Liberty Mutual and Long Term Disability | Appeal a Denial Letter

Hi, I'm Nick Ortiz. I'm a board certified disability insurance attorney. Today, I'm here to talk about Liberty Life Assurance Company of Boston. Oftentimes they go by Liberty Mutual instead. So you may know them by that name.

More specifically, we're here to talk about some of the reasons why Liberty Mutual may deny long term disability claims, and what you can do to appeal it.

One of the reasons why Liberty Mutual denies claims is because they say there is insufficient objective medical evidence to support the claim. What do they mean by that? Objective medical evidence is the type of evidence that can be shown through testing such as x-rays, MRIs, CT scans, the types of things that you can take a picture of or you can measure. Measurements might include other types of tests like an echocardiogram for the heart, or an ejection fraction measurement of the heart, or a pulmonary function test which is measuring the breathing capacity of the lungs. Those are objective in nature because there are certain metrics that are used to evaluate one's abilities in those areas. Problem is that not every single type of medical condition is subject to objective testing. So for example, let's take fibromyalgia, or connective tissue disorder. Those are types of claims where there is no test that you can use to take a picture of the types of muscular pain that you're experiencing.

And so what you need to do to prove up those types of cases is introduce other types of evidence such as a statement from you under penalty of perjury, or statements from your doctors about the types of impairments that you have because of your underlying condition. Maybe they'll fill out a form for you, an attending physician statement, or they'll order additional testing like a functional capacity evaluation where they do specific measurements about what your abilities are given your underlying condition. So those are some of the ways that you can counteract the objective evidence argument.

That last part also goes towards another common reason why they deny claims is that they say that there's insufficient medical evidence to show a specific functional impairment. What that means is they might try to argue, "Okay, we see that there is something like an MRI "or an x-ray, but we don't see how the results "from those tests show what your functional impairment is "which is what your limitations are." Functional impairment is something like the inability to lift over 10 pounds, or the inability to bend, stoop, crouch, or crawl, the inability to stand for more than five minutes, walk more than a block. So what they're saying is, "We don't see enough evidence "to show that you're gonna have "those types of impairments." So what I referenced earlier, the functional capacity evaluation, is perhaps a testing that can be done by an expert to specifically measure how long you can do those things. So if they want to try to determine how long you can walk, they might have you go on a treadmill and literally measure how long you can walk before you need to sit down and take a break. They'll measure how long you need to break before you can get up again. They'll have you lift dumbbells to specifically measure how much weight you can lift and carry. So that is the type of testing that can be done to show functional impairment.

Another reason why the insurance company might deny your claim is because they say that they still think you can do the exertional requirements of your job. Exertional means the physical requirements of the job. So for example, let's say that your prior job was primarily sedentary in nature which is a desk job which requires mostly sitting throughout the day. And they argue that through testing, whether it's functional capacity testing or they ordered an independent medical exam, they say, "Look, as a result of his tests, "we think you can do a sit-down desk job." But the reality is, that maybe is not taking into account what we call the cognitive requirements of the job, or the thinking requirements. So even if one has the ability to sit for a lot of the day, what if their pain is so significant that they can't think straight or maintain sufficient attention and concentration to stay on task. That's particularly important for let's say a doctor, or an accountant, or a lawyer where there's a lot of thinking involved in the job. So just because they can sit around doesn't necessarily mean that they have the ability to perform the thinking, cognitive requirements of that job. So if you can show that your pain in and of itself, or the side effects of the medications let's say, very significantly impairs your memory and thinking and cognition, then that's a way of counteracting their argument that just because you can do a sit-down job, you are not entitled to benefits any longer.

And then, just one more example of why Liberty Mutual might deny the claim is because your doctors have stopped filling out reports. But there might be a really good reason why the doctors have stopped filling out reports. It's because they're tired of doing all the administrative work that goes behind that. Oftentimes, these insurance companies will send forms to the doctors constantly like once a month, calling doctors' office trying to get them on the phone, asking them to comment on their own doctor's reports. So they're asking the doctor to take a lot of time to fill out reports and answer questions til it gets to the point where the doctor tells the patient, "Hey, I can't do this for you any more. "This is taking up too much of our time administratively. "And to be honest I don't have the time to do "that type of thing for you any more. "So I'm not really gonna fill out "any more paperwork for you." Then the insurance company, by driving that wedge between you and your doctor, they then leverage that against you by saying, "Oh, if your doctor's "not filling out forms any more, "then you must not be disabled any more." And they use that against you and deny your case. So there are things that we do such as asking the doctor if they're not gonna fill out a report, maybe write a letter saying, "My opinions have not changed since my last report." Even a simple sentence like that is designed to carry over their opinions from the last report.

But there are things that you can do to help counteract that type of argument from the insurance company. So just as we have tips and advice and things that we do in that last example, there are things that we do in every one of our cases to try to counteract each and every reason why an insurance company denies our clients' cases. And if you would like to talk to us about what we could do in your case, I encourage you to give us a call for a consultation at 850-308-7833. Or if you'd like additional written materials, there is a book that I wrote called, "The Top 10 Mistakes That Will Destroy Your Long-Term Disability Claim." You can download a free copy of that book at www.freeltdbook.com. Thanks for listening. Look forward to hearing from you