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Denied ERISA LTD Claims

Has your ERISA LTD claim been denied, because the Insurance company did not believe or discounted your complaints of pain using language such as the “severity of impairment” does not show you are disabled? Many insurance companies are denying claims where a claimant’s complaints of pain are at issue by discounting their validity or just saying in effect, you might hurt, but we don’t think you hurt too much to be disabled. In the case of DuPerry v. LINA, 2011 U.S. App. LEXIS 1399 (4TH Cir., Jan 24, 2011), the Fourth Circuit overturned LINA’s denial of benefits. The claimant suffered from rheumatoid arthritis, osteoarthritis and fibromyalgia, all of which are diseases that are painful but do not lend themselves to “objective” criteria of the degree of pain. The claimant supported her claim with evidence that she relied significantly on her family to performs activities of daily living, that she sometimes used a cane or walker, and that she spent most of her time in her bedroom. The treating physician supported the disability claim. The insurer denied the claim based on a file review that found no objective evidence of the condition, that the osteoarthritis appeared controlled by medication, and that “generally, patients with fibromyalgia are able to work a sedentary occupation.” The court concluded this was an insufficient basis to disregard the treater’s opinion of disability. If you have had an ERISA LTD claim denied where an insurance company used the phrase the “severity of impairment” does not show you are disabled, please contact the lawyers at Burke Harvey & Frankowski, LLC regarding this matter.