O COURT OVER TUNA DEFENDANT BY MISTAKE The Louisiana Department of Wildlife and
Prudential Would Would You Want an ER Physician on Opioids in Charge of Your Family?
Fisheries boat flashed its lights, asking us to stop as we entered Barataria Pass. We were just minutes from camp and eager to show our catch. I preached about having current fishing licenses to my sons while handing them to the agent, proud of the big fish he was eyeing on deck. But then he said, “Show me your HMS license.”
I asked, “My what?” And the mood changed instantly.
Our client, a Texas ER physician, fought to continue working as long as he could after major cervical and thoracic spine issues which ultimately required the fusion of levels C2–T3 vertebrae. His job duties in the ER required quick thinking and rigorous physical action, performing orthopedic dislocation reductions, intubation, and lumbar punctures as well as placing central lines. He also regularly encountered combative, intoxicated, and drug-altered patients. His post-laminectomy syndrome pain and medication regimen took their toll. He began to falter physically and mentally until it became impossible for him to perform his job safely. Unrepresented, he filed for long-term disability insurance benefits with Prudential after years of premium payments. He explained to Prudential that his pain and increasingly limited mobility endangered his patients. His treating surgeon said he had become “increasingly reliant on a chronic pain regimen including opioids and other controlled substances to function in even the most basic manner” and suffered slow, clouded, and unreliable thinking. He figured there was no way in the world he’d be denied. Everything he submitted was the absolute truth. Prudential had its physician review his medical records. Without bothering to meet with our client, Prudential’s physician decided that he could continue his full-time duties as an ER physician. Prudential credited its record reviewer’s opinions over our client and his treating providers’ opinions, denying the claim. We filed his ERISA-mandated pre-litigation appeal, loading the administrative record with better objective and opinion evidence of his disability. We also included a more detailed sworn testimony from our client, explaining exactly how his restrictions would endanger patients under different scenarios. Prudential reversed its denial, and they will now pay our client monthly through retirement age. Unfortunately, this case is typical. When insurers like Prudential deny long- term disability claims, they hope their insured will “appeal” by arguing disagreement with the denial. They know ERISA law prohibits the court from considering any evidence not submitted with the appeal before filing suit (most people don’t realize this until it’s too late). Loading the administrative record with the best evidence before filing a lawsuit is critical to getting claim denials like these reversed.
Having a “highly migratory species” permit for yellowfin was news to me. It was a freak accident that we had caught one at all. The grim agent photographed us with the contraband, advised that he was confiscating it, and wrote me an arraignment summons.
He ultimately let us keep the fish, which made us and some neighbors happy, and the DA dismissed the case with a warning at the arraignment. Let’s just say if I ever find myself with a wildlife violation again, I will surely regret it. What I won’t regret is that fantastic day!
Vegan Butternut Squash Chili
Ingredients • 1 1/2 cups vegetable broth, plus 2 tbsp for sautéing • 5 cloves garlic, minced • 2 lbs butternut squash, peeled and diced • 2 chipotle peppers in adobo, chopped • 1 yellow bell pepper, diced • 15-oz can black beans, drained • 15-oz can pinto beans, drained • 28-oz can diced tomatoes • 1 cup cooked quinoa • 1 1/2 tsp paprika • 1/2 tsp ground cinnamon • 1/4 tsp table salt • 1/4 tsp ground black pepper
Directions 1. In a large pot,
heat 2 tbsp vegetable broth over medium heat. 2. Add garlic, butternut squash, and chipotle peppers. Cook for 10 minutes, stirring occasionally. 3. Add bell pepper and cook for another 5 minutes. 4. Add black beans, pinto beans, diced tomatoes (with liquid from can), remainder of vegetable broth, quinoa, paprika, cinnamon, salt, and pepper, stirring to combine. 5. Bring mixture to a simmer
and cook uncovered for 10 minutes or until butternut squash is tender, then serve!
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