Pre-existing Medical Condition

FINANCIAL MANAGER
Denied for Pre-existing Medical Conditions

We represented a Manager of a financial institution who suffered from a long history of heart attacks (myocardial infarction). Suddenly, while at work, he began experiencing shortness of breath and chest pain, which eventually led to him undergoing emergency surgery to repair a valve in his heart. 

He applied for disability benefits and was denied. There was no dispute as to whether he was disabled. Instead, his claim was denied on the sole basis that he had a “preexisting medical condition”, which is excluded under his long-term disability policy. According to the insurance company, he suffered symptoms consistent with a heart attack and, therefore his condition must be preexisting. 

We filed suit in federal court alleging that the insurance company failed to perform a full and fair review as required under ERISA. The Judge ordered both parties to attempt to settle the case through mediation. Confident it had a solid case, the insurance company initially refused to seriously discuss settlement until we presented our side of the case. We argued that they hastily denied the claim without conducting a proper investigation into the current medical condition and showed that there are various chronic disorders of the heart that are entirely separate and distinct conditions.  Specifically, we argued the medical evidence confirmed the client did not suffer a heart attack. We were successful in getting a favorable settlement because of our ability to make compelling legal arguments and provide a thorough analysis of the client’s medical conditions.