Autoimmune Disability – Fibromyalgia Settlement
When a hard working women with autoimmune issues was denied Short Term and Long Term Disability, she called Disability Attorney John V. Tucker for help. Her disability insurance company denied her claim despite clear evidence from her doctors that she was disabled.
Her medical records proved that she suffered from:
- widespread pain,
- overwhelming fatigue,
- inability to concentrate,
- lack of focus, and
- significant side effects of medications.
Perhaps worst of all, her symptoms were completely unpredictable. One day she would improve only to find that she was met with overwhelming symptoms the next day.
According to the disability insurance company, her case was denied because her doctors had yet to give her a specific diagnosis. For the STD and LTD insurer, her doctors notes stating “autoimmune disease” was not enough. The disability insurance company ignored the fact that our client’s doctors were still in the process of testing to see whether she suffered from Fibromyalgia, Sjögren’s syndrome, Systemic Lupus or any one of the numerous other autoimmune diseases. The insurance company had a nurse review the medical records, and it was clear that their nurse failed to understand the complexity of autoimmune issues including Fibromyalgia disability and the resulting condition known as Fibro Fog.
We filed an appeal with the disability insurance company for our client and included medical evidence that showed a confirmed diagnosis of fibromyalgia. The records also included pages of drastic restrictions and limitations that clearly showed that our client was disabled and could not perform her own occupation or any occupation in the nation economy.
The disability insurance company sent our client’s records to a doctor they called a medical reviewer. This medical reviewer never physically examined our client but merely looked at her medical records. Not surprisingly, the disability insurance company’s hired medical reviewer opined our client could work. their doctor included a list of the medical records that he reviewed, and it was clear from his report that he did not even see all the medical records we submitted on behalf of our client. Of course, the disability insurance company denied the appeal stating that our client could perform her past occupation.
Our firm filed a lawsuit in federal court against the disability insurance company arguing that they violated out client’s rights under ERISA, the Employee Retirement Income Security Act.
RESULT: We were able to negotiate a favorable settlement for our client.