WHY IT IS SO IMPORTANT THAT A SOCIAL SECURITY DISABILITY CLAIMANT’S TREATING PHYSICIANS SUPPORT HIS OR HER DISABILITY

With respect to the opinion of a Social Security disability Claimant’s treating physicians, according to 20 C.F.R. § 404.1527(d)(2), an Administrative Law Judge (“ALJ”) is supposed to give more weight to opinions from treating physicians since these sources are likely to be the medical professionals most familiar with a Claimant’s medical impairments. Additionally, an ALJ must consider the length of the treatment relationship and the frequency of examination, and the nature and extent of the treatment relationship. Continue reading “WHY IT IS SO IMPORTANT THAT A SOCIAL SECURITY DISABILITY CLAIMANT’S TREATING PHYSICIANS SUPPORT HIS OR HER DISABILITY”

INSURANCE COMPANIES IMPROPERLY RELY UPON OPINIONS OF NON-EXAMINING, FILE REVIEWING MEDICAL CONSULTANTS TO DENY BENEFITS IN ERISA LONG-TERM DISABILITY CASES

Under ERISA, before denying a claim, an insurance company or “plan” has “the responsibility to fully investigate” that claim. Capone v. Aetna Life Ins. Co., 592 F.3d 1189, 1199-1200 (11th Cir. 2010). Moreover, to survive judicial review, the termination of benefits must have “a reasoned explanation,” resulting from “a deliberate, principled reasoning process.” Davis v. Kentucky Fin. Cos. Ret. Plan, 887 F.2d 689, 693 (6th Cir. 1989); Killian v. Healthsource Provident Administrators, 152 F.3d 514, 520 (6th Cir. 1998). Continue reading “INSURANCE COMPANIES IMPROPERLY RELY UPON OPINIONS OF NON-EXAMINING, FILE REVIEWING MEDICAL CONSULTANTS TO DENY BENEFITS IN ERISA LONG-TERM DISABILITY CASES”

ERISA DISABILITY COVERAGE FOR IMPAIRMENTS CONSISTING PRIMARILY OF SELF-REPORTED SYMPTOMS

Some disability policies or ERISA plans limit coverage for “self-reported” symptoms. See, e.g., Chronister v. Baptist Health, 442 F.3d 648 (8th Cir. 2006) (2 year limitation for claims based on “self-reported” symptoms with “self-reported” defined as those that “are not verifiable using tests, procedures or clinical examinations standardly accepted in the practice of medicine”); Holcomb v. Unum Life Ins. Co. of Am., 578 F.3d 1187, 1188-89 (10th Cir. 2009) (similar limitation). Continue reading “ERISA DISABILITY COVERAGE FOR IMPAIRMENTS CONSISTING PRIMARILY OF SELF-REPORTED SYMPTOMS”