Multiple Sclerosis Disability: MS Disability Lawsuit Settled
A national disability insurance company denied long term disability benefits to our client – a nurse that suffered from Multiple Sclerosis. Our client participated in a group Long Term Disability (LTD) plan through work, and the disability insurance company underwrote the group disability insurance policy which funded the plan. Not surprisingly, the disability insurer denied her disability claim, taking the position that she could still perform her own occupation as a nurse.
The LTD insurer claimed that our client’s symptoms were not disabling. They ignored all of the records from the nurse’s treating doctor who opined that she was unable to perform her own job or any job in the national economy, and explained many limitations as the reason for his opinion.
The nurse contacted John Tucker to challenge this denial of her LTD benefits. The pre-lawsuit appeal was handled by experienced Disability Attorney William C. Demas, a member of our Disability Benefits Team, who obtained vast amounts of evidence, including detailed statements from our client’s treating doctor who specializes in treating MS patients. Multiple Sclerosis had exacted a toll on her, and her doctor explained that her diseases had limited her such that
- she could not work a full day as a nurse;
- she likely would miss at least four days of work a month, a key standard for most vocational experts to conclude that a person is incapable of holding down a competitive job in the marketplace; and
- she would not be able to concentrate or remember simple tasks and could not ensure patient safety as a nurse.
Among the objective evidence that our disability team developed was proof from radiologists and her treating neurologist that her MRI reports that showed that the MS lesions had increased in size and number. In Multiple Sclerosis disability claims, this is a key marker not only to prove that MS is present, but also to prove that it is progressing.
Tragically, our client had also suffered a rapid decline her overall health, and she was diagnosed with early onset dementia. With this evidence, Mr. Demas filed an appeal. The disability insurance company upheld its own denial even in the face of all the evidence. It was clear in the appeal decision that the disability insurance company did not send all the medical records to their reviewing doctor. Also the paper review doctor hired by the LTD insurance company did not specialize in treating MS patients; he was merely a general Neurologist. Despite this, the insurance company denied our client’s disability claim appeal.
Attorneys John Tucker and William Demas filed suit in Federal Court under ERISA, the group employee benefits law to fight the insurance company’s denial. Our team developed significant evidence that the disability insurance company failed to properly provide a full and fair review of the claim, as required under ERISA. After months of litigation, we were able to obtain a substantial settlement for our client.