Case Studies:
Disability Insurance Denial - Trial Avoided - Lump Sum Resolution Achieved

Darla Jones*, a divorced 48-year old with two adopted disabled children, worked as a paralegal for a major Seattle law firm until she became disabled from fibromyalgia, chronic fatigue syndrome ("CFS") and diabetes. Fortunately, her employer provided her and her co-workers with a disability insurance policy.

Ms. Jones filed her claim for disability benefits thinking that the insurance company would fully and fairly investigate her claim. As in so many other disability claims, the insurance company selectively chose portions from her medical records which gave the impression that her disability was "caused or contributed to" by a mental disorder, such as depression. The insurance company acknowledged that she was sick with fibromyalgia, CFS and diabetes, but refused to consider these diagnoses as medically disabling. Ms. Jones was paid two years of benefits, the period allowed for coverage of what the insurance company determined was her disabling psychological injuries, but her permanent disability claim was closed.

Ms. Jones retained Nelson Langer Nelson after her attempts to reopen her disability insurance claim were denied by the insurance company. Since her claim was governed by ERISA (the group of federal statutes known as the "Employee Retirement Income Securities Act"), the Washington State Insurance Commissioner could not be of any assistance to her. Nelson Langer Nelson filed suit in federal court and, before trial, successfully negotiated a lump sum settlement of her past and future disability benefits.

Nelson Langer Nelson is one of the few law firms in the Pacific Northwest that devotes a significant amount of resources fighting to obtain the disability benefits owed to disabled workers through ERISA plans or private insurance policies. Many times the information developed by Nelson Langer Nelson can also be used to obtain disability benefits from other sources, such as from the Social Security Administration.

* name changed