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Fibromyalgia Sufferer Denied Benefits by Insurer

Fibromyalgia Sufferer Denied Benefits by Insurer

Nature of the Case

P.D., a city employee for twenty-five years had worked as a parking lot attendant and parking meter collector. Prior to being diagnosed with fibromyalgia, P.D. experienced several symptoms including back, arm and leg pain. P.D. was unable to fulfill his duties as an employee – duties that included bending, carrying, lifting and walking. The chronic nature of the pain eventually led to depression. P.D. found himself unable to work.

P.D. injured his back while lifting a large and heavy planter while at work. Subsequently, P.D. experienced shoulder pain, emanating to his arms and legs. Due to the severity of the pain and suffering, P.D. was forced to go on disability leave.

Once P.D.’s short-term disability leave ended, P.D. submitted medical and other required documentation to the insurer to move onto long-term disability leave. The insurer denied the long-term claim. P.D. suffered chronic pain, fibromyalgia and depression and despite the medical merits of his illness, he was denied long term benefits to which he was entitled.

The Resolution

Bogoroch & Associates assisted P.D. in scheduling medical appointments and the gathering of critical medical documentation which not only proved P.D.’s chronic illness, but also his inability to perform the requirements of his employment.

As the Bogoroch team developed the case, they discovered that the benefits had been denied to P.D. due to surveillance by the insurer. P.D. was being watched.

A mediation was scheduled with the insurer in order for all parties to have an opportunity to speak about the case. P.D. spoke about how the illness had adversely affected his life and how moving through the day caused him chronic, unforgiving pain. The merits of his case were put forward by the Bogoroch team in an effort to reestablish disability payments, however, a settlement was not reached at that time.

Several months passed before another meeting was held to determine a final settlement. Once again, the two sides could not agree on final terms. The case went to a pre-trial hearing where the case was outlined again before a judge.

There were several aggravating issues in this case. P.D. was adamant that he would not settle to any terms that would create deductions from his pension. The judge agreed with the insurer and felt that there was a legitimate dispute as to whether P.D. was totally disabled and unable to work.

In the end, we reached a considerable, non-taxable settlement. P.D.’s pension remained in tact, and included extended health care coverage. The difficult case came to an end with a reasonable outcome for P.D. who was pleased with the outcome.

*Please note that the settlement amounts will vary from case to case and are not reflective of what your case may be worth.