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At the Ortiz Law Firm, we know that navigating the complexities of disability claims can be overwhelming, especially when insurance companies deny benefits due to a lack of so-called “objective evidence.” A recent case illustrates the challenges our client faced and how we stepped in to help her secure the benefits she rightfully deserved.
The Client’s Situation: A Digital Coach for Walmart
Our client, a digital coach for Walmart, began experiencing a variety of debilitating symptoms. Despite ongoing testing and treatment, her doctors were still in the process of diagnosing the underlying cause of her health issues. As a result, she was placed on short-term disability (STD) to give her time to seek answers and treatment for her condition.
After just seven weeks of receiving STD benefits, Sedgwick, the third-party administrator handling her claim, cut off her benefits. The reason? Sedgwick claimed there was a lack of “objective findings” to support her disability, even though her medical team was still running tests and working on a diagnosis.
The Client’s Attempt to Appeal
Determined to fight for the benefits she deserved, our client initially appealed Sedgwick’s decision on her own. However, her efforts were met with resistance. Sedgwick sent her reports from peer review doctors who concluded that she was “fine” and not disabled, despite her ongoing symptoms. Realizing that she was in over her head and up against a team of insurance professionals, she decided to call the Ortiz Law Firm for help.
Our Approach: A Two-Fronted Strategy
Once we accepted her case, we immediately went to work using a two-pronged approach to secure both her short-term and long-term disability (LTD) benefits.
Strengthening the STD Appeal
We bolstered her existing STD appeal with strong legal arguments and additional medical evidence. Sedgwick had cherry-picked “normal” test results to justify their denial, while ignoring the broader context of her condition. Our team worked closely with her doctors to provide detailed accounts of her symptoms, medical history, and functional limitations. We also emphasized that the lack of a definitive diagnosis did not negate the fact that she was unable to work.
Filing a Long-Term Disability with Lincoln
At the same time, we filed an LTD claim with Lincoln Financial Group, using the same medical evidence we had prepared for Sedgwick. Unlike Sedgwick, Lincoln’s adjuster took a broader view of the evidence and evaluated her condition as a whole. After reviewing the documentation, Lincoln approved her for long-term disability benefits, recognizing that she was indeed unable to perform the duties of her job.
The Results: A Win for Our Client
As a result of our detailed approach and legal advocacy, our client began receiving her LTD benefits from Lincoln. Meanwhile, Sedgwick finally relented and approved the remainder of her short-term disability period after we had presented a stronger case for her claim. We recovered tens of thousands of dollars in past-due benefits and the claimant could be eligible for almost half a million dollars in future benefits if she remains disabled through the maximum benefit period of her policy.
Lessons from the Case
This case illustrates several important lessons for anyone dealing with a disability claim denial:
- Don’t Be Discouraged by Initial Denials: Insurance companies often deny claims based on “lack of objective evidence” or incomplete information. But that doesn’t mean your case is unwinnable. With the right approach, denials can often be overturned.
- Your Medical History Is Key: Insurance companies may focus on what’s missing or incomplete, but a thorough review of your medical records, test results, and doctor statements can provide a clearer picture of your condition.
- Professional Legal Help Matters: Our client had already begun the appeals process on her own, but the insurance company continued to push back. By bringing in a legal team experienced in long-term disability claims, she was able to strengthen her case and get the benefits she deserved.
Moving Forward After a Disability Denial
If you’re facing a denial of your disability benefits, you don’t have to go through the process alone. At the Ortiz Law Firm, we specialize in helping individuals navigate the appeals process and secure the benefits they need to support themselves and their families. Contact us to discuss your case and find out how we can help. Call (888) 321-8131 to schedule a free case evaluation today.
