Standard Overturns Denial of Benefits to Shareholder of Major Law Firm
Author: Attorney Victor Peña
When Mr. L contacted us he had recently left a major law firm where he had been working for 27 years. Mr. L, a commercial finance and real estate transaction attorney, was forced to stop working due to debilitating symptoms from several medical conditions. He had been suffering from these conditions for several years but his symptoms had gradually worsened over time and eventually reached the point where he was experiencing substantial limitations in his ability to continue to work effectively.
To effectively perform the duties of his occupation, Mr. L needed the ability to maintain prolonged focus and operate under pressure to complete work with unyielding deadlines. In his practice, Mr. L had to review, revise and transmit drafts of documents via computer and email. Naturally, an inability to focus on a computer screen would make it difficult to perform the important duties of his position as a transactional attorney.
In 2011, Mr. L suffered from what was later diagnosed as a visual migraine, which essentially prevented him from comprehending words on his computer screen. He continued experiencing similar symptoms although he was able to continue working.
Over time, Mr. L noticed that his symptoms were directly related to working on computer screens and his symptoms were more severe when he was tired or had been looking at computers for long periods. As his symptoms worsened Mr. L began to think that he needed to retire and started seeing a mental health counselor to assist with the transition.
To make matters worse, in the fall of 2015, Mr. L began to suffer from very noticeable hearing loss accompanied by a dramatic increase in tinnitus which he had been experiencing for years. In October of the same year, Mr. L suffered a severe episode causing him to become severely nauseous while he felt his office was spinning out of control. He was taken to the ER and diagnosed with vertigo.
Following the October episode, he began to experience other and unpredictable episodes of vertigo with nausea about 3 to 5 times a month. The worsening of his symptoms together with the increase in frequency of episodes caused Mr. L to have to work longer non-billable hours to make up the time lost. He became less efficient at performing the important tasks of his position.
In the spring of 2016 Mr. L made the difficult decision to take a medical leave of absence. Soon thereafter, his visual migraines began to improve. This confirmed his suspicions that computer use was exacerbating his symptoms.
After filing his claim for disability benefits, The Standard, his disability insurance company, denied the claim stating Mr. L was not disabled under the terms of the policy. Mr. L contacted our firm for help with his appeal and spoke with Attorney Victor Peña. Attorney Peña agreed to take the case. Upon reviewing the denial letter and claim file it became clear that The Standard did not fully understand the nature of Mr. L’s occupation. According to Mr. L’s policy, he would be considered disabled if he is unable to perform the substantial duties of his regular occupation. However, The Standard had to fully understand what was required to perform Mr. L’s regular occupation. Additionally, The Standard’s internal medical staff completely disregarded how Mr. L’s medical conditions affected his ability to work.
The appeal was 192 pages long and focused on making The Standard fully understand how Mr. L’s condition prevented him from effectively performing his occupation. The appeal included detailed responses from Mr. L’s treating physicians in support of Mr. L’s claim for benefits.
In denying the claim, the Standard had been focused on Mr. L’s ability to perform non-work related activities such as playing golf and yoga and relied on such abilities as a basis to deny his claim. The Standard also relied on the fact that some of Mr. L’s disabling conditions had been present for years.
Unfortunately, this is the case for many claims where the claimant files a disability claim based on conditions that have been present for years. It is often tough to pinpoint when the condition reaches the point where it is disabling under the terms of the policy. In Mr. L’s case, The Standard did not fully understand the nature of Mr. L’s occupation and the importance of the billable hour in the context of a large law firm.
After reviewing the appeal, The Standard overturned its decision to deny Mr. L’s claim and is currently paying Mr. L monthly disability benefits.