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Assurant overturned its previous denial of long term disability benefits for Maine Sales Consultant

Attorney Jay SymondsAuthor: Attorney Jay Symonds

Our client, Ms. C, formerly worked as a Sales Consultant for an international manufacturer of dental materials. In July 2013 a number of medical issues, including the debilitating effects of chemotherapy treatment as well as recurrent breast cancer forced Ms. C to stop working and submit her claim for disability benefits first under her employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. Both benefits were funded and administered by Assurant. Under her employer’s disability policy Ms. C would be considered totally disabled if she was unable to perform the material duties of “any gainful occupation” for which she was qualified by education, training and experience and with additional consideration of her functional limitations and transferable skills. Material duties included, among other things, the sets of tasks or skills required generally by employers from those engaged in an occupation, which cannot be reasonably accommodated.

After paying Ms. C for 24 months under the Policy’s “own occupation” definition of disability, Assurant denied continued LTD benefits on the basis that she allegedly no longer met the policy definition of disability. Specifically, Assurant stated that Ms. C’s condition had “improved to allow [her] to perform full-time sedentary and light work.” After receiving the denial, Ms. C contacted Dell & Schaefer and discussed her case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in Assurant’s denial letter and in the evidence it relied on and agreed to prepare and submit Ms. C’s ERISA appeal with the assistance of his appeal team.

The LTD appeal addressed all of Assurant’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of Assurant’s denial and significant inconsistencies with its medical reviewer’s findings. The appeal next addressed Assurant’s mischaracterizations and overstatements regarding the nature and relevance of Ms. C’s purported activities. Finally, the appeal addressed Assurant’s incorrect and incomplete vocational assessment by retaining a vocational expert to discredit Assurant’s report and establish that Ms. C was, in fact, incapable of performing any sedentary occupation in light of her documented physical and cognitive restrictions and limitations.

Just over five weeks later, and after reviewing the appeal and hundreds of pages of exhibits and medical records, Assurant overturned its decision to terminate benefits and reinstated Ms. C’s long-term disability benefits.