Category: Health insurance

Disability Caused by Subjective Symptoms

Courts struggle with disability claims caused by subjective symptoms due to the difficulty in quantifying the level of pain and fatigue experienced by a claimant. Unfortunately, pain and fatigue are the principle disabling symptoms caused by many diseases such as multiple sclerosis, fibromyalgia, rheumatoid arthritis, degenerative spine conditions, etc. The Ninth Circuit has recognized that an insurer may not disregard subjective symptoms merely they cannot be quantified or “proved” by objective testing. However, at the same time, courts also recognize the difficulty in assessing or quantifying the level of pain and fatigue caused by a disease.

There are means for helping to determine the severity of one’s pain or fatigue. We encourage clients to keep logs or journals of their symptoms. This is especially useful for those who suffer from migraines, which are unpredictable. Written notes from family members and co-workers who have observed expressions of, or limitations caused by pain may also be instructive.

Courts also look to the treatment obtained by a claimant in an effort to alleviate pain. If one undergoes nerve block injections or a subsequent surgery in an effort to alleviate pain, this is useful evidence. A person does not undergo painful treatments merely to obtain disability benefits.

Referral to a pain management specialist is also evidence of severe pain. Courts consider the fact that the pain was of such severity that a referral was necessary. It is also helpful to have documented treatment with a physician who specializes in pain management.

Finally, evidence of prescription medication for pain is extremely important. If there has been a change or increase in the medication, this is proof that the medication is not “controlling” the symptoms. Pharmacy records prove that the medication was purchased and are an accurate record of what has actually been prescribed over the course of time.

Medications may also cause adverse side effects, such as drowsiness or dizziness. This can be expected with narcotic medication and the side effects alone can be disabling. However, insurers often disregard the potentially disabling symptoms of medication side effects because the adverse symptoms were not “documented in the medical records.” We encourage clients to report side effects to their physicians, even if they are to be expected. This will ensure that all symptoms are accurately recorded in the medical records.

If you have been denied long term disability benefits based on a failure to prove disabling pain, or for any other reason, please call Kantor & Kantor at 800-446-7529 for a free consultation.

Bainbridge Island Health Insurance Experts

Question of the week! What is health insurance " special enrollment "? As we all know, the current health insurance marketplace is closed for open enrollment and you can no longer apply until the end of this year. What many…

Bainbridge Island Health Insurance Experts

Question of the week! What is health insurance " special enrollment "? As we all know, the current health insurance marketplace is closed for open enrollment and you can no longer apply until the end of this year. What many…

New York Department of Financial Services Announces New Cyber Security Measures Directed at Strengthening Insurers’ Cyber Defenses

This post was written by Emily Garrison and Andy Moss.
The New York Department of Financial Services (NYDFS) announced last week a series of measures it plans to take “to help strengthen cyber hacking defenses at insurers.” Those measures …

New York Department of Financial Services Announces New Cyber Security Measures Directed at Strengthening Insurers’ Cyber Defenses

The New York Department of Financial Services (NYDFS) announced last week a series of measures it plans to take “to help strengthen cyber hacking defenses at insurers.” Those measures include, among other things: regular, targeted assessments of cyber security preparedness at insurance companies; putting forward enhanced regulations requiring institutions to meet heightened standards for cyber security; and considering the ways in which NYDFS can support and encourage the development of the cyber security insurance market. The NYDFS stated that it plans to initiate these measures in the coming weeks and months.… Continue Reading

Healthcare Open Enrollment- final day

Today is the last business day of this years healthcare open enrollment. 2/13//15. We offer many carriers and options outside and inside the Exchange program. Please call us today if you still need help! 206 842 7410…

Healthcare Open Enrollment- final day

Today is the last business day of this years healthcare open enrollment. 2/13//15. We offer many carriers and options outside and inside the Exchange program. Please call us today if you still need help! 206 842 7410…

Health Insurance Open Enrollment ends 2/15/15

The open enrollment period for health insurance is quickly closing. There is less than a month left to enroll and the final day is 2/15/15. If you have questions, concerns, confusions, desire coverage etc…PLEASE call us! We offer no pressure,…

Health Insurance Open Enrollment ends 2/15/15

The open enrollment period for health insurance is quickly closing. There is less than a month left to enroll and the final day is 2/15/15. If you have questions, concerns, confusions, desire coverage etc…PLEASE call us! We offer no pressure,…