Bartolic Law helps clients suffering from ALS get their long-term disability claims approved and paid. A frequent issue arising in ALS claims is whether it is a pre-existing condition. Often there are some symptoms that, in hindsight, may have been manifestations, though patients and doctors do not always suspect ALS as the cause, especially when there are other illnesses or injuries. In one case, our client submitted a claim for long-term disability due to ALS after receiving the diagnosis. The client earlier treated for symptoms, with both the client and doctors believing leg numbness to be caused by a decade-old back injury. After progression of symptoms, doctors began to suspect the presence of ALS and performed workup for that diagnosis, ultimately confirming it.
Because the insurer had little basis to deny the client was disabled, it denied the claim on the basis of a pre-existing condition exclusion, trying to avoid the maximum policy benefit payment for years to come. We detailed the evidence in the relevant window of time and provided the insurer with mounds of research documenting the purpose of pre-existing condition exclusions was to minimize information asymmetry and adverse selection. The purposes are not to just equip insurers to deny claims where claimants and doctors have no reason to suspect the disabling illness before the patient obtains insurance coverage. Ultimately, we got the insurer to approve the claim, permitting our client to live comfortably through medical retirement.
Few diagnoses are more concerning than one of amyotrophic lateral sclerosis (ALS), which is also commonly referred to as Lou Gehrig’s disease. ALS causes the demise of motor neurons, which prevents the brain from controlling muscle movement. Diagnoses can include familial ALS, which is inherited, or sporadic ALS, which has no known cause and affects the large majority of ALS sufferers. Early signs of ALS include stiff muscles, muscle weakness, slurring speech, or difficulty swallowing. Victims quickly lose more and more movement abilities, and most people cannot work following an ALS diagnosis.
ALS can often begin with muscle rigidity or numbness, and diagnosis can be particularly difficult if the patient ever experienced any injuries that can produce similar symptoms. This is especially true if your symptoms begin in your legs, as such symptoms can often be confused for manifestations of radiculopathies. There is no cure, and treatment is focused on slowing symptom progression as much as possible and managing pain.
Ferrin v. Aetna Life Ins. Co., 336 F. Supp. 3d 910 (N.D. Ill. Sept. 28, 2018) (holding insurance policy’s grant of discretionary authority is void under Texas law due to certificate being issued after effective date of regulation, and policy renewing after effective date, and holding Plaintiff was disabled from Any Reasonable Occupation where treating doctors certify she can sit at the occasional level, and insurer’s consultants opine Plaintiff can sit frequently, as weighing all evidence together would make capacity likely at low end of frequent range at best).
Sadowski v. Tuckpointers Local 52 Health & Welfare Trust, 281 F. Supp. 3d 710 (N.D. Ill. Dec. 20, 2017) (holding plan was arbitrary and capricious in denying medical benefits for removal of spinal cord stimulator following a fall down the stairs and infection where plan argued the expenses were caused by the same injury as the car accident necessitating implantation of the stimulator years earlier)
Tassone v. United of Omaha Life Ins. Co., 264 F. Supp. 3d 867 (N.D. Ill. Aug. 30, 2017) (awarding client long term disability benefits denied by United of Omaha despite insurer’s doctor opining there was no objective evidence of functional impairment)
Suson v. PNC Fin. Servs. Grp., Inc., No. 15-CV-10817, 2017 WL 3234809 (N.D. Ill. July 31, 2017) (holding Liberty Mutual’s denial of client’s long term disability benefits was arbitrary and capricious where Liberty Mutual disregarded client’s carpal tunnel syndrome and relied on a vocational opinion to which client never had an opportunity to address before litigation)
ALS is chronic and progressive. Insurers have few options to terminate long-term disability claims of insureds suffering from ALS once approving their claims. Evaluating exclusions, and ensuring you will have coverage long enough to avoid denial on the basis of an exclusion becomes even more important for such chronic and progressive conditions.
An ALS diagnosis can be devastating for you and your family, and you should not have to spend time and energy fighting with disability insurance companies. Bartolic Law assists with the disability claim process so you can receive the benefits you need while spending precious time with your loved ones. Contact us today to learn more about how we can help with an initial disability insurance claim or appealing a denied claim.