Personal Injury, Medical Malpractice, and Insurance Disputes Case Results

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Partial Disability Claim for Fibromyalgia

The plaintiff was a 49-year-old Northern Virginia businessman who had a private (non-ERISA) long-term disability insurance policy with Penn Mutual for many years. In 1980 he began to complain of chronic m U.S.C. le stiffness and pain. In 1995 he had an automobile accident and was later diagnosed with fibromyalgia. This was confirmed by his primary care physician and a rheumatologist.

He submitted a claim for "partial disabilty" with Penn Mutual, who began paying partial monthly benefits. In 2002 the company had an independent medical examination done by Dr. Ross Myerson, of Maryland, who opined that plaintiff had no trigger points diagnostic of fibromyalgia and that he had simply made a "lifestyle choice" to cut back on the hours that he worked.

In 2003 the insurance company sent the plaintiff an "activities log" in which the insured was told to track his activities for the week. At the same time video surveillance was ordered by the insurance company. The insurance company then claimed that the video was not consistent with the self report of activities. Penn Mutual refused to produce the video or any claim file and threatened to close the claim and terminate the disability payments. After an initial offer of $166,000, the parties agreed to a lump sum buyout of the policy for $300,000, and the case was settled before litigation began.

Type of Action — Insurance

Type of Injuries — Fibromyalgia leading to partial disability

Name of Case — Steiner v Penn Mutual Life Insurance Company

Court / Case No. — Settled before litigation

Special Damages — Benefits of $5,790 per month

Awarded / Settled — Settled

Amount — $300,000

Insurance Carrier — Penn Mutual Life Insurance Company

Awarded: Lump Sum Settlement For Partial Disability Claim

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