The BenGlassLaw Long-Term Disability Team Settles Fibromyalgia Case for $300,000
The plaintiff was a 49-year-old Northern Virginia businessman who had a private (non-ERISA) long-term disability insurance policy with Penn Mutual for many years. He began to complain of chronic leg stiffness and pain. Several years later he had an automobile accident and was later diagnosed with fibromyalgia. This was confirmed by his primary care physician and a rheumatologist.
Fibromyalgia is a health condition that makes a person feel pain all over their body. People with fibromyalgia feel achy and might feel tired all the time. It can also make it hard for them to sleep well, and sometimes they might feel sad or forget things easily.
What It Feels Like
When someone has fibromyalgia, their muscles and joints hurt a lot. It’s like having a bad flu where everything aches. The pain can come and go and can move around to different parts of the body. Along with pain, people might feel really tired, even if they haven’t done much all day. It’s also common for them to feel nervous or worried.
How Do Doctors Know It’s Fibromyalgia?
Diagnosing fibromyalgia can be tricky because its symptoms are like many other conditions—there’s no simple test that can tell if someone has it right away. Instead, doctors talk to the person about their symptoms, how long they’ve been feeling them, and check if the pain is all over the body. The doctor might also do some tests to make sure the pain isn’t caused by something else.
Doctors also look for “tender points” on the body. These are specific spots that hurt more when the doctor presses on them. If someone has a lot of these tender points and their pain has been there for a long time, the doctor might say they have fibromyalgia.
Dealing with Fibromyalgia
Even though fibromyalgia can be tough, there are ways to help manage the pain and feel better. Doctors might suggest exercise, like walking or swimming, which helps with the pain and makes you feel less tired. Sometimes, they might give medicine to help with the pain or sleep problems. Talking to a counselor can also help, especially if the pain makes you feel sad or worried.
It’s important for people with fibromyalgia to take good care of themselves, eat healthy foods, get enough sleep, and try to stay active. By working with their doctor and following their advice, they can still have fun and enjoy life, even with fibromyalgia.
The Claim for Long-Term Disability Benefits
He submitted a claim for “partial disability” with Penn Mutual, who began paying partial monthly benefits. Later the company had an independent medical examination done by Dr. Ross Myerson, of Maryland, who opined that plaintiff had no trigger points diagnostic of fibromyalgia and that he had simply made a “lifestyle choice” to cut back on the hours that he worked.
After that the insurance company sent the plaintiff an “activities log” in which the insured was told to track his activities for the week. At the same time video surveillance was ordered by the insurance company.
How Disability Insurance Companies Use Activity Logs
In the process of managing long-term disability claims, insurance companies often use an activities log as a tool to assess the claimant’s daily functioning and limitations. This log requires the claimant to document their daily activities in detail over a specified period, providing insight into how their disability affects their day-to-day life. The information recorded can include physical activities, duration of activities, levels of pain experienced, and any assistance required for completing tasks.
Claimants need to be particularly careful and honest when filling out this activities log. It is essential to provide accurate and consistent information that reflects true capabilities and limitations. Any exaggeration or underreporting of abilities can lead to questions about the credibility of the claim. Insurance companies may also conduct surveillance or use other methods to verify the accuracy of the information provided in the log. If the surveillance evidence contradicts the activities recorded in the log, it could potentially jeopardize the claim, leading to a denial or reduction of benefits. Therefore, it’s crucial for claimants to be meticulous and truthful in documenting their daily activities, ensuring that the entries are a reliable reflection of their actual physical condition and daily life constraints.
In this case the insurance company then claimed that the video was not consistent with the self report of activities. Penn Mutual refused to produce the video or any claim file and threatened to close the claim and terminate the disability payments.
Negotiation and Settlement of the Long-Term Disability Claim
After an initial offer of $166,000, the parties agreed to a lump sum buyout of the policy for $300,000, and the case was settled before litigation began.
Ben Glass leads the long-term disability team at BenGlassLaw.
More Information on Long-Term Disability Claims
- Did the Disabled Claimant Go Back to Work or Not? Reliance says “Yes.”
- Third Circuit Court of Appeals Victory for a Southwest Virginia Coal Miner’s Disability Claim
- Win Your Long Term Disability Claim – Use An Expert Attorney
- Virginia Disability Attorney – Your Absolute Right to Your Claim File if Your Long Term Disability Claim has Been Denied