At the Ortiz Law Firm, we recently had the privilege of helping a client who had been unfairly denied his long-term disability (LTD) benefits. Our client became disabled due to a combination of debilitating medical conditions, including long COVID syndrome with shortness of breath and dizziness, chronic fatigue syndrome, chronic migraines, dyspnea on exertion, cervical radiculopathy, anxiety, mild obsessive-compulsive disorder, sleep apnea, and brain fog.
His insurance company, MetLife, denied his claim when the definition of disability changed from the inability to perform his “own occupation” to the inability to perform “any occupation.” The denial was based on an “independent” peer review by a physician who claimed that our client could work with light restrictions. This conclusion blatantly ignored strong medical evidence and testimony from our client’s treating physicians who clearly stated that he was unable to work due to his near constant fatigue, brain fog, migraines, dizziness, and other symptoms.
The peer review physician dismissed these statements as “excessive,” undermining the credibility of the very doctors who know our client best. That’s when our client turned to us for help.
How We Fought Back
We knew this case required a strategic approach to hold MetLife accountable under ERISA (the Employee Retirement Income Security Act). Here’s how we fought for our client:
- Exposing Flaws in the Review Process: We painstakingly exposed the flaws in MetLife’s reliance on a paper review by a doctor who had never examined our client. We emphasized the weight and credibility of the treating physicians’ opinions, which were based on years of consistent care.
- Demonstrating Subjective Symptoms: We emphasized the importance of our client’s subjective symptoms—such as fatigue, brain fog, and dizziness—and the impact they had on his ability to work. Subjective symptoms cannot be ignored, especially when supported by medical evidence and consistent treatment records.
- Pointing to SSDI Approval: Our client’s recent approval for Social Security Disability Insurance (SSDI) further validated his inability to work. We ensured that MetLife did not ignore this critical evidence.
Faced with a compelling appeal that exposed their errors and ERISA violations, MetLife reversed its decision and reinstated our client’s benefits. This victory ensured that he could focus on managing his health without the added stress of financial uncertainty.
Need Help with a Denied Long-Term Disability Claim?
If your long-term disability benefits have been unfairly denied, you don’t have to fight the insurance company alone. At the Ortiz Law Firm, we specialize in helping people like you get the benefits you rightfully deserve. Call us today at (888) 321-8131 or fill out our online contact form for a free case evaluation.
