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$79,000 in long term disability insurance benefits is recovered for disabled teacher

Attorney Cesar GavidiaAuthor: Attorney Cesar Gavidia

For over 40 years, Mrs. K had been employed as a middle school guidance counselor and teacher. In order to protect her income in the event of a disability, Mrs. K enrolled in her school board’s long-term disability plan and even purchased additional options to increase her monthly benefits.

In 2007, Mrs. K became disabled under the terms of the school board’s long-term disability plan due to what was originally thought to be a stroke. Later, it was confirmed that she in fact had contracted viral meningitis. She was also having significant restrictions resulting from cervical neck pain, dizziness and headaches resulting from a cystic mass in her neck, as well as, chronic spondylosis; fibromyalgia; rheumatoid arthritis; osteoarthritis; and chronic low back pain. Shortly after Mrs. K submitted her claim to the long term disability insurance carrier, Mrs. K’s claim was approved.

Following the approval of her claim, Mrs. K diligently continued to provide the disability insurance carrier with proof of loss and medical documentation supporting that she was not capable of working as a middle school guidance counselor. Notwithstanding, approximately 6 months after her claim for disability benefits was approved, the disability insurance carrier terminated Mrs. K’s disability benefits. In arriving at its decision to terminate benefits, Mrs. K’s disability insurance carrier failed to consult any of Mrs. K’s treating physicians or send her to any type physical examination. Instead the disability carrier advised her that based upon their review of her medical records she appeared to have the physical capacity to perform her job.

Following her denial of benefits, Mrs. K immediately spoke with a family friend who was an attorney. Through her family friend, Mrs. K appealed the disability insurance carrier’s denial of disability benefits. After receiving notice that she was appealing the disability insurance carrier retained three purportedly independent doctors to conduct a paper review of Mrs. K’s file. Again, without conducting any physical examination of Mrs. K and only reviewing her medical records, the three physicians retained by the disability insurance carrier, found that Mrs. K did not have any functional impairments. Based on the findings of these hired doctors, the disability insurance carrier upheld its previous denial of disability benefits.

On the advice of her family friend, Mrs. K retained disability insurance Attorneys Dell & Schaefer to represent her. Mrs. K’s litigation team of Cesar Gavidia, Gregory Denes and Gregory Dell promptly filed suit for breach of contract against the disability insurance company in state court. Two months prior to trial, the lawsuit was resolved when the disability carrier offered to pay our client every dollar she was entitled to receive. Due to the terms of a confidentiality agreement, the name of the insurance company must remain confidential.