Case Results

Our Firm Proves Second Bout with Breast Cancer was not a Pre-Existing Condition, Wins Benefits for Client

OUTCOME– Walker & Hern worked with her treating physicians and compiled a comprehensive, formal administrative appeal proving that she was cancer-free prior to and after the effective date of the policy. Walker & Hern proved that the second instance of breast cancer was not a pre-existing condition and that she was entitled to benefits under the policy. The insurance company reversed its decision and approved our client’s claim. She received all past-due payments and all monthly disability benefit payments thereafter.

CASE DESCRIPTION– A Texas resident successfully battled breast cancer and remained cancer-free for five years. In that first battle with cancer, she underwent a lumpectomy and post-operative treatment for cancer in the outer upper left breast, she completed all treatment with positive results. In the years that followed, repeated testing showed that she was cancer-free and no longer suffering from breast cancer.

During a routine examination five years later, she complained of severe pain in her left breast in the vicinity of her lumpectomy and subsequent radiation treatment, where there is significant local scarring and induration. This is a common side-effect. This examine took place within three months of our client starting a new job and, thus, the effective date of her long-term disability policy. Notably, just one day after the effective date of the policy, she underwent a bilateral breast MRI without and with contrast enhancement with CAD review. Although she continued to report some left breast discomfort, the final report of these tests demonstrates that she was cancer-free after the effective date of her policy.

Unfortunately, 6 months later, our client was again diagnosed with breast cancer, but in an area different and apart from that of the prior lumpectomy that continued to cause discomfort. She underwent an MRI scan, a PET scan, and an image-guided biopsy that revealed cancer in the left axilla. It was determined that surgery and radiation therapy would not be effective and that she was eligible for Eribulin studies with HER2 Neu positivity. She then underwent chemotherapy in a clinical trial. Throughout her treatment, she suffered from cognitive impairment and edema making it increasingly difficult for her to perform the essential functions of her occupation.

The insurance company denied her claim for long-term disability benefits based on the policy’s exclusion of pre-existing conditions. Walker & Hern worked with her treating physicians and compiled a comprehensive, formal administrative appeal proving that she was cancer-free prior to and after the effective date of the policy. Walker & Hern proved that the second instance of breast cancer was not a pre-existing condition and that she was entitled to benefits under the policy. The insurance company reversed its decision and approved our client’s claim. She received all past-due payments and all monthly disability benefit payments thereafter.

Monthly Benefits & Lump-Sum Settlement Won for Client With Degenerative Disk Disease & Depression.

OUTCOME– After two years, Walker & Hern negotiated a very favorable lump sum settlement of all future benefits, giving the client immediate access to significant financial resources, and protecting him from additional inquiries and the potential loss of benefits in the future.

CASE DESCRIPTION– A Minnesota resident suffering from chronic degenerative disc disease was denied long-disability benefits and contacted Walker & Hern for help. He underwent two surgeries, a cervical spine fusion and a lumbar spine fusion procedure. He had also undergone facet blocks, radiofrequency rhizotomy, and trigger point injections with no sustained relief. These treatments failed to alleviate his pain and physical impairment, and his condition continued to deteriorate until he was forced to cease work.

Despite his total disability, the insurance company denied his claim for long-term disability benefits based on the findings of an RN clinical consultant, an on-site physician, a designated medical officer, a staff neuropsychologist, and a vocational consultant – all of whom are paid by the insurance company to review benefit claims. However, these consultants did not thoroughly examine available records, and they did not possess all of the medical records which supported our client’s claim for long term disability benefits.

Walker & Hern worked with our client’s treating physicians and retained experts to rebut the conclusions of the insurance company’s experts. Our formal administrative appeal was successful, and the decision to deny benefits was reversed. The insurance company paid all past-due benefits, and made monthly benefits payments for over two years. Walker & Hern continued to represent the client through the entire two years, working his doctors, and responding to all inquiries and information requests from the insurance company to ensure that his claim file had all the objective medical records needed to prove his continued eligibility for benefits. After two years, Walker & Hern negotiated a very favorable lump sum settlement of all future benefits, giving the client immediate access to significant financial resources, and protecting him from additional inquiries and the potential loss of benefits in the future.

Benefits Restored for Registered Nurse with Back Injury

OUTCOME– The decision to deny benefits was reversed. The insurance company paid all past-due benefits and agreed to a favorable lump-sum settlement payment of the future benefits payable through retirement age. By securing a lump-sum settlement of future payments, we were able to protect our client from on-going reviews of her claim and the potential that her benefits would be terminated again.

CASE DESCRIPTION– A registered nurse in Georgia suffered an injury to her lumbosacral spine while attempting to restrain a patient. Initially, she was treated with a host of different modalities including oral analgesics, muscle relaxants, and anti-inflammatory medications. Early in her treatment, she also underwent subsequent facet joint blocks, and an MRI revealed a central disc herniation at L3-4. She underwent revision reconstructive surgery that included exploration of fusion with excision of posterolateral pseudoarthrosis at L3-4. This was followed by removal of segmental spinal instrumentation augmented by posterolateral arthrodesis with instrumentation utilizing pedicle screw-rod construct from L3 to L4.

The insurance company approved her claim for long-term disability benefits and paid her monthly benefits for over 16 years. From 1998 to 2011, the insurance company conducted 13 annual reviews of her eligibility for long-term disability benefits, and each review concluded that she was totally disabled and eligible for benefit payments. Then, in 2012, the insurance company reached a different conclusion and determined that she could perform light duty work. The insurance company terminated her benefit payments based on a misinterpretation of her doctor’s office notes and based on a functional capacity examination that was paid for by the insurance company.

The nurse turned to Walker & Hern for help. We worked with her doctors to supplement the objective medical records proving her disability, and we rebutted the functional capacity examination with proof that she could not perform light duty work. Walker & Hern submitted a comprehensive, formal administrative appeal to the insurance company, and the decision to deny benefits was reversed. The insurance company paid all past-due benefits and agreed to a favorable lump-sum settlement payment of the future benefits payable through retirement age. By securing a lump-sum settlement of future payments, we were able to protect our client from on-going reviews of her claim and the potential that her benefits would be terminated again.

Benefits Awarded to Client with Meniere’s Disease

OUTCOME– The insurance company paid all past-due benefits, and is paying all monthly benefits payments going forward. Walker & Hern continues to represent the client in all interactions with the insurance company, responding to all inquiries and information requests and making certain that his claim file contains objective medical evidence proving that his disabled.

CASE DESCRIPTION– The insurance company denied the long-term disability claim of a South Carolina man suffering from Meniere’s disease, a disorder of the inner ear causing severe dizziness, a roaring sound in his ears called tinnitus, hearing loss, and the feeling of ear pressure and pain. Several times a day, he experiences attacks of dizziness, which come on suddenly and after short periods of tinnitus, or muffled hearing. At least several times a week, he experiences “drop attacks” during which the dizziness is so bad that he loses his balance and cannot stand or walk without falling. He also suffers from a lack of appetite, nausea, and a severe loss of concentration and analytical skills. His loss of hearing requires the use of external hearing aids, and he must take 13 different medications, with side effects including drowsiness and depression. He also suffers from extremely high blood pressure and malignant hypertension.

After the insurance company denied his claim for benefits, the client turned to Walker & Hern for help. Walker & Hern worked with his doctors and retained experts, and submitted a formal administrative appeal proving that he is entitled to benefits under the policy. The insurance company paid all past-due benefits and is paying all monthly benefits payments going forward. Walker & Hern continues to represent the client in all interactions with the insurance company, responding to all inquiries and information requests and making certain that his claim file contains objective medical evidence proving that his disabled.

Arizona Man Receives Benefits Through Federal Lawsuit

OUTCOME– Walker & Hern filed a lawsuit in Federal Court under the Employee Retirement Income Security Act. As a result, the client received long-term disability benefits.

CASE DESCRIPTION– An engineer in Arizona became totally disabled after a 20-year battle with spinal problems. He underwent a lumbar and cervical fusion, as well as nerve conduction studies that documented severe motor and sensory polyneuropathy and bilateral S1 radiculopathy. A functional capacity evaluation found that he is unable to perform almost any tasks at all, including the inability to perform even sedentary work. He demonstrated a poor quality of movement and pace of activity. He required frequent changes, hand support, and short rest periods while sitting due to spinal weakness and limited endurance without spinal support. When he progressed from one task to another, his heart increased from 80 to 120 beats per minute. He was found to have low to below average manipulative and coordination skills, poor balance for narrow-based ambulation and inability to perform floor activities. An independent medical examination was also performed after the doctor reviewed the functional capacity examination. The doctor found that our client had significant functional limitations due to his cervical and lumbar disc disease and operative fusions along with chronic pain syndrome. Ignoring the results of the functional capacity examination and independent medical examination, the insurance company denied his claim for benefits. In fact, in its letter denying benefits, the insurance company misquoted the functional capacity examination and independent medical examination as concluding that he was not disabled and could work. Assuming that this was a typographical error, the client decided not to hire a lawyer and submitted an appeal without the assistance of a legal professional. The insurance company upheld its decision to deny benefits, and the client turned to Walker & Hern for help. Walker & Hern filed a lawsuit in Federal Court under the Employee Retirement Income Security Act. As a result, the client received long-term disability benefits.   Testimonials found on this website are actual client reviews of Walker & Hern. We appreciate our clients and their willingness to share their experiences. Please keep in mind that the success of any legal matter depends on the unique circumstances of each case: we cannot guarantee particular results for future clients based on successes we have achieved in past legal matters.

Federal Lawsuit Restores Benefits for Client With COPD

OUTCOME- As a result of the lawsuit, our client received past-due benefits, and the insurance company is now paying her disability benefits each month. Walker & Hern continues to represent the client in all interactions with the insurance company, responding to all inquiries and information requests, and making certain that her claim file contains objective medical evidence proving that she is disabled.

CASE DESCRIPTION– The insurance company initially approved benefits for a California resident suffering from severe Chronic Obstructive Pulmonary Disease (“COPD”), hypoxia, morbid obesity, nicotine dependency, and hypertension. Pulmonary Function Testing (“PFT”) demonstrated that she suffers from a severe mixed type A and type B COPD and severely decreased volume of air moved in one second, and at each level of her breath cycle. She only uses ½ of her lungs to breath and the other half of the air is trapped in her lung. Moreover, the studies also show that only a small fraction (as compared to normal) of oxygen taken into the lungs is sent into the blood. After only a few months of payments, the insurance company reversed course, concluded that she could perform sedentary work, and terminated her claim. She turned to Walker & Hern for help. Walker & Hern worked with her treating physicians, retained experts, and compiled a comprehensive, formal administrative appeal proving that she is unable to perform even sedentary work. In our appeal, we submitted objective medical evidence proving that the oxygen saturation level is only 40% when she wakes in the morning. This means she is awakening with only 40% of the oxygen in her blood, normal being 96% to 99% for people without COPD. This also means she is severely compromised from both a physical and a mental capacity point of view when she starts out the day. During the day, her oxygen saturation is at times 92% until she starts to do any type of movement at all, and when that happens her level goes down into the mid-80s. Ignoring the unrefuted medical evidence in our formal administrative appeal, the insurance company upheld its decision to deny her claim for long-term disability benefits. Walker & Hern filed a lawsuit in Federal Court under the Employee Retirement Income Security Act. As a result of the lawsuit, our client received past-due benefits, and the insurance company is now paying her disability benefits each month. Walker & Hern continues to represent the client in all interactions with the insurance company, responding to all inquiries and information requests, and making certain that her claim file contains objective medical evidence proving that she is disabled. Testimonials found on this website are actual client reviews of Walker & Hern. We appreciate our clients and their willingness to share their experiences. Please keep in mind that the success of any legal matter depends on the unique circumstances of each case: we cannot guarantee particular results for future clients based on successes we have achieved in past legal matters.

J. Brooke Hern, Esq. – Federal Cases