California Insurance Lawyer Blog

The Kantor & Kantor website contains useful information to guide an insured if he or she elects to handle their own ERISA appeal. In some circumstances, this may be appropriate. However, we frequently see problems created by insureds who have handled their own appeals. These problems are usually due to the fact that an insured is unfamiliar with the claim review process. The errors we frequently see are:

• The insured is under the misconception that a request for a “written explanation” or “a narrative” from the insurer will be satisfied with a detailed letter from the insured describing his disability. Although an insurer may request an “explanation” or “a narrative,” it rarely gives any weight to statements by the insured. Rather it relies upon medical or vocational evidence by experts, such as physicians and vocational counselors.

• The insured believes that an insurer’s designated “independent medical examination” is truly “independent.” Insurers routinely hire physicians who will support the financial interests of the insurers. These physicians obtain repeat business from the insurers and are motivated to support the entity who is paying for their report. In reality, the examinations are far from “independent.”

• There is misinformation in the attending physician’s records. Often clients will downplay their true medical condition when describing their ailments to their attending physicians. We often see notes in medical records indicating that the insured is “about the same” or “doing better.” These notes do not give the full picture of the ailments which are currently being experienced and may give the false impression that one has improved to the point of being able to return to work. When a physician inquires how the patient is doing, the better response is to accurately describe all current symptoms. The patient should also give a full description of any medication side effects he or she is experiencing. Without a full description of the problems, the necessary information will not be contained in the attending physician’s records.

• The insured does not supply adequate evidence of the true job duties he or she was required to perform. Often, job descriptions are vague or outdated. Merely advising the insurer of the job requirements is not sufficient. Rather, the information should come from the employer or a vocational expert.

Although one’s attending physician and/or employer believes that a patient/employee is truly disabled, they may not have the time to advocate on the insured’s behalf. If this is the case, we strongly recommend that the insured retain an attorney to ensure that supportive, credible evidence is submitted with the appeal. If you find that you need assistance with your ERISA appeal, please call us for a no-cost consultation at (800) 446-7529 or visit www.kantorlaw.net.

New research by Cathrine Austad, MD (Department of Rheumatology Diakonhjemmet Hospital, Oslo, Norway) calls attention the impact of sleep disturbances on pain and functional status in rheumatoid arthritis (RA) patients. This new research, presented at the annual meeting of the American College of Rheumatology http://www.rheumatology.org/, found poor sleep quality to be independently associated with increased pain. See: www.painmedicinenews.com

Sleep disturbances in RA – most likely due to factors such as inflammation, corticosteroid usage or pain itself- has been a relatively understudied issue. Based on these findings, Dr. Austad and her team suggest that clinicians address sleep disturbances with RA patients in their daily practice. In doing so, physicians might help improve sleep quality and reduce the effects of RA. Theodore A. Omachi, MD, assistant professor at University of California San Francisco School of Medicine predicts that“…addressing this issue more directly may allow providers to take a large step forward in treatment.”

At Kantor & Kantor, many of our clients living with RA have been adversely affected by the various painful (and cognitive) symptoms of their illness. Although a challenging and complex task, addressing and improving sleep patterns could potentially ease some of the pain and discomfort associated with RA. Living with an autoimmune disease can present many debilitating struggles. Unfortunately, restful sleep is one of them.

In 2011, researchers from the University of Pittsburgh's School of Nursing questioned 162 people with RA and found that their pain and fatigue levels were higher during days when they didn't sleep well the night before. See: http://www.upmc.com/media/NewsReleases/2011/Pages/pitt-school-of-nursing-study-finds-poor-sleep-associated-with-greater-pain-ra-patients.aspx. Leading researcher on this study, Faith S. Luyster, Ph.D., assistant professor, School of Nursing, explained that “not sleeping well at night can contribute to greater pain sensitivity and fatigue during the day, which in turn can limit a patient’s ability to engage in activities of daily living and discretionary activities.”

Though not effective for everyone, there are many suggested techniques for improving quality of sleep for patients with RA. Read more about them here: www.everydayhealth.com/

As attorneys who represent clients who have been denied Long Term Disability benefits for RA, we understand how life changing this illness can be. If you have questions about your RA and Long Term Disability benefits, do not hesitate to call us for a no-cost consultation. We work on a contingency basis, meaning that we do not collect a fee unless we get your claim paid.

We understand, and we can help.
www.kantorlaw.net (800) 446-7529

After extensive examination, Cigna (aka LINA) faces major consequences for improper denials of long term disability claims. In a settlement with five state insurance regulators (California, Connecticut, Maine, Massachusetts, and Pennsylvania), Cigna is responsible for setting aside $77 million to fund a re-evaluation of previously denied claims.

Cigna has agreed to review a subset of past long-term disability claims which were denied in 2009 and 2010 (California residents will have claims reviewed for 2008 through 2010) to see if they meet updated claims standards. Preparing for a possible payout to policyholders, Cigna has set aside $48 million as they review their procedures for gathering information and documenting decisions in claim files.

“This regulatory action is intended to provide long-awaited relief for consumers who have a right to expect that their carrier will make good on contractual promises,” Connecticut Insurance Commissioner Leonardi said in a statement. “This settlement resulted from market conduct exams and encompassed issues of serious concern.”

This regulatory settlement also requires Cigna to improve their claims handling process to benefit current and future policyholders, participate in a 24-month monitoring program, and pay fines and administrative fees totaling $1.7 million. See http://www.hartfordbusiness.com/article/20130522/NEWS01/130529904

As attorneys who represent clients unfairly denied long term disability benefits, we are unfortunately all too familiar with improper decisions and wrongful denials by insurance companies. At Kantor & Kantor, we spend every working day correcting and challenging improper disability denials so that our clients have access to the disability benefits to which they are entitled. If you have questions about your long term disability insurance claim, do not hesitate to contact us for a no-cost consultation.

We understand, and we can help. www.kantorlaw.net (800) 446-7529

Insurance woes. Many of us have heard about a “friend of a friend,” or “some guy” who has been well and truly abused by their health insurance company. We all have the same response -- “that’s horrible,” or something to that effect. Luckily, though, most never get the pleasure of dealing with insurance shenanigans first hand. Well, I’m here to tell you that real people do have to deal with health insurance B.S., for lack of a better word, and it can range from being mildly annoying to thoroughly life-changing.

I was diagnosed with Rheumatoid Arthritis when I was nine. In 1987, before compact discs, the PC, and MTV, I was a mere third-grader who, we thought, had simply caught a bad case of the flu. After several weeks of harboring this “flu” without improvement, the doctors began to look for other causes. To cut a two-year story very short, let’s just say that I was diagnosed with something called Juvenile Rheumatoid Arthritis when I was eleven. My mother diligently spent hours upon hours reading and researching the disease at libraries all over – the “Wikipedia” of the real world at the time. Unfortunately, as is still true today, doctors did not have any idea what caused the illness. So, as one of the first serious cases of the disease in my area, my parents and I went from doctor to doctor, agreeing to test after test, just on the off chance one of the procedures would provide some insight into the ailment that was previously unknown. That never happened, though, and I went from a child with Juvenile Rheumatoid Arthritis to an adult with plain old R.A.

Throughout my childhood and early adulthood, I was lucky enough to be covered by what could be called a “Cadillac” insurance plan. I was able to choose my own doctors, purchase experimental medication, and have any procedure performed without pre-authorization. I cannot imagine what would have happened if we had to fight my health insurance company in those uncertain initial years – I could have ended up in a wheelchair. I tell you this because I want you to understand that I have experienced the good side of health insurance as well as the bad, and the difference is striking.

Eventually the Cadillac plan became too expensive to sustain. Because I was officially disabled, I was also automatically enrolled in Medicare. Because Medicare is always the primary insurance, I was basically paying upwards of $12,000 dollars a year for secondary insurance. So I dropped the Cadillac plan and Medicare became my sole insurance carrier.

Now, I have to take this opportunity to tell you that Medicare is one of the best insurance carriers I have ever dealt with – but that classification comes with two corollaries. First, it must be said that I suffer from a disease that is on the Medicare short list for ailments that are allowed a very large amount of leeway when it comes to insurance claims. Second, I am only talking about hospital stays, doctor’s visits, and medical procedure coverage. Prescription coverage is an absolute and utter nightmare.

For those of you who don’t know how Medicare works here is a brief summary. Part A is the hospital coverage, which covers hospital stays and part B is the actual medical insurance, which covers doctor’s visits and the like. Both of those parts pretty much take care of themselves and are more or less painless in their execution. Part D, though, is the prescription coverage, and even understanding it is a Rubik’s Cube of donut holes, external medical insurance companies, and denial appeals.

...

Continue reading "Our First Guest Blog: Daniel Malito writes about struggles with getting his pain medication paid for" »

Like the average consumer, we are always curious about the claim approval and denial rates of health insurance companies. A new law in Vermont satisfies that curiosity by requiring health insurers who do business in Vermont to disclose claim denial rates. Not surprisingly, the insurer with the largest profit also had the highest denial rate. Blue Cross Blue Shield of Vermont denied 7.6% of claims, MVP denied 15.5% of claims, and Cigna denied 21% of claims. Blue Cross and MVP are non-profit companies and Cigna is a for-profit corporation.

The most alarming statistic is that of the 377,352 claims that were denied last year (as reported to Vermont) there were only 456 post-service appeals. That means that 99.8% of all denied claims are never appealed. What this really means is that health insurers are winning the fight unless insureds are willing to step up and hold insurance companies accountable for benefits that are available and payable under the policy. As the Vermont Public Interest Research Group (VPIRG) reported, “These numbers confirm what we already knew, that insurers have little disincentive to deny claims when there is such a miniscule chance that these denials will actually be appealed.”

You can read more about Vermont’s efforts to gain transparency at Vermont Public Interest Research Group’s website: http://www.vpirg.org/news/pulling-back-the-curtain-on-denied-claims/ and a link to the filings of MVP and Blue Cross at http://vtdigger.org/2013/03/20/new-disclosures-show-mvp-denied-15-5-percent-of-patient-claims-in-2012-blue-cross-denied-7-6-percent/
And http://www.huffingtonpost.com/wendell-potter/the-higher-health-insurer_b_3137831.html

Brent Dorian Brehm, a seventh year associate of Kantor & Kantor LLP, was recognized by The Recorder as part of their 2013 Lawyers on the Fast Track list - which recognizes California’s young emerging legal leaders.

Unlike many other honors in the legal field, this list considers both a lawyer’s body of significant legal achievements and their achievements in serving the larger community. As such, this award sets Mr. Brehm apart from his peers, highlighting a body of motion and trial experience few attorneys have compiled to this point in their career while recognizing the work he has performed in the greater Los Angeles community.

Mr. Brehm has spent his entire career advocating for individual’s rights to disability, life, health, and long term care insurance benefits with one of the preeminent firms in the area of ERISA (Employee Retirement Income Security Act) and bad faith insurance litigation, Kantor & Kantor, LLP. While with the firm, Mr. Brehm has resolved well over 150 disputes with insurance companies on behalf of his clients, and has made the transition to lead attorney on many of his cases. At least 13 nationally reported decisions in his client’s favor (including five cases published in the official reporter and five trial judgments in which Mr. Brehm was lead counsel) speak as testament to Mr. Brehm’s advocacy skill and experience gained through practice.

In addition to his many legal accomplishments, Mr. Brehm gives back to his community. When not practicing law, Mr. Brehm enjoys volunteering for Reading to Kids, an organization dedicated to helping inspire a love of reading in children from underserved portions of inner-city Los Angeles. Mr. Brehm was recognized by Reading to Kids when it named him as a recipient of the Distinguished Volunteer award. This effort to better serve the underprivileged members of his community has its roots in Mr. Brehm’s early volunteer activities with the Mexico Orphanage Mission and Food Not Bombs. After law school, his efforts sprouted into working to improve the quality of life for the homeless through work with the East San Gabriel Valley Coalition for the Homeless. On an international level, Mr. Brehm has paired his love of cycling with World Vision’s Bikes for Africa project: helping raise awareness for the project in addition to offering financial support.

After careful review of the professional and civic achievements from nearly 200 California attorneys in their first 10 years of practice, Mr. Brehm was selected as a top contributor to the practice of law and to his community. Mr. Brehm is honored to be recognized by The Recorder. Earlier this year Mr. Brehm was recognized by the Los Angeles and San Francisco Daily Journal, as part of their “Top 20 Under 40” list as a rising star in the California legal industry. Mr. Brehm is proud that these publications, through such awards, recognize the importance, skill, and dedication of all ERISA attorneys in protecting the rights of claimants.

See an online version of the Recorder’s announcement here: http://www.law.com/jsp/ca/PubArticleCA.jsp?id=1202596780843&Introducing_50_California_Lawyers_on_the_Fast_Track&slreturn=20130319154839. Be sure to check a special edition of The Recorder on June 24th for the full profile.

To learn more about Mr. Brehm and the firm of Kantor & Kantor see www.kantorlaw.net or call (800) 446-7529.

If you have long term disability insurance through your employer, you probably know that you are entitled to a benefit if you ever become unable to work because of injury or sickness. The amount of the benefit varies, but it is typically 50-60% of your salary.

However, what you may not know is that most long term disability benefit plans usually don’t even pay that much. Why? Because most plans contain “offset” provisions.

What are offset provisions? Offset provisions state that if you are receiving money for your disability from other sources, the plan can reduce your benefit by that amount. Typically, benefit plans contain offsets for such things as state disability benefits, Social Security disability benefits (both SDI and SSI), and worker’s compensation benefits, among other things. Plans can even offset for income that isn’t related to your disability, like pension benefits.

If this is all new to you, you might want to get an idea of how this offset could work for Social Security Disability Benefits. You can go to the SSA website to calculate an estimated benefit, which you can then use to estimate how the offset would reduce your long term disability benefit. Visit the SSA site here: http://www.ssa.gov/OACT/quickcalc/index.html

Because most people are entitled to at least one other form of disability benefit, this means that your employee benefit is usually not even the 50-60% amount stated in the benefit plan – it’s actually less. In fact, in some cases, your benefits from other sources can be large enough that your employee benefit is reduced to zero. Some plans will still pay a nominal minimum benefit in such cases, but some do not. In other words, even though you are disabled and eligible for an employee disability benefit, your benefit amount could be nothing at all.

Because the amount of your employee benefit is dependent on your receipt of other benefits, you must be very careful in deciding whether to apply for other benefits, and if so, how to do it. Realize however, that sometimes, you may not even have a choice as your disability plan may require you to apply for these other benefits. As employee benefit specialists, we can help if you have questions. If an insurance company is reducing your benefit because of offsets, and you think they have made a mistake, please contact us.

In January of this year, Kantor & Kantor secured a judgment against Unum Life Insurance Co. http://www.unum.com/, a Fortune 500 company and the largest group and individual disability carrier in the United States. (click here for a copy of the ruling Mondolo v. Unum Life Ins. Co. of Amer., C-11-07435 CAS (MRWx) (C.D. Cal., order filed January 16, 2013). http://www.kantorlaw.net/documents/59-Mondolo-13-01-17-Findings-of-Fact-Order.pdf

Our client, a resident of Los Angeles County, was suffering from fibromyalgia and avascular necrosis (aka bone death, believed to be a result of leukemia treatment). She had been treating for these conditions at U.S.C.’s Keck School of Medicine and had been on disability since July 2009. After paying long term disability benefits for over a year, Unum terminated our client’s disability benefits. Unum’s Gilberto Del Real determined that our client was not disabled because she was capable of working in a sedentary occupation. After our client appealed, Unum’s Stephanie LeSieur also erroneously concluded that our client was capable of sedentary work.

“Like so many group disability insurers, Unum labored under a structural conflict of interest because Unum has both the duty to determine whether claimants qualified for benefits and the responsibility for paying those benefits,” said Kantor & Kantor partner Alan E. Kassan
, who assisted associate Brent Dorian Brehm on the case. “Unum’s bias led the court to review Unum’s decision regarding our client’s benefits with enhanced skepticism and the denial could not withstand scrutiny.”

Kantor & Kantor was able to prove that Unum’s structural conflict of interest had contributed to its decision to terminate his client’s disability insurance benefits. In reaching its decision, the court noted Unum’s history of biased claims administration and case specific facts that the Kantor lawyers argued aggravated Unum’s conflict of interest. The court found the following:

•Unum failed to properly investigate the client’s claim, neglecting to determine how much sitting she could tolerate without significant pain.
•Unum did not investigate whether the alternative jobs it claimed our client could perform were appropriate for her limited ability.
•Unum and its reviewing physicians failed to consider psychological evidence, even though the policy expressly stated that such evidence must be considered.

In addition, attorneys Kassan and Brehm argued that Unum’s conclusions were unreasonable. For example, Unum insisted our client could sit between one-third and two-thirds of a work day. The Kantor attorneys proved even if Unum’s supposition was accurate, our client was still not able to meet the requirements of, or perform the sedentary work for which Unum argued she was capable.

Click here http://www.kantorlaw.net/Cases_Resources/Document_Library.aspx to learn more about this case.

At Kantor & Kantor, we spend every working day doing one thing: helping people resolve disputes with their insurance companies. Life is difficult enough for people living with chronic illness, and we understand that being denied disability coverage by your insurance company or employer only exacerbates the situation. If you are in need of the services we provide, please call us at (800) 446-7529 for a no-cost consultation or go to www.kantorlaw.net for more information.

In 2003, the Food and Drug Administration approved the use of growth hormone (GH) for the long-term treatment of idiopathic short stature (ISS), which refers to extreme short stature that does not have a diagnostic explanation, such as GH deficiency. Unfortunately, GH treatment is expensive and, as a result, insurance companies often resist paying for it.

Follow this link to an article we have prepared which discusses how ISS is defined, how it is diagnosed, how insurance companies try to avoid payment for it and how we respond to the insurance companies’ arguments: http://www.kantorlaw.net/documents/Article-on-HGH-treatment-DJO-4-5-13-pdf.pdf

In August 2012, Kantor & Kantor posted this blog on the unfounded assertion that receiving disability insurance is a positive substitute for gainful employment: http://www.californiainsurancelawyerblog.com/2012/08/ridiculous_to_claim_disability.html

More recently, we encountered NPR’s week long series titled, “Unfit for Work: The Startling Rise of Disability in America." This series advanced a number of misleading thoughts about living and working with a disability. These include:

1. The implication that people with disabilities are either taking advantage of government assistance or being victimized by it.
2. The failure to explain why people might have the same diagnosis, yet experience symptoms that differ in severity and impact on daily living.
3. A false impression expressed about how disability is actually determined, suggesting that one’s personal physician can make this claim without the involvement of insurance investigations, background checks, medical examinations, medical/employment/financial records, interviews by insurance companies, etc.

As attorneys who represent clients with various types of chronic illnesses, we have come to appreciate the devastating and painful effects of life with a disability. Those who disparage the necessity of Social Security Disability Insurance (SSDI) and disability insurance, which our clients depend on, have probably never suffered from a chronic disabling condition nor had a loved one disabled by disease. Beyond the physical impact, our society has a long history in which many people acquire a sense of identity and purpose from their occupation. This is lost when they become disabled. Additionally, this is a space where many social relationships are formed as a result of job-related interactions. When illness forces you to prematurely leave your occupation, this experience can be just as painful and isolating as being diagnosed with a debilitating illness.

Before assuming that disability has become “a de facto welfare program for people without a lot of education or job skills,” it is important to consider the reasons for the rise in disability claims. Firstly, baby-boomers are aging, and with age comes a host of disabling conditions. Also, during the past 40 years, more and more women have entered the workforce. Although medicine can’t explain why, women tend to be impacted more than men by some severely disabling conditions. Both of these factors will drive up the number of disability claims.

Charles Martin and Debra Shifrin from the National Organization of Social Security Claimants' Representatives (NOSSCR) have said that “Disability benefits protect the most vulnerable members of our society, who have no other options.” We couldn’t agree more.

If your long term disability claim has been denied, contact Kantor & Kantor for a no-cost consultation at (800) 446-7529. We understand, and we can help.

Chronic fatigue syndrome (CFS) is a long-term and debilitating condition that affects at least one million Americans. The symptoms are complex, often including intense physical and mental fatigue (usually made worse by exertion), muscle and joint pain, disturbed sleep, and both concentration and memory problems.

Chronic fatigue syndrome derives its name from its dominant symptom – fatigue. However, CFS has eight other official symptoms:
• Loss of memory or concentration
• Sore throat
• Enlarged lymph nodes in your neck or armpits
• Unexplained muscle pain
• Pain that moves from one joint to another without swelling or redness
• Headache of a new type, pattern or severity
• Unrefreshing sleep
• Extreme exhaustion lasting more than 24 hours after physical or mental exercise

Those who suffer from CFS can experience debilitating cognitive dysfunction and mental fatigue. This is commonly referred to as “brain fog.” A recent research study found that the main cognitive disruption in those living with CFS was attributed to slow information processing. After comparing several types of cognitive dysfunction between control subjects and those with CFS, they found information processing speed and reaction time to be impaired in those with CFS.
Interesting to note, researchers discovered that information processing problems did not seem to be a consequence of psychiatric status, depression, anxiety, the number or severity of CFS symptoms, fatigue, sleep quality, or everyday functioning. While the CFS group showed impaired reaction time, they displayed comparable performance on attention, memory, motor function, verbal ability, and spatial ability (even though these remain commonly reported problems in CFS) to the control subjects. The significance of these findings is unclear, but prompts us to consider the relationship between the cognitive symptoms of CFS and information processing difficulties.

While parts of CFS and its relationship with its symptoms are not yet fully understood by the scientific community, studies continue to show that the symptoms and life altering effects are real. Many of our clients have been deeply impacted and disabled by the cognitive and physical symptoms of CFS. Their complaints of extreme fatigue, pain, and cognitive impairment are often dismissed by insurance companies in deciding claims. Often this is because there is no single diagnostic test to confirm the illness.

If your CFS has adversely affected your ability to work, contact Kantor & Kantor for a no-cost consultation. We can help. Find us at www.kantorlaw.net or call (800) 446-7529.

On March 29, 2012, the United States Senate officially declared April as Parkinson's Disease (PD) Awareness Month. With many clients who suffer from Parkinson’s Disease, Kantor & Kantor recognizes the magnitude of this illness and the importance of dedicating this month to research, promoting awareness, and spreading information about the disease.

The Parkinson’s Disease Foundation (PDF) is an organization with the mission to find a cure, to advance research, to increase knowledge, to empower the community and to ensure that those living with the disease enjoy the best quality of life possible. See http://www.pdf.org/en/mission

This organization offers valuable information for our clients and their families on topics that include: understanding the illness, coping with a recent diagnosis, managing PD and support for care partners and family. These are just a few examples of the many resources available on the PDF’s website. See http://www.pdf.org/.

In addition to providing assistance with coping with PD, the website can also serve as a valuable resource for those who choose to make a disability claim. If you have been diagnosed with PD, and the symptoms of the disease and side effects of treating medications becomes disabling, you might want to consider submitting a claim for disability benefits through your private or employer-provided disability plan.

Unfortunately, insurance companies don’t always understand how devastating and life changing this illness can be. If your Long Term Disability claim is denied, The Parkinson’s Disease Foundation can be used as a valuable resource when researching how to prove to your insurance company that your condition and its symptoms are disabling. One requirement of most disability policies is that the claimant be undergoing ongoing treatment for the disabling condition. This website provides information that helps you to understand exactly what type of care that is.

If you get your insurance coverage through your employer, as most people do, you fall under the umbrella of ERISA (Employee Retirement Income Security Act). Under the Employee Retirement Income Security Act, you have a legal right to appeal the denial of disability benefits. The burden and responsibility of proving your claim becomes yours. It is crucial for you to create a record of documented evidence during the appeal in case litigation becomes necessary in the future. Do NOT rely on your insurance company to help you.

Managing an appeal on your own can be risky if you are not physically or mentally capable. If the case becomes too complicated to handle on your own, you may want to seek out advice from a professional. Kantor & Kantor has a team of experts that work on a on a contingency fee basis, which means you only pay if we obtain a benefit for you. We understand the struggle of living with a chronic disease, and we are here to help. For questions about your long term disability claim, call (800) 446-7529.

Brent Dorian Brehm, a seventh year associate of Kantor & Kantor LLP, was recognized by the Los Angeles and San Francisco Daily Journal, as part of their “Top 20 Under 40” list of California’s emerging legal leaders, as a rising star in the California legal industry. Mr. Brehm has spent his entire career advocating for individual’s rights to disability, life, health, and long term care insurance benefits.

Mr. Brehm has spent his career with one of the preeminent firms in the area of ERISA (Employee Retirement Income Security Act) and bad faith insurance litigation, Kantor & Kantor, LLP. While with the firm, Mr. Brehm has resolved well over 150 disputes with insurance companies on behalf of his clients. As a litigation associate, Mr. Brehm has developed a body of motion and trial experience few attorneys have compiled to this point in their career.
At least 13 nationally reported decisions in his client’s favor (including five cases published in the official reporter and five trial judgments in which Mr. Brehm was lead counsel) speak as testament to Mr. Brehm’s advocacy skill and experience gained through practice.

Having established a track record of success early in his career, Mr. Brehm has made the transition to lead attorney on most of his cases. In one such case litigated in San Francisco, Mr. Brehm secured the first trial judgment in the nation on behalf of a plan participant against AT&T’s long term disability plan in the hotly contested case of Peterson v. AT&T Umbrella Ben. Plan No. 1, 2011 WL 5882877 (N.D. Cal. 2011). Last month, in a case tried in Los Angeles, Mr. Brehm received another favorable trial judgment, this time against Unum Life Insurance Company – the largest group disability insurer in the United States. (Mondolo v. Unum, 2013 WL 179711 (C.D. Cal. 2013)).

To learn more about Mr. Brehm and the firm of Kantor & Kantor see www.kantorlaw.net or call (800) 446-7529.

In 2006, March was designated MS (Multiple Sclerosis) Awareness Month. This year, the National Multiple Sclerosis Society spreads awareness by emphasizing the impact of connection. While MS destroys the connection between the body and mind, and between people, advocates can strengthen and encourage connections through sharing knowledge and information.

According to the National MS Society:
• There are currently 2.1 million people living with MS.
• Every hour of every day someone in the U.S. is diagnosed with MS.
• Most people are diagnosed in their 20’s or 30’s…but it lasts a lifetime.
• There is no cure.

What is MS?

MS is a chronic disease that strikes the central nervous system (CNS). The immune system attacks the CNS leading to damaged nerve fibers. This damage creates scar tissue (sclerosis), and distorts the nerve impulses traveling to and from the brain and spinal cord. The flow of information between the brain and body is interrupted. The symptoms can be disabling- affecting the brain, spinal cord, and optic nerves. MS presents itself differently for each individual, and its severity and symptoms are difficult to predict.

Each year at this time, advocates come together to spread awareness, raise funds for research, and offer support and connections within the MS community. At Kantor & Kantor, many of our clients suffer from MS, and seek our assistance when their disability benefits have been unfairly denied. We understand that living with MS can be painful, difficult, and challenging. Being denied benefits by your insurance company only aggravates an already complicated condition. Contact our office at (800) 446-7529 or on www.kantorlaw.net if your claim has been denied. We can help.

In 2006, March was designated MS (Multiple Sclerosis) Awareness Month. This year, the National Multiple Sclerosis Society spreads awareness by emphasizing the impact of connection. While MS destroys the connection between the body and mind, and between people, advocates can strengthen and encourage connections through sharing knowledge and information.

According to the National MS Society:
• There are currently 2.1 million people living with MS.
• Every hour of every day someone in the U.S. is diagnosed with MS.
• Most people are diagnosed in their 20’s or 30’s…but it lasts a lifetime.
• There is no cure.

What is MS?

MS is a chronic disease that strikes the central nervous system (CNS). The immune system attacks the CNS leading to damaged nerve fibers. This damage creates scar tissue (sclerosis), and distorts the nerve impulses traveling to and from the brain and spinal cord. The flow of information between the brain and body is interrupted. The symptoms can be disabling- affecting the brain, spinal cord, and optic nerves. MS presents itself differently for each individual, and its severity and symptoms are difficult to predict.

Each year at this time, advocates come together to spread awareness, raise funds for research, and offer support and connections within the MS community. At Kantor & Kantor, many of our clients suffer from MS, and seek our assistance when their disability benefits have been unfairly denied. We understand that living with MS can be painful, difficult, and challenging. Being denied benefits by your insurance company only aggravates an already complicated condition. Contact our office at (800) 446-7529 or on www.kantorlaw.net if your claim has been denied. We can help.

The Regulations governing ERISA claims have time limits governing the claim and appeal process. According to the Regulations, a claimant has a minimum of 180 days to appeal a denied disability claim. An insurer must decide the appeal within 45 days, or if “exceptional circumstances,” exist, may request an additional 45 day period to decide the appeal.

Recently, we have seen insurers attempt to obtain additional time by delaying or “tolling” the appeal, while they purportedly obtain additional information from third parties (such as an “independent” medical examination). We believe that any delay due to a request for third party information is an insufficient basis to “toll” the time for conducting an appeal and is an improper delay of the appeal process.

The Regulations do permit an insurer to “toll” an initial claim, while they request and wait for records or information. However, once a claim has been denied and it has been appealed, an insurer may not extend the deadlines, by claiming that it needs additional information from third parties. Rather, the time for deciding an appeal may not be “tolled” unless the insured has failed to submit information to decide a claim. 29 C.F.R. 2560.503-h(i)(4).

Don't let your insurance claims administrator take advantage of you, and delay the payment of your benefits longer than the law allows. Insist that they comply with the regulations and communicate with you in a timely manner. If you let them know that you are an educated consumer, the odds are that they will attend to your claim more carefully.

Of course, if you ever have any questions. Call us, we can help!

The American Academy of Neurology published a report in its journal Neurology predicting that many more people than previously thought will become disabled by Alzheimer’s disease, the total number reaching 13.8 million by 2050 and costing more than $1 trillion a year to treat. See, “Alzheimer’s cases, costs, projected to swell.”

“The growth in new cases – especially as baby boomers pass the age of 75 – will put pressure on generations behind them to provide massive amounts of care,” writes Los Angeles Times reporter Joseph Serna.

The federal government is spending hundreds of millions to fund research for development of drugs to treat the disease. The National Alzheimer’s Project was founded in 2011 to ask public, private and nonprofit groups to come up with treatment plans and ways to help caregivers tasked with the overwhelming responsibility of caring for family members with Alzheimer’s. This is all important work.

But for now, one of the few resources many rely on for the expenses of care, other than family and friends, is long-term care (LTC) insurance. And even people who have LTC insurance often have to fight for benefits. Nothing can be more frustrating, or even devastating, than when you are not able to obtain the LTC insurance benefits from a policy you have paid premiums on for years.

If you are stuck in the cycle of insurer delays and denials for long-term care, disability, health or life insurance benefits, call us at (800) 446-7529. We can help.

Many chronic diseases have the potential to flare and fade without much notice. Thus, living with a chronic disease can force changes into your life. For instance, many people suffering from flaring rheumatoid arthritis might be forced to stop working. When this happens, seeking public and private disability benefits may help the financial burden caused by the flare.

Unfortunately, insurance companies have made a regular practice of refusing to pay disability benefits. Once denied, you almost always have the right to appeal the adverse decision.

Here are some valuable tips to consider when preparing your appeal for a group disability insurance benefit under ERISA. Please note that because each claim is unique, this is not a complete list, but simply a reminder of important materials for an appeal.

• Before initiating the appeal process, request your claim file and policy from your insurance carrier or employer. You will need to review your policy: without it, you don’t know the rules!

• Consider what evidence you have to prove that you are not capable of performing your job because of your disability, and include this in your appeal packet. Remember that in an ERISA governed policy, once a decision is made on your final appeal, your file is closed. Any information you leave out may never be heard or considered by a court!

o Personal Statement (make your appeal letter more of a cover letter, telling the insurance company why you disagree with their decision, and what information they will find in your appeal packet that will change their minds)
o ALL Doctors’ records (including side-effects of the treatment of your disabilities, and how those impact your ability to work)
o Attending Physician Statements
o Job description (do not rely on a generic job description provided by your insurance company- they might not use a full and complete list of your actual duties)
o Performance reviews
o Statements from supervisor/co-worker/subordinates, caretaker, family and friends
o Social security award
o Independent medical examination

• Communicating with the insurance company: Try and stay off the phone as much as possible! All communication should be in writing, in traceable forms such as certified mail, fax or e-mail. If you can't prove it, it never happened. Although it’s not always possible, while you are on the phone try to get the name, title, phone number and email address of everyone you talk to. Speaking with different insurance representatives can become confusing and overwhelming. Keep a journal of your conversations so that you can refer back to them later.

• Your appeal has a deadline; don’t miss it! In most cases, failing to appeal before your deadline means that you will be unable to pursue your claim any further.

Supplying your insurance company with the information mentioned above does not guarantee that your disability claim will be approved; however, it does create a documented record of evidence to which you can rely up on if any subsequent litigation ensues. If you have questions about what to include or how to file your appeal, contact Kantor & Kantor at (800) 446-7529 or log on to www.kantorlaw.net.

A new Mayo Clinic study discovered that residents of Olmsted County, Minnesota are most often visiting physicians due to chronic conditions such as skin issues, joint disorders, and back pain. As a population ages, more individuals experience multiple chronic medical conditions. However, it is important to note that these findings were not due to typical aging progressions, but chronic illness found among both genders and across age groups.

To identify the prevalence of the most common non-acute conditions in a defined US population, the Mayo Clinic used the Rochester Epidemiology Project (REP). This comprehensive medical records linkage system was used to track more than 140,000 Olmsted County, Minn., residents who visited Mayo Clinic, Olmsted Medical Center and other Olmsted County health care providers between Jan. 1, 2005, and Dec. 31, 2009.

The top disease groups encountered were:
• Skin disorders
• Osteoarthritis/joint disorders
• Back problems
• Cholesterol problems
• Upper respiratory conditions (not including asthma)
• Anxiety, depression and bipolar disorder
• Chronic neurologic disorders
• High blood pressure
• Headaches/migraine
• Diabetes

"Much research already has focused on chronic conditions, which account for the majority of health care utilization and costs in middle-aged and older adults," says Jennifer St. Sauver, Ph.D., primary author of the study and member of the Population Health Program within the Mayo Clinic Center for the Science of Health Care Delivery. "We were interested in finding out about other types of conditions that may affect large segments of the population across all age groups."

Recognizing the widespread occurrence of chronic illness may encourage improvement in the areas of health care delivery, access to treatment, and adequate insurance coverage. This study illuminates the magnitude of individuals suffering from chronic illness in a defined US population, and raises essential questions. What can be done to prevent, treat, and better care for these patients?

Many of our clients at Kantor & Kantor struggle with chronic conditions, and we understand how difficult living with these types of illnesses can be. If you have been denied disability benefits by your insurance company, we can help. Contact us at (800)446-7529 or www.kantorlaw.net .

Recognized for Excellence in Representing People Denied Insurance Benefits
Kantor & Kantor partners Glenn Kantor, Lisa Kantor, Alan Kassan and Corinne Chandler have all been named to the 2013 list of Southern California Super Lawyers, selected for their achievements representing people denied disability, long-term care, health or life insurance benefits. The list, compiled by national rating service Super Lawyers which honors lawyers based on peer recognition and professional achievement, appears in the February issue of Los Angeles magazine.

Mr. Kantor worked with California Insurance Commissioner Dave Jones to help pass Insurance Code section 10110.6, a law that bans “discretionary clauses” in insurance contracts and prevents disability insurance companies from inserting language into polices that gives them discretion to deny claims. He won the first ever decision against AT&T’s benefits plan when a court ruled AT&T took advantage of its policyholder and wrongfully denied long-term disability benefits. A few weeks later another decision relied on arguments and rulings he made and won on behalf of other clients. The Los Angeles Daily Journal named him a Top Employment Lawyer for 2012.

Ms. Kantor focuses her efforts litigating insurance company denials of coverage for treatment of eating disorders and other mental health conditions. In August, after Blue Shield’s repeated attempts for rehearing, she won a Ninth U.S. Circuit Court of Appeals ruling that insurers must pay for all medically necessary treatment for people with mental illnesses listed in California’s Mental Health Parity Statute. Since then, a number of other courts have cited that precedent in ruling on behalf of policyholders. She received the Los Angeles Daily Journal “Top Women Lawyers” award in 2009 and 2012; the San Francisco Recorder “Lawyer of the Year” award in 2012; the California Women Lawyers 2010-11 “Women of Distinction” award; and the International Association of Eating Disorders Professionals Foundation 2012 “Special Recognition” award.

Mr. Kassan has handled hundreds of cases representing plaintiffs in actions to recover damages against insurance companies and other defendants. Most of those cases have involved claims for benefits under disability, long-term care, health, and life insurance policies under both the Federal law of ERISA and California Bad Faith law. Most recently, he convinced a court to overturn Unum Life Insurance Co.’s denial of disability benefits to a young woman suffering from Fibromyalgia, and Avascular Necrosis due to treatment for leukemia. He is also working with partner Corinne Chandler on the settlement of a large long term care insurance class action. Mr. Kassan is a member of the Board of Trustees for the San Fernando Valley Bar Association.

Ms. Chandler has litigated close to 500 disputes and regularly obtains trial and appellate decisions overturning insurance company coverage denials and recovering benefits for policyholders. She is currently working on settlement of a long-term care class action, which will benefit thousands of long-term care policyholders and ensure they will obtain the benefits to which they are entitled while residing in assisted living facilities.

If you have been denied life, health, disability or long-term care insurance benefits, Kantor & Kantor lawyers can help. Call us at (800) 446-7529.

Rare Disease Day is a national and international event designed to impart the general public, and decision makers, with awareness of the impact of living with a rare disease. Initiated by EURORDIS (Rare Diseases Europe) and it’s Council of National Alliances in 2008, this worldwide campaign has created a far reaching energy and impact.

The U.S. defines a disease or disorder as “rare” when it affects fewer than 200,000 Americans at any given time.

• 80% of rare diseases have identified genetic origins while others are the result of infections (bacterial or viral), allergies and environmental causes, or are degenerative and proliferative.

• 50% of rare diseases touch children.

The characteristics of rare diseases are diverse, and vary across distinct diseases and individuals. There are 6,000-8,000 rare diseases; affecting quality of life in ways such as loss of autonomy, chronic, progressive, and degenerative pain, and other life-threatening symptoms. Many suffering with rare diseases endure high levels of pain and discomfort. Regrettably, there is a lack of scientific understanding and knowledge surrounding these types of illnesses, which can lead to delays in diagnosis or even misdiagnosis. There are no existing effective cures for rare diseases.

On February 28, 2013 we observe the sixth international Rare Disease Day, coordinated by EURORDIS and organized with rare disease national alliances in 24 European countries. Awareness raising activities will take place across Europe, all the way to Russia, continuing to China and Japan, in the U.S. and Canada, and as far as Australia and New Zealand!

In order to continue developments and gains with our understanding of rare diseases, we must persist with scientific research, as well as the sharing of scientific knowledge about all rare diseases.

Click here to get involved

Many of our clients suffer from various types of rare diseases, requesting our services when their long term disability claim has been denied. At Kantor & Kantor, we understand that being denied disability coverage by your insurance company or employer only exacerbates an already difficult situation. We work tirelessly to advocate for the rights of our clients, and we proudly support 2013 Rare Disease Day.
http://www.rarediseaseday.org/

The very first Rheumatoid Arthritis (RA) Awareness Day will be observed this Saturday Feb 2, 2013. This unique initiative, established by the Rheumatoid Patient Foundation (RFP), hopes to promote awareness of this debilitating autoimmune disease, raise funds for further research and treatment, expose the true nature of the impact of living with RA, and to help overcome misconceptions that surround the illness. RPF founder Kelly Young points out, "joint inflammation is a prominent symptom of this disease for most patients, but it's a disservice to refer to it as merely a type of arthritis."

Rheumatoid arthritis is a progressive inflammatory disease that causes damage to joint and organ tissues, which often leads to pain, disability, and even increased mortality. Individuals struggling with RA have a higher incidence of stroke, atrial fibrillation, and silent heart attack. Although RA is a very serious autoimmune disease, the symptoms are often invisible to others making it very difficult to understand.

Rheumatoid Arthritis sufferers often come to our firm, Kantor & Kantor, when their disability claim has been denied by their insurance company. The denial of a disability insurance claim is one of the most financially and emotionally devastating events that can happen to a disabled person. With effective representation, you will be able to present the claim in such a way that the insurer may reverse its decision and pay the claim. If you or someone you know has had a disability claim wrongfully denied, we can help. Call (800) 446-7529 or navigate to www.kantorlaw.net.

To support Rheumatoid Arthritis Awareness Day, click here http://rheum4us.org/rheumatoid-arthritis-awareness-day/

To learn more about the Rheumatoid Patient Foundation, click here http://rheum4us.org/

Kantor & Kantor is pleased to announce that partner Alan E. Kassan has been named a “Southern California Super Lawyer” in the area of health, life, disability, and long term care insurance disputes.

Super Lawyers, a highly esteemed attorney rating service, has recognized Kassan for his expertise, professional success, and exceptional achievement. The selection process used to designate a Super Lawyer is multi-phased; including independent research, peer nominations and peer evaluations.

Since 1984, Kassan has been representing plaintiffs in actions to recover damages against insurance companies and other defendants, and he has handled hundreds of these cases. His practice is now dedicated to helping people obtain the health related insurance benefits to which they are entitled under Disability, Long Term Care, Health, and Life insurance policies. He handles actions involving both the Federal law of ERISA and state insurance bad faith law.

To learn more about Mr. Kassan and the firm of Kantor & Kantor see www.kantorlaw.net or call (800) 446-7529.

Attorneys Glenn Kantor and Alan Kassan, partners at Kantor & Kantor, LLP, will be speaking at the San Fernando Valley Marketing & Admissions Professionals for Seniors (MAPS) meeting on Tuesday February 5th, 2013. This presentation entitled “Understanding How to Get Long Term Care Claims Paid!” will explain common strategies used by insurance companies when denying your Long Term Care Claims, and provide tips for avoiding these frequent and unfortunate denials.

For more than 20 years, the lawyers at Kantor & Kantor have represented people with disabilities such as Multiple Sclerosis, Lupus, Crohn's Disease, Fibromyalgia, Epstein Bar, HIV/AIDS, Parkinson’s Disease, Alzheimer’s, cancer, spine and back injuries, cardiac disease, depression, drug and alcohol addiction and a host of other conditions against insurance companies who have wrongfully denied health, disability or long-term care benefits.

To learn more about how to get your claim paid, join us at: The Village at Northridge: 9222 Corbin Ave. Northridge, 91324 from 8:00-10:00 am.

For more information about what we do see:
www.kantorlaw.net and http://www.californiainsurancelawyerblog.com/

Kantor & Kantor is delighted to announce that our Eating Disorder Law blog has been named one of the Top 25 Eating Disorder Blogs online of 2012. We are honored to be recognized for this award by Eating Disorder Hope (one of the largest independent sites for information about eating disorders). Our blog was designed as a space for the eating disorder community to access ED legal news and updates, current events surrounding eating disorders and mental health, and tools for accessing treatment. This blog serves to inspire and instill advocacy for eating disorder recovery; including providing readers with some of the information necessary to understand and fight for the insurance coverage to which they are entitled.

See our blog here: http://www.kantorlaw.net/Eating_Disorder_Blog.aspx

About Kantor & Kantor’s Eating Disorder Practice
Our firm has developed a specialized legal practice representing clients whose claims for treatment of eating disorders, and dual diagnosis (substance abuse and other co-morbid conditions) have been unfairly denied by their health insurers or benefit plan. Dealing with, and seeking treatment for eating disorders can be emotionally and financially devastating. When your health insurance company gives you a hard time, or when it denies payment for benefits, matters go from bad to worse. WE CAN HELP.
Call us at (800) 446-7529 log on to www.kantorlaw.net

If you are submitting a claim or appeal for health benefits or disability benefits, you can find inspiration from some determined individuals whose diligence and preparation got their claims paid:

- Wayne Harris was diagnosed with ALS (Lou Gehrig’s Disease) in 2010. When Mr. Harris required additional adaptions to his home to suit his physical needs, he did not accept the insurance company’s denial: “Instead of accepting his insurance company’s denial for his request for a lift system to get him out of his power wheelchair and into a bath tub, he studied the reasons for the denial, then carefully detailed his needs. He received documentation from medical professionals that justified and verified the necessity for the lift equipment, which enables him to bathe in his own home.”
http://www.alsa.org/news/public-awareness/als-awareness-month/2012/wayne-harris.html

- Maria Carr was denied health benefits by United Health for arthroscopic surgery to treat a bone spur on her hip. Ms. Carr “researched medical journals and other publications to find proof that her procedure was a bona fide and safe treatment. She then wrote a formal letter to her insurer making her case and including copies of the research she had found. Her doctor backed her up with a thorough letter of his own. The appeal was initially denied, but Ms. Carr kept fighting. She took her case to her insurer’s external review board, where an impartial medical expert weighed the evidence. The expert agreed with Ms. Carr, saying UnitedHealth had to pay the claim.”
http://www.nytimes.com/2010/02/06/health/06patient.html?pagewanted=all&_r=0

- Jennifer C. Jaff required a certain drug prescribed by her doctor to treat her Crohn’s disease. “Her insurer argued that other, more established drugs could treat the problem. True enough, but Ms. Jaff had already tried those drugs without success. For her appeal, Ms. Jaff collected her medical records that showed when she had tried each drug and how each had failed. The strategy worked, and her claim was ultimately paid.”
http://www.nytimes.com/2010/02/06/health/06patient.html?pagewanted=all&_r=0

A denial by your insurance company is not the final word. With a little advocacy, research, and determination, you will have the tools to fight for the health benefits to which you are entitled.

For some, it might be possible to overturn a denial without legal assistance. If a case becomes too complex to manage on your own, you may want to consider seeking assistance from a reputable professional.

For help with a long-term disability insurance claim, call us at (800) 446-7529.

A new study from the Mayo Clinic found that Fibromyalgia (http://www.arthritistoday.org/conditions/fibromyalgia/index.php) may be more common than previously believed, especially among men.

Until recently, Fibromyalgia has been understood as a difficult to diagnose and treat rheumatic disease, primarily affecting women. Researchers found that men have been underdiagnosed with the disease- and they might actually account for as many as one-third of undetected Fibromyalgia cases. Experts believe the reason for this misrepresentation in men can be attributed to outdated diagnosis methods.

The American College of Rheumatology (ACR) http://www.rheumatology.org/ developed a checklist that has faithfully been used to diagnose Fibromyalgia since 1990. This checklist has been criticized for overlooking significant symptoms – such as fatigue, depression, sleep difficulties and cognitive problems – and requiring a difficult-to-perform “tender point” exam – a physical check for 18 predetermined painful areas on the body. In 2010 and again in 2011, the ACR published an updated checklist including symptoms important to those who suffer from Fibromyalgia. Both of these newer checklists leave out the tender point exam.

In this study, researchers used both the 1990 and 2010 versions to look for Fibromyalgia in the population of Olmsted County, Minn. When using the 2010 checklist, the rate of Fibromyalgia in women was three times higher than officially diagnosed; in men it was 20 times higher. Ann Vincent, MD, medical director of the Fibromyalgia and Chronic Fatigue Clinic at Mayo Clinic in Rochester, Minn. says that “Men are innately less tender than women and they’re less likely to pay attention to pain or seek medical attention for it,” she says. “What this study shows is that men who meet the 2010 criteria for Fibromyalgia are unlikely to have been diagnosed [using earlier standards].”

The older tender point checklist restricts men- who are less likely to report pain or seek medical attention for it- from a more accurate assessment. Broadening the definition of Fibromyalgia to include other important symptoms opens up opportunity for proper diagnosis and treatment for both men and women.

Dr. Vincent explained the significance of broadening the definition of Fibromyalgia to include other symptoms besides pain. This will not only facilitate a more accurate diagnosis, but will improve the quality of treatment too. “Fibromyalgia is multidimensional,” she says. “Patients have pain receptors firing all the time. This generates a lot of pain, to which the body gradually becomes sensitized. And in fighting that pain, people become fatigued, have unrefreshing sleep and cognitive problems. It’s important for primary providers to recognize that chronic pain kicks the symptom burden much higher and that symptom management [is important].”

Researchers emphasize that the 2010 guidelines are expected to compliment, not replace, the 1990 criteria. Dr. Vincent says, “The most important finding of our study is that the new criteria provide a more comprehensive way for clinicians to recognize Fibromyalgia.” The findings of this study offer new insight into the prevalence, diagnosis, and treatment of a very complex disease. See http://www.arthritistoday.org/news/fibromyalgia-in-men-239.php

If they were paid, reports Indiana University, the total cost for the care would be $375 billion a year. See “5 Hidden Costs of Family Caregiving.” That astronomical amount includes such things as the following:
• Lost wages during the months and years the adult child takes off work to care for the parent;
• Decreased employability from time and skills lost;
• Increased healthcare cost for the caregiver from the stress of caregiving;
• Lost savings and retirement benefits;
• Decrease in workplace productivity.

For those that had the foresight to purchase Long Term Care (LTC) Insurance, the personal cost may not be as high. That is, of course, if the LTC insurance company actually pays once the claim is made. Our clients become our clients because they have to fight for the benefits they purchased, and this can be a tremendous headache during a time that families are making life-altering decisions. As we frequently point out, however, long-term care policyholders at least have a source of funds to fight for, as opposed to all the others who must depend on family for care after their own resources are exhausted.

We help fight that fight, if and when it becomes necessary. If you have an issue with denial or delay of long-term care benefits, call us at (800) 446-7529. We can help.

The Crohn’s & Colitis Foundation of America (CCFA) has declared the first week of December as Crohn’s & Colitis Awareness Week; a time reserved to inspire Americans to reach toward a cure for inflammatory bowel diseases, help raise awareness, and support research for the 1.4 million Americans who suffer from these diseases.

Crohn’s disease and ulcerative colitis, known together as inflammatory bowel diseases (IBD), are painful diseases that attack the digestive system. Crohn's disease can attack anywhere along the digestive track, while ulcerative colitis targets only the large intestine (colon).

Many of our clients have experienced symptoms such as abdominal pain, persistent diarrhea, rectal bleeding, fever and weight loss. Some patients require several hospitalizations and surgery. All of this can understandably result in functional disability sufficient to prevent one from engaging in the material duties of his or her occupation, or any occupation for that matter. Unfortunately, insurance companies don't very often agree, which is whywe are always battling them on behalf of our clients.

This year’s awareness week creates the opportunity to educate the public on the various types of debilitating inflammatory bowel diseases, and to highlight the work being done to find a cure.

Learn more here: http://www.ccfa.org/news/crohns-colitis-foundation-1.html

As reported in the Scientific American’s article “How Chronic Pain Affects Memory and Mood,” researchers from Northwestern University have found a possible cause for the fuzzy thinking, memory problems, anxiety and depression that so many people with long-term pain endure. The culprit may lie with an impaired hippocampus.

Many of our clients are in chronic pain due to an objectively identifiable cause. However, along with the pain, they often complain about a change in their cognitive abilities and their personality. These subjective changes have a circumstantial connection to their pain. These additional complaints are often dismissed by insurance companies in deciding claims because there is no definitive link to the pain. That lack of a connection may be changing.

Using brain scans from people suffering from chronic back pain or Complex Regional Pain Syndrome (formerly known as RSD), researchers found these people had smaller hippocampus than healthy people. As reported in the Journal of Neuroscience, the researchers then began to study mice in an effort to obtain clues about how this part of the brain might impact the side effects experience by people suffering from chronic pain. It turned out those mice with chronic pain displayed greater anxiety like behaviors than normal mice. They also had disruptions in the functioning of their hippocampus. What was stated to be the most striking finding was that the mice in chronic pain had stopped producing new neurons in the hippocampus. Because the hippocampus is one of the few brain areas where new neurons can grow, this lack of growth may explain the smaller sized hippocampus in chronic pain sufferers.

Lead researcher A. Vania Apkarian suspects that the size difference seen in human’s hippocampus may reflect the lack of neuron growth and other problems seen in the mice. The hypothesis is that without new neurons forming, memory and emotional processes would become impaired. Apkarian says that this research underscores the importance of treating the suffering caused by chronic pain as a brain-based disorder in addition to trying to treat the source in the body.