Case Results

Family Practitioner with Short Term Memory Impairment Approved for Long Term Disability Benefits

MetLife terminated this claim based on information in the claimant’s file which indicated that he was able to perform the duties of his own occupation, including an independent medical evaluation (IME) and the opinion of MetLife’s in-house psychologist. We provided a copy of the IME report to the claimant’s treating provider and asked that he issue a statement regarding the claimant’s inability to work. We also obtained updated medical records and prepared a detailed appeal letter. MetLife completed their appeal review and determined that the claim should be reinstated.

Long Term Disability Benefits Reinstated for Radiologic Technologist Suffering from Crohn’s Disease

This claimant had been receiving benefits for over a year when Cigna terminated his claim based largely on the opinions of a Nurse Case Manager and a Medical Director who never met or treated our client. Despite his diagnoses of Crohn’s disease, clostridium difficile and severe post-operative complications, Cigna determined that he could meet the demands of his own occupation. We filed an appeal that included Medical Assessment forms completed by two of the claimant’s treating physicians and additional medical evidence. Cigna ordered an Independent Peer Review as part of the appeal review process, the review was favorable, and our client was promptly awarded benefits.

Successful Long Term Disability Claim for Registered Nurse with Migraine Headaches

Prudential denied this claim after an internal file reviewer determined that there were no objective findings documented to warrant any medically necessary restrictions or limitations from working as a Registered Nurse, and that the claimants complaints were based on self-report. We provided updated medical evidence with our appeal and one of the claimant’s treating physician advised Prudential that the claimant was unable to work; however, a Senior Appeals Analyst upheld the decision to deny the claim.

We filed an additional appeal and Prudential had the claim reviewed by two independent physicians. Based on the independent reviews and the medical evidence that we submitted with our second appeal Prudential determined that the claimant was eligible for benefits.

Senior Security Technician Suffering from Paralysis, Acute Transverse Myelitis, and Incontinence Approved for Long Term Disability Benefits

While reviewing her claim for long term disability benefits, Cigna ordered a Transferable Skills Analysis (TSA). The TSA indicated that the claimant was able to perform two other occupations that were similar to her past work and would result in the claimant earning at least 60% of her pre-disability earnings. As such, Cigna denied the claim. We obtained additional medical evidence and filed an appeal, and as part of the appeal review Cigna ordered an Independent Medical Examination (IME). Cigna concluded that our client could not return to a similar type job and overturned the decision to deny her claim.

Successful Long Term Disability Claim for Client Service Administrator with Major Depression, PTSD, Anxiety and Insomnia

Prudential denied this claim by cherry picking the medical evidence for damaging evidence . The claimant appealed and Prudential ordered an external file review with a Board Certified Psychiatrist, who agreed that there were no medically necessary restrictions that would prevent the claimant from performing the duties of his occupation.

We filed a second appeal and Prudential ordered an Independent Medical Evaluation (IME). Based on the IME report and the medical evidence that we submitted on appeal the insurance company determined that the claimant was eligible for benefits.

Long Term Disability Benefits Reinstated for Senior Sales Specialist Suffering from Status Post Stroke, Polyneuropathy and a Left Leg Amputation

Liberty Mutual paid disability benefits for more than two years, then terminated this claim following an internal vocational analysis which determined that she can perform the duties of several other occupations based on her capacity and skill level. We obtained additional medical evidence and argued that Liberty Mutual failed to analyze vocational factors which clearly prevent her from performing the duties of any occupation. Liberty Mutual completed their review and reinstated the claim.

Professional Systems Administrator with Lupus, Rheumatoid Arthritis, and Hashimoto’s Thyoriditis Approved for Long Term Disability Benefits

AT&T Integrated Disability Service Center terminated our client’s claim for long term disability based on the opinions of a Physician Advisor who never met or treated our client. The advisor claimed that the claimant’s doctor contacted him and indicated that the claimant’s conditions would not preclude her ability to return to work. AT&T also ordered a transferable skills analysis which determined that there are alternative occupations available. We filed an appeal and submitted additional medical evidence to the Quality Review Unit, and the unit determined that the previous denial should be reversed.

Long Term Disability Claim Approved for Registered Nurse with Borderline Personality Disorder, PTSD and Chronic Pain

Hartford’s decision to deny this claim was based largely on an independent psychiatric peer review which indicated that the claimant was able to perform her own occupation, despite the reviewer never having treated or met our client. We obtained additional medical evidence and filed an appeal in which we argued that the claimant’s own treating providers have clearly detailed her severe psychiatric impairments. Hartford ordered an independent medical review, the reviewer determined that due to a combination of medical conditions that the claimant could not work on a full time basis, and her claim was approved.

Successful Long Term Disability Claim for Ultrasound Lead with Cubital Tunnel Syndrome and Other Upper Extremity Conditions

Our client was suffering from a wrist triangular fibrocartilage complex (TFCC) tear, wrist impaction syndrome, cubital tunnel syndrome, wrist extensor carpi ulnaris tendonitis, weakness in her left hand and wrist, tingling and numbness, and wrist pain and tenderness. While reviewing her claim for benefits Cigna ordered a medical file review, but the review doctor determined that the objective findings in the medical records were not consistent with her subjective complaints despite never having treated our client, and the claim was denied. We submitted an appeal with additional medical evidence and a statement from her doctor, and the denial was promptly overturned.

Long Term Disability Benefits Reinstated for Telehealth Nurse with Spine Problems, Rheumatoid Arthritis and Lupus

Cigna terminated our client’s claim for long term disability benefits based on the opinions of an in-house Physician Advisor who indicated that she could return to work. We appealed the decision to terminate her claim, which prompted Cigna to order a Peer Review Report, and the reviewing physician determined that the claimant was able to perform the duties of her occupation. As such, Cigna upheld the decision to terminate the claim.

For our second appeal we obtained a copy of the Peer Review Report and provided it to the claimant’s treating provider, who then issued a statement disputing the report. We included this statement along with additional medical evidence with our second appeal and Cigna overturned the prior decision to terminate the claim.

Successful Long Term Disability Appeal for System Administrator Suffering from Post-Concussion Syndrome

Hartford terminated this claim for long term disability benefits after reviewing the medical information in the file and conducting an occupational analysis.  We filed an appeal and submitted new medical evidence, a statement from the claimant’s doctor, and statements from the claimant and his wife. Hartford completed their appeal review and our client was promptly awarded benefits.

Service Desk Analyst Suffering from Anxiety, Depression, Headaches, and Chronic Pain and Fatigue Approved for Long Term Disability

Reliance Standard denied our client’s claim for long term disability benefits on the grounds that he had just recently been terminated and was no longer a member of the eligible class of employees. We appealed the denial and argued that the claimant’s disability began prior to his termination – and while he was still a participant in the Program – such that he would be eligible for benefits. Reliance then ordered an Independent Medical Examination (IME), and less than one month later the denial was overturned.

The claimant continued to receive benefits due to his severe anxiety and depression up to December 16, 2017, at which point the benefits were terminated due to a policy provision that limits payment of benefits for disability caused by or contributed to by a Mental or Nervous Disorders to 24 months. We appealed this decision and Reliance Standard ordered an additional IME which determined that the claimant was disabled due to frequent headaches, chronic neck and back pain, and chronic fatigue.

Successful Long Term Disability Appeal for Property Manager with Congestive Heart Failure

This claimant filed a claim for disability benefits with State Farm and indicated that he became unable to work in September of 2014; however, the attending physician statement indicated that he was first treated in January 2017. As such, State Farm updated his date of disability to January 2017. State Farm also asserted that he was not working in January 2017, so his benefits would be dependent on his ability to perform any occupation for which he is reasonably qualified by education, training, or experience.

We provided an Occupational Capacity Evaluation with details regarding the claimant’s self employment along with two Attending Physician’s Statements and a Cardiac Medical Source Statement to support his claim, and less than one month later the claim was approved.

Long Term Disability Benefits Reinstated for Service Agent Suffering from Post-Stroke Symptoms, Diabetes, Headaches and Heart Disease

This claimant received Long Term Disability benefits from Reliance Standard for two years, at which point the definition of disability changed and the claimant had to prove that she was unable to perform any occupation. Reliance ordered a neuropsychological evaluation, determined that the claimant was able to perform sedentary work, and her claim was terminated. Our firm filed an appeal on behalf of the claimant, Reliance ordered an Independent Medical Examination with a doctor specializing in physical medicine and rehabilitation, and shortly thereafter the decision to terminate the claim was overturned.

Successful Long Term Disability Appeal for Nutrition Service Supervisor Suffering from Osteoarthritis and a Left Knee Replacement

Aetna terminated our client’s claim for Long Term Disability benefits after the definition of disability changed and the claimant had to prove that she was unable to perform any occupation.  We filed an appeal and Aetna invoked their right to an extension so they would have an opportunity to order Peer Reviews and conduct peer to peer contact with the claimant’s treating providers. Her claim was soon reinstated and the evidence supporting her disability was so compelling that she received a lump sum payment offer just a few months after her benefits are reinstated.

Long Term Disability Benefits Reinstated for Supply Chain Manager with Back and Neck problems, Neuropathy, Sjogren’s syndrome, and Cognitive Problems

This claimant received Long Term Disability benefits from Cigna for two years before the definition of disability changed and the claimant had to prove that she was unable to perform any occupation. We submitted an appeal and Cigna ordered three independent medical reviews by different specialists, but each review indicated that the claimant was able to work. Cigna also ordered a Transferable Skills Analysis and determined that the claimant would be able to perform several different occupations. As such, the claim was denied.

As part of the second appeal we obtained an Independent Vocational Analysis from a local vocational expert who determined that the claimant could not even perform sedentary work. Cigna ordered additional medical and vocational reviews which indicated that the claimant was unable to work, so Cigna overturned the previous decision to terminate her claim.

Successful Long Term Disability Appeal for Estimator/Project Manager with Osteoarthritis

After receiving disability benefits for nearly three years, Standard conducted a review of the claim and determined that the claimant was no longer eligible for benefits. The Standard even obtained a Physician Consultant Review which indicated that he is able to work in a medium level capacity. We filed an appeal and the claim was reinstated.

Long Term Disability Benefits Reinstated for Electronic Technician Suffering from Cervical Radiculopathy

Principal Life Insurance terminated our client’s claim for Long Term Disability benefits after the definition of disability changed and the claimant had to prove that he was unable to perform any occupation. Although the claimant had already filed an appeal when he contacted our office, we were able to secure a 30 day extension of time to obtain and submit additional evidence in support of the appeal. Principal ordered a Physician File Review and determined that they would pay monthly benefits while waiting for an Independent Medical Examination (IME). Following the IME we received notification from Principal that the claim would be approved through the end of the Drug and Alcohol limitation, for a maximum of 24 months, unless it is determined that the claimant’s physical conditions are severe enough to be disabling.

Operating Room Registered Nurse with Rectal Dysfunction, Proctitis, Bleeding and Pain Approved for Long Term Disability Benefits

Cigna denied this claim for Long Term Disability benefits was denied based on the pre-existing condition limitation in her insurance policy; however, the pre-existing conditions for which she was treated were not the reason she went out of work. We obtained additional medical evidence and statements from the claimant’s treating providers which we included in our appeal, and we argued that Cigna failed to properly analyze and give credit to the claimant’s true disabled conditions. Several weeks later the claim was approved.

Long Term Disability Benefits Reinstated for Backroom Receiver Suffering from Back Problems, Neuropathy, Fatigue and Depression

Our client was suffering from hand pain, back pain, spinal stenosis, neuropathy, chronic fatigue, diabetes and depression and had only received two months of benefits when Liberty Life referred her claim for clinical review by a Board Certified Psychiatrist and a Board Certified Neurologist. Based on these clinical reviews Liberty Life determined that the claimant no longer met the definition of disability as defined by the policy, and her benefits were terminated. We submitted an appeal with a statement from the claimant’s treating physician, a sworn statement from the claimant and the claimant’s updated medical records, and upon review of the appeal Liberty Life overturned the previous decision to terminate her claim.

Successful Long Term Disability Appeal for Sr. Pharmaceutical Materials Specialist Suffering from Spinal Stenosis, Chronic Back Pain and Lumbar Degenerative Disc Disease

Liberty Life paid our client’s long term disability benefits for nearly two years before terminating the claim based on the opinion of one independent physician who never treated him or even spoke to his treating physician. The independent physician noted that subjective complaints alone do not meet the qualification for restrictions and the available medical records do not indicate a severity of symptoms that would prevent full time work without restrictions. We obtained updated medical records and statements from the claimant’s treating physicians, which contained vast amounts of medical evidence detailing his severe limitations and restrictions. Shortly after we submitted the appeal Liberty Life reinstated his claim.

Mobile Mechanic Approved for Long Term Disability Due to Degenerative Arthritis and Neck and Back Pain

Our client filed a claim for Long Term Disability benefits due to degenerative arthritis in his bilateral knees and shoulders and neck and back pain. Sedgwick reviewed medical documentation from the claimant’s treating providers and ordered a Peer Review conducted by an orthopedic surgeon; however, Sedgwick denied the claim due to a lack of objective medical evidence to support the claim. We appealed the denial and provided Sedgwick with additional medical records and a Physical Capacities Evaluation form, which clearly detailed the claimant’s inability to stand or walk long, or lift over 25 pounds. After review of the records that we submitted Sedgwick approved the claim.

Nurse Suffering from Chronic Regional Pain Syndrome/Reflex Sympathetic Dystrophy, Degenerative Disc Disease, Hashimoto’s Disease, Fibromyalgia and Polyneuropathy Approved for Long Term Disability Benefits

Our client received long term disability benefits for 24 months, at which point the policy’s definition of disability changed from the inability to perform all the material duties of the claimant’s own occupation to the inability to perform the material duties of any occupation. Cigna identified several sedentary occupations that the claimant could perform, and as such her claim for benefits was terminated. The claimant filed her own appeal, and Cigna ordered two peer reviews to clarify the severity of her impairments,. Both of the peer review physicians determined that there was insufficient evidence to support the claim and the denial was upheld.

Rather than filing a second appeal on her own the claimant contacted our office for assistance. We obtained additional medical evidence and statements from the claimant’s treating physicians which we submitted with out appeal letter. Cigna ordered yet another peer review and a vocational evaluation, but the documents supported the claim and the decision to terminate the claim was overturned.

Long Term Disability Claim Approved for Project Director Suffering from Chronic Pain, Hyperuricemia and Nephrolithiasis

The claimant had been receiving Long Term Disability benefits from MetLife for two years when the policy’s definition of disabled changed from an inability to perform his own occupation to an inability to perform any occupation. MetLife’s Medical Director reviewed the claim and determined that the claimant could perform several different occupations, and as such his claim was terminated.

We obtained additional medical evidence and filed an appeal on behalf of the claimant. MetLife began their appeal review by ordering an Independent Physician Consultant review and invoked their right to an extension. MetLife eventually provided us with a copy of the review, we responded, and we later received notification that the claim had been reinstated.

Patrol Deputy Suffering from Epilepsy Approved for Long Term Disability Benefits

Our client received long term disability benefits for 24 months, at which point the policy’s definition of disability changed from an inability to perform all the material duties of the claimant’s own occupation to any occupation. Cigna determined that the claimant could perform the duties of an Information Clerk or a Civil Service Clerk despite his various limitations and terminated his claim. 

The claimant filed his own appeal and shortly thereafter Cigna ordered several medical reviews and an Independent Medical Examination (IME) with a Board Certified Neuropsychologist, but the evidence obtained supported Cigna’stermination of the claim so the decision was upheld. At this point the claimant contacted our office to file his second appeal. We submitted new evidence from the claimant’s treating physicians that contradicted the evidence obtained by Cigna and the claim was reinstated.