability policy free of charge and answer any questions you may have.

If you are involved in a long-term disability claim and need a qualified attorney to review your case  at no charge, please call the professionals at Cody Allison & Associates, PLLC (615) 234-6000.  You can also visit our website LTDanswers.com. At Cody Allison & Associates, PLLC we fight denied long term disability claims everyday. It’s what we do. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.

 

Systemic Lupus Erythematosus

The website Medline Plus, a service of the U.S. National Library of Medicine and the National Institutes of Health, has a great deal of information on Systemic Lupus Erythematosus, or SLE, which we have attached below.

If SLE is causing a disability, a person claiming long-term disability benefits needs to see a specialist who can administer all relevant testing. Rheumatologists are the appropriate specialists to diagnose and treat lupus. If a claimant suffering from SLE has not treated with a rheumatologist, it will be difficult for them to prove that they qualify for long-term disability benefits. Regular treatment is necessary to control symptoms, although there is not a known cure at this time.  A claimant of long-term disability benefits must maintain regular treatment, or they may not be able to show the severity of their symptoms.

If you are involved in a long-term disability claim and need a qualified attorney to review your case  at no charge, please call the professionals at Cody Allison & Associates, PLLC (615) 234-6000.  You can also visit our website LTDanswers.com. At Cody Allison & Associates, PLLC we fight denied long term disability claims everyday. It’s what we do. If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000. We are based in Nashville, TN; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com.

MEDLINE PLUS INFORMATION ON SLE:

Symptoms of Systemic Lupus Erythematosus vary from person to person, and may come and go. Almost everyone with SLE has joint pain and swelling. Some develop arthritis. The joints of the fingers, hands, wrists, and knees are often affected.

Other common symptoms include:

  • Chest pain when taking a deep breath
  • Fatigue
  • Fever with no other cause
  • General discomfort, uneasiness, or ill feeling (malaise)
  • Hair loss
  • Mouth sores
  • Sensitivity to sunlight
  • Skin rash — a “butterfly” rash in about half people with SLE. The rash is most often seen over the cheeks and bridge of the nose, but can be widespread. It gets worse in sunlight.
  • Swollen lymph nodes

Other symptoms depend on which part of the body is affected:

  • Brain and nervous system: headaches, numbness, tingling, seizures, vision problems, personality changes
  • Digestive tract: abdominal pain, nausea, and vomiting
  • Heart: abnormal heart rhythms (arrhythmias)
  • Lung: coughing up blood and difficulty breathing
  • Skin: patchy skin color, fingers that change color when cold (Raynaud’s phenomenon)
  • Kidney: swelling in the legs, weight gain

Some people have only skin symptoms. This is called discoid lupus.

Exams and Tests

To be diagnosed with lupus, you must have 4 out of 11 common signs of the disease.

Your doctor will do a physical exam and listen to your chest. An abnormal sound called a heart friction rub or pleural friction rub may be heard. A nervous system exam will also be done.

Tests used to diagnose SLE may include:

You may also have other tests to learn more about your condition. Some of these are:

Treatment

There is no cure for SLE. The goal of treatment is to control symptoms. Severe symptoms that involve the heart, lungs, kidneys, and other organs often need treatment from specialists.