As a sales and marketing business analyst at Breaktrhru Beverage Group, LLC in Fort Lauderdale, Florida, our client has group disability insurance through her employer. Although she worked her way up from assistant to award-winning creative analyst, she was forced to stop working at age 44 due to lumbar spine multilevel degenerative disc disease with nerve root compression, chronic bilateral knee pain (status post right knee arthroscopy), chronic bilateral foot pain (status post multiple surgeries), peripheral neuropathy, complex regional pain syndrome, low back and hip pain, and major depression and anxiety.
Our client had a promising career and a zest for life, and she did not want to stop working, but her medical conditions made it impossible for her, so she filed for long-term disability (LTD) benefits.
Reliance Standard approved our client’s claim and paid LTD benefits for 2 years. After 24 months, however, the definition of disability changed, and the insurance company suddenly decided our client was no longer disabled.
Dabdoub Law Firm helped set the record straight.
When Is a Medical Condition a Disability?
Under the terms of our client’s policy, a medical condition becomes a disability when it prevents an individual from fulfilling the duties of their own occupation. This definition applies for 2 years, then a medical condition is only a disability when it prevents an individual from fulfilling the duties of ANY occupation.
Although Reliance Standard was correct to review our client’s claim at the 2-year mark, the company was incorrect to terminate our client’s LTD benefits.
This is because our client is disabled – regardless of the policy’s definition of disability.
Dabdoub Law Firm presented medical evidence proving that our client is incapable of working in any job due to her physical and mental health conditions.
Evidence of Our Client’s Physical Conditions and Pain
Not only can our client not work anymore, but she also struggles to find any joyous moments in life. On top of immense pain and physical limitations, she suffers from major depression and anxiety. She continues to see doctors for her conditions, all of whom confirm the fact that she can no longer work.
Our client suffers from chronic debilitating pain and weakness due to degenerative disc disease, chronic knee pain on both sides, foot pain despite multiple surgeries, peripheral neuropathy, complex regional pain syndrome, and additional problems with her hips and low back.
She can barely sit, stand, and walk, much less work full-time, and these facts are backed up by her doctors and medical records.
Our client’s doctors include a board-certified orthopedic surgeon who has outlined her severe restrictions, limitations, and functional impairments and specified that her conditions prevent her from “working in any sedentary occupation on a reliable and consistent full-time basis” – and put her at risk of harm via falls and other accidents.
To further illustrate our client’s disability, we had her undergo multiple functional capacity evaluations (FCEs), the results of which confirmed an extreme pain disability and an inability to sit or stand for more than 59 or 49 minutes, respectively.
An occupational therapist independently reviewed our client’s FCEs and came to the same conclusion. Our client functions below a sedentary level, and any physical activity can make the pain she deals with every day even worse.
Returning to work would be excruciating and dangerous for our client; she simply cannot do it.
Additionally, our client’s physical health conditions are directly tied to her mental health conditions, which will require her to need psychiatric care and interventions for the rest of her life.
As if Reliance Standard needed any more reasons to approve our client’s appeal for LTD benefits, 5 of her closest friends and family member spoke out in support of her disability.
Our client used to love baking, gardening, exercising, going out to eat, fishing, and doing a job that she loved and excelled out. Now, they are constantly afraid for her health. Our client’s own mother believes it would take a “miracle” to see her daughter healthy again. Her friends and family members worry about the day when her physical and mental pain will become too much to bear.
Surely, Reliance Standard does not want to see this day come faster.
Reliance Standard’s Wrongful Termination of Benefits
In the letter it wrote our client terminating her LTD benefits, Reliance Standard spent just as much time suggesting alternative occupations for her as it did “reviewing” her medical records. Had Reliance Standard actually reviewed our client’s medical records, they would have never dared to challenge her disability.
Our client’s condition is precarious, and her continued LTD benefits are a matter of life and death. Since Reliance Standard first issued LTD benefits 2 years ago, our client’s condition has only gotten worse.
Instead of providing our client with an honest and competent review as required under ERISA, Reliance Standard clung to a definition change and failed to acknowledge our client’s rapidly deteriorating conditions.
On appeal, Dabdoub Law Firm gave the insurance company an opportunity to remedy its frankly appalling mistakes. Fortunately, Reliance Standard reinstated our client’s LTD benefits, hopefully giving her even a moment of reprieve in the wreckage of her previously happy, enjoyable life caused by the horrific physical and mental health conditions she battles against every day.
Help from a Lawyer with Expertise in Disability Insurance
Dabdoub Law Firm was built to be a disability insurance law firm.
That focus means:
- All of our lawyers specialize in disability insurance claims.
- We have experience with every major disability insurance company.
- We have won important long-term disability lawsuits.
Our disability lawyers can help you with:
- Submitting a disability insurance claim,
- Appealing a long-term disability denial,
- Negotiating a lump-sum settlement, or
- Filing a lawsuit against your disability insurance company.
Hiring an experienced disability attorney can help you recover the disability benefits you deserve. Because federal law applies to most disability insurance claims, our lawyers do not have to be located in your state to handle your case.
Call us at (800) 969-0488 or send us a message online for a free consultation with an experienced disability attorney. Pay no fees or costs unless you get paid.
