
SOCIAL SECURITY DISABILITY
LONG TERM DISABILITY
AUTO ACCIDENT CASES
PEDESTRIAN CASES
PREMISIS LIABILITY CASES
Social Security Disability
"Kathy" a 32-year-old former bartender
and avid figure skater, was severely injured in a car accident. She had
undergone unsuccessful spinal surgery which was followed by the implantation
of a spinal stimulator to ease her pain. She testified that she was unable
to maintain any position without pain. This pain was helped little by
the use of the spinal stimulator and substantial doses of narcotic medication,
leaving her drowsy and lethargic.
"Roy" worked as a bartender at a restaurant for many years.
He loved his work and although his arthritis grew worse over the years,
he still showed up for work without fail until he could no longer take
it. His doctor told him to stop working to preserve himself so he could
still be social with his family and lend guidance to his grown children.
Since he always worked hard, putting in long hours including weekend work,
"Roy" failed to see doctors on a regular basis. He came to us
after he had been denied benefits. His case was successfully appealed
and he was awarded a new hearing at which time he was awarded benefits.
"Danielle," a 25-year-old woman, was badly burned as a result
of a house fire. Despite many surgeries, the disfiguring scarring left
her in chronic pain and feeling extremely depressed. After contacting
the Chief Judge before the hearing, we were able to arrange for an on-the-record
decision in order to spare Danielle the embarassment of having to travel
and appear at a hearing.
"Norm," a 50-year-old former construction worker, suffered from
degenerative back and neck conditions which were inoperable and had become
aggravated by the presence of arthritis. He was no longer capable of his
past work and was extremely limited in his ability to move or remain in
a seated position for any substantial period of time. He had become unable
to do household chores and had become dependent on his family for assistance
with all activities of daily living.
"Maya" was an eight-year-old who suffers from a learning disability
causing her to be unable to keep up with her peers in school. She would
become inattentive and unruly due to her frustration at school. When she
was finally assessed by the school system, she was found to be two grades
behind her age group in math and reading abilities. Although originally
denied benefits, her case was successfully appealed and benefits were
awarded when her test results were completely explained to the presiding
judge, who gained a better understanding of the educational testing process
utilized.
"Deborah," a 44-year-old former police officer, developed a
condition called blepharospasm, a disorder resulting in uncontrolled facial
twitching and blinking. This condition was unsuccessfully treated with
botulism toxin injections and surgical stripping of muscle from the eyelids.
She testified that she saw life as if she were constantly in a strobe
light, making it impossible for her to concentrate on tasks or focus on
anything which required more than minimal focused vision.
"Jim," a 60-year-old former construction worker, contracted
full body psoriasis, a painful skin rash which caused constant itching,
irritation and bleeding. This was confirmed by whole body photography
placed in the claims record showing the whole body involvement of his
condition. This condition was not improved by any available prescription
or holistic remedy evidenced by the bag filled with attempted remedies
produced at his hearing. A subsequent psychologic examination arranged
at Social Securitys expense determined that Bob was unable to pay
sufficient attention to tasks due to interference by his painful itching
so as to be unemployable.
"Frank," a 53-year-old former minister, suffered from sleep
apnea, a condition causing unrestful sleep due to snoring and restlessness.
His condition had resulted in narcolepsy (uncontrolled periods of sleeping).
This condition was not relieved by prescriptions or medical devices. Frank
testified at his hearing that he survived on "love offerings"
given to him by parishioners in return for his counsel and handyman repairs
in their homes. Testimony at his hearing by two supervising bishops demonstrated
that Frank had not performed any handyman activities for several years
and barely was able to stay awake for a few minutes. Frank slept through
their entire testimony and awoke only after the hearing ended when he
learned he was to receive benefits.
"Bill" suffered from a bad back caused by a bulging disc which
caused him to limp while he walked. Although he had been a very good athlete
throughout his life, he could no longer participate in sports as he once
did. Unfortunately, his condition became so severe that he could no longer
sit or stand for more than a few minutes at a time causing him to be unable
to sustain any job. His previous conditioning allowed him to keep a youthful
appearance although he had gained a significant amount of weight due to
inactivity. At his original hearing, the presiding administrative law
judge ignored the findings of his treating physician and based his decision
on the nonexamining reviewer employed by the Social Security Administration.
The decision was overturned on successful appeal and "Bill"
was given a new hearing before the same judge who listened to the compelling
evidence and rendered a decision in "Bills" favor. Persistence
in many cases such as this pays off in the end.
"Lila" suffered with an insect bite for many years which became
infected and would not heal. Over the years, she sought treatment from
every specialist and could not be helped. In fact, her infection grew
worse until it had eaten all the way to the bone in her leg. The infection
site was raw and painful. It also smelled very badly due to the dead tissue
surrounding the permanent hole in her leg. Additional information was
obtained from her doctors which substantiated "Lilas"
claims of pain and physical restrictions. Photography of the wound site
was also entered into the record to demonstrate the severity of the condition.
"Rhonda" suffered from panic attacks for years. When the attacks
hit, she would sweat and lose her breath, feeling as if she would pass
out. These attacks grew worse over the years despite continual medical
treatment with drugs and psychologic therapy. The attacks became triggered
any time "Rhonda" was placed in enclosed spaces such as buses,
crowded areas and elevators. "Rhonda" adapted to her condition
by walking up stairwells one floor at a time and open a door at each level
to prevent attacks. Unfortunately, her hearing was held at a modern building
in which the stairwells were secured and could only be utilized for exit
purposes. The building management would not permit her to walk up the
eight floors to the hearing room and required that she use the elevator.
We had a Social Security Administration employee witness the conduct of
"Rhonda" in the elevator during the eight flight trip. "Rhonda"
became panicked and put her face into her boyfriends chest. After
the short trip, she was unable to speak at all. A half hour later at her
hearing, "Rhonda" could only rock back and forth and could not
express herself. The testimony of her boyfriend and the Social Security
employee were presented and benefits were awarded.
Long Term Disability
"Richard,"
a 59-year-old former anesthesiologist, had to stop practicing medicine as
a result of the fatigue and exhaustion he suffered due to the effects of
sclerosing cholangitis, a form of liver disease, and hepatitis C. The defendant
insurer wrongfully denied Richards long term disability benefits application.
Richard made his application over one year after ceasing his medical practice.
He had been treating on an informal basis with a specialist who had not
kept complete medical records. The insurer failed to review the ample
blood testing evidence and CT scan which demonstrated the extent of disease
processes. In addition, the insurer did not undertake a vocational analysis
to determine the duties of the claimants work as an anesthesiologist
as part of the "OWN OCCUPATION" policy definition governing
disability in this matter. In addition, there was evidence in the claims
file of coordinated activity between the claims handler and an in-house
reviewing physician resulting in a questionable medical denial of benefits.
"Larry," a 53-year-old former electronics marketing manager,
suffers from central nervous system angiitis accompanied by depression.
The long term disability carrier attempted to terminate benefits after
two years of payment asserting a mental health limitation under its policy.
Larry underwent a new MRI and neuropsychologic testing which revealed
organic brain damage which was the cause of his deficits. These new findings
were further supported by CT scan evidence which revealed cerebral atrophy,
confirming an organic cause rather than any alleged mental involvement.
This strong evidence resulted in a reinstatement of benefits and payment
of all past due benefits.
"Hanna," a 43-year-old former physician, suffers from fibromyalgia
and chronic fatigue syndrome. Hanna had consulted multiple specialists
and holistic practitioners across the country in her attempt to seek relief
from her painful and exhausting condition. The medical records only told
part of the story. Record supplementation including functional capacity
assessments with vocational expert opinion, as well as medical literature,
set forth the appropriate diagnostic criteria. This, in combination with
the overwhelming concert of medical and vocational opinion, prompted the
insurer to pay long term disability benefits.
"Edward," a 42-year-old former vice-president of a publishing
company, suffers from HIV and related fatigue. His HIV condition had been
stabilized in terms of T-cell count and viral load through the use of
an "HIV cocktail" of drugs. Unfortunately, Edward still suffered
from severe fatigue and gastrointestinal side effects from his medication
regimen. The insurer took the position that his condition had been "successfully"
treated and any remaining disability was caused by depression despite
the fact that depression had been mentioned only twice in the nearly two
hundred pages of medical documentation concerning Edward's condition.
Medical studies and pharmacological evidence were researched and submitted.
This evidence documented a host of side effects of the medication regimen
suffered by Edward. One of the side effects cited was cognitive deficits,
which was confirmed though neuropsychologic assessment that was also made
part of the successful appeal for benefits. Subsequently, Edwards
partner, "Tom" suffered similar deficits from HIV and its associated
regimen. Edward received benefits for a period of time until he sufficiently
recovered and returned to work.
"Doug," a 52-year-old former corporate executive suffers from
multiple spinal injuries resulting from several accidents. As a result
of his conditions, he was no longer able to manage the many duties of
his former demanding work resulting in approval of one of the largest
claims ever paid by the disability insurer following a successful appeal
which included extensive documentation of the many symptoms suffered by
Doug and their effects on his ability to move and think.
"Ron" was a software analyst hired by the United States government
through a contractor. He served overseas and made very good money. As
a child, "Ron" had been diagnosed with sickle cell anemia. He
was one of many adults who survived this disease, but his attacks have
grown more frequent and have become very debilitating. These often occurring
attacks caused Ron to cease working and apply for short term disability
benefits. After being paid short term disability, he was denied long term
disability despite no change in his condition. A full appeal was prepared
in which medical literature was cited which substantiated his condition
with further confirmation from his specialists.
"Max" was a successful podiatrist who suffered a terrible heart
attack. It turns out that he suffers from arteriosclerosis which ran in
his family. As a coincidence, his father suffered a fatal heart attack
in the same year of life as his son. The difference is that "Max"
survived his heart attack and required a quadruple bypass to clear his
clogged arteries. "Max" became increasingly short of breath
and suffered from chest pain despite his doctors efforts. This was
made worse by the sense of anxiety he suffered in losing his livelihood
and fear that his condition would become fatal. Eventually, he could no
longer sustain his busy practice and applied for disability. Evidence
in the form of medical testing and literature was gathered which proved
that "Max" could no longer manage the stress of his former work
on a sustained basis.
Auto Accident Cases
"Leonard" was a 45-year-old father who suffered a car accident the day before his
only daughters wedding. He treated successfully and recovered. Unfortunately,
the insurer fought the claim and arbitration was made necessary. At the
arbitration, Leonard produced photographs from his daughters wedding
in which he was seen wearing a cervical collar which could not be removed
due to the severe pain he suffered. This resulted in an award of benefits
far higher than anticipated.
"Gwendolyn" was a former 36-year-old government employee who was struck
in the rear by an intoxicated driver. She suffered injuries to her spine
and a decline in her ability to remember. Her impairment was so severe
that she could no longer perform work and was determined to be disabled
by the Social Security Administration. She underwent extensive
psychologic testing which documented her cognitive decline. The matter
eventually went to trial at which time five experts testified on her
behalf resulting in a substantial verdict.
"Mark" was driving his small sports car to work one day when
he was struck from behind with such force that his car was pushed underneath
the higher vehicle in front of him."Mark" had several gaps in
his treatment as he had to travel for his work. His work was listed as
several different jobs to different physicians. The gaps in treatment
and inconsistent job references led the insurer to contest coverage. The
case resulted in an arbitration at which, after completing many lengthy
forms, it was disclosed that "Mark" was a CIA operative and
was working on dangerous missions overseas for which he allowed us to
see photography of his work although the exact nature of his missions
and locations could not be disclosed. At the conclusion of the hearing,
a substantial award was made and the defense representative admitted that
he could not say a negative remark about "Mark" as he had made
an impressive effort to help this nation despite his injuries.
Pedestrian Cases
"John" was transferring equipment from his work van into another work van owned
by his employer at his employers residence. John was struck by a
motorist who failed to see him, pinning his legs between the bumpers of
both vehicles and causing severe injuries. Along, the residential neighborhood
was a curved road which did not allow view beyond one or two parked car
lengths. On the day of the accident, the sun was shining brightly, making
vision for the striking driver even worse. Following extensive investigation,
a full map of the neighborhood including all angles with appropriate photography
proved that the striking driver was traveling at an excessive speed for
the required safe stopping distance required.
Premisis Liability Cases
"Carrie" was a three-year-old child who was severely injured while playing in the
kitchen in the apartment where her mother lived. Evidence revealed that
Carrie stepped on the stove door causing it to tilt forward and pour hot
soup on her. Injuries included burns to approximately 40% of her body
requiring extensive surgery and rehabilitation. Police investigation revealed
that the contractors who recently renovated the apartment had failed to
install the stove anti-tip device which was still taped to the appliance.
Since no party would admit to ever touching the stove, a lawsuit was filed
against the property owner, the property manager, the construction company
that performed the renovation, and the subcontractors for negligence in
failing to install the bracket. The responsible parties each contended
that some other party was at fault. We settled the case for $1.5 million
for which a carefully structured settlement was arranged in order to take
care of the childs medical and educational needs for the rest of
her life.
"Luis" was visiting his brothers apartment and was offered
food on the stove. When he tried to use the gas stove to warm the food,
the stove exploded causing him to suffer extensive burns over his body.
Following several surgeries and rehabilitation, Luis remained severely
disfigured despite successful rehabilitation allowing him to regain use
of his body. Investigation during the lawsuit determined that the exploded
stove was over 40-years-old and received no maintenance in over ten years.
Further, the property manager disposed of the stove the day after the
explosion resulting in unlawful destruction of the evidence. The insurer
relied upon the absence of this important evidence as well as the testimony
of the local fire marshal who reported that Luis was at fault for lighting
the stove himself. Deposition of the fire marshal revealed that he had
no knowledge of the alleged stove lighting other than a conversation with
an unidentified witness who did not speak English (The fire marshal spoke
no Spanish). The fire marshal admitted that he found no evidence that
Luis tried to light the stove in the form of a lighter or matches. Extensive
motions were filed with the court concerning the destruction of the evidence
and the fire marshal testimony which resulted in a large settlement on
the day of trial.
"Mary" lived in apartment building which would leak water into
the entry hall when it rained hard. One day, she was late for work as
her friend sounded her car horn for "Mary" to hurry up and leave.
In her haste, "Mary" forgot it had rained hard the evening before
and could not see the transparent puddle of water at the bottom of the
staircase. She slipped and broke her leg. It was shown that the apartment
management was aware of the condition, but made no effort to repair the
defective condition.
"Joan" was stuck in her apartment following a snowstorm and
realized she had run out of toilet paper. There was a small store in her
apartment complex located a few hundred yards from her building. She bundled
up and proceeded to the store at which time she slipped and fell. Her
fall resulted in a broken ankle. The landlord would not pay compensation
claiming that it was not responsible for an "Act of God." During
depositions and from official weather reports, it was shown that the apartment
complex management failed to make any effort to remove the snow despite
every opportunity to do so. In fact, the management failed to adhere to
any of its own snow removal policies due to insufficient labor and equipment.
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