Tuesday, August 13, 2013

Risky Side Effects

Disability claim adjudicators try to guess claimant’s motivation for seeking disability benefits. Depending upon the type of disability benefit at stake, different methods are used to determine motivation. 

Long term disability (“LTD”) insurers, such as Unum and Cigna, assume that claimants are lying about their disorder in order to defraud the insurer out of their money. LTD insurers use surveillance, field visits, and background checks for criminal history, financial problems and so, to create evidence to show that claimants are being dishonest. LTD insurers have adopted an irrational culture of corporate paranoia as a way of doing business. 

Social Security has rules and regulations that provide how a claimant’s credibility must be assessed. While those rules and regulations can be misapplied, they at least provide an objective guideline that provides grounds for appeal when not followed. One of things that Social Security is supposed to analyze when evaluating a claimant’s credibility are the side effects of medication. 

 I represent a 43 year old stock broker with psoriatic arthritis whose Social Security Disability (“SSD”) claim was approved today, without a hearing. The diagnosis of psoriatic arthritis itself does not show that the claimant was disabled. Like other psoriatic arthritis cases that I have had where a hearing was required, the stockbroker’s doctors provided reports explaining why the condition precluded work. What is different here was the claimant’s treatment. 

For years, the claimant has been required to take Humira, Remicade and now Enbrel injections. Those medications are known as disease-modifying antirheumatic drugs (“DMARDs”). DMARDs have very serious side effects caused by the medications’ blocking the immune system. I contended that the claimant having no choice but to continue taking DMARDs shows that his psoriatic arthritis is very severe. The Administrative Law Judge agreed, and approved the SSD application.

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