Federal Lawsuit Restores Benefits For Client With COPD
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.
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 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 al 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 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.