Bartolic Law has helped numerous clients suffering from Ehlers-Danlos Syndrome with long-term disability insurance claims. Often, the Ehlers-Danlos Syndrome diagnosis follows a history of symptomology and other illnesses unsuccessfully treated. In one client’s case, the client suffered from chronic widespread pain, treated as Fibromyalgia. Additional symptoms, like joint hyperextension and joint pain, caused the client to undergo a diagnostic workup for Ehlers-Danlos Syndrome. The insurer denied the long-term disability claim because there was no definitive diagnosis of the etiology of the client’s symptoms.
We successfully persuaded the insurer that an illness does not have to be diagnosed or pinpointed to cause disabling symptoms, under the so-called “unknown etiology” theory. The insurance policy did not require a diagnosis, just disabling symptoms due to an illness. This resulted in the insurer approving our client’s claim. In another case, the insurer denied our client’s claim asserting no evidence of clinical findings showing Ehlers-Danlos Syndrome. We directed the insurer’s attention to numerous physician findings of joint hypermobility and joint pain. We obtained a functional capacity evaluation where the evaluator documented audible joint clicking during the exercises and limited balance. Due to our efforts, the insurer overturned the denial and paid the claim.
Ehlers-Danlos syndrome refers to various genetic disorders that impact your joints, connective tissue, skin, and more. This condition can result in skin that is overly fragile and stretchy, as well as joints that are overly flexible. One form of this condition is vascular Ehlers-Danlos syndrome, which can result in the rupture of your blood vessel walls, uterus, or intestines. Pregnant women with this disorder can experience severe complications. The symptoms of this disorder can differ from person to person. Some symptoms and effects can include overextension of joints, joint pain and dislocation, difficulty healing from wounds on the skin, curved or bowed limbs, teeth and gum issues, spinal curvature, heart valve problems, and thinning of the corneas in your eyes. Complications can develop, such as early-onset arthritis. Organ or blood vessel ruptures can be fatal in many situations.
Ehlers-Danlos syndrome cannot be prevented, as it is a genetic disorder. The overall outlook of sufferers depends on the type and severity of symptoms they experience. Some people need pain management and physical therapy, while others might suffer life-threatening complications at any time and might have extremely limited movement without pain. In these situations, it can be difficult to work and earn a living to support yourself, and you might need to seek disability benefits.
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)
If you suffer from a disabling condition, you should not delay in consulting with a disability claims lawyer at Bartolic Law. For a consultation, please fill out the questionnaire below, and one of our representatives will contact you.