Recently, our firm represented a nurse with a 20 year history of headaches. She was able to work with the condition until one day was suddenly hospitalized with an extreme migraine and cognitive dysfunction. The doctors in the hospital diagnosed her with a Chiari Malformation. A chiari malformation is a serious condition where part of the brain leaks out of the skull into the spinal canal. This condition was confirmed by an MRI of the brain.
Our client was rushed for immediate brain surgery. After the surgery, she continued to suffer from cognitive issues, headaches, memory problems, dropping items and lack of basic coordination. Because she was unable to return to work due to these disabilities, she applied for Long Term Disability benefits from a national disability insurance carrier. Shockingly, the disability insurance company denied her claim.
The disability claim representative decided that her condition was pre-existing condition, because she had headaches, a symptom of Chiari Malformation, within the disability insurance policy’s pre-existing “look back period”. Fortunately for our client, she had had an MRI of her brain only a few weeks earlier which showed no Chiari Malformation.
The disability insurance company literally ignored the MRI scans and the opinions of our client’s treating doctors that the chiari malformation was a new issue unrelated to her past headaches. The disability insurance company adjuster based their decision on a medical review of the file – a paper review, not an exam – that was not even done by a doctor, but instead was done by a nurse.
Our client hired Tucker Law Group to challenge the finding she was not disabled. After a lengthy investigation, our team of disability attorneys and paralegals prepared a comprehensive appeal. The disability claim appeal was filed with statements from our client’s doctors and surgeons that the condition was not pre-existing, as well as a detailed timeline of medical treatments and events that included the MRIs of the brain and statements from the doctors that our client could not safely perform the job of a nurse. The disabled nurse was once again denied without one physical examination of her by the disability insurance company’s doctors or even a phone call to her treating doctors.
A lawsuit was filed in federal court by our experienced ERISA disability attorneys. We wanted the Court to award our client the disability benefits she deserved. Based on the strong evidence filed in the appeal the attorney for the insurance disability company quickly contacted our office and a substantial settlement was obtained.