After appeal filed by Attorney Jay Symonds, Sun Life overturned its previous denial of long term disability benefits for Florida ICU Nurse

Our client, Ms. A, formerly worked as a Nurse in the Intensive Care Unit. In September 2014 a number of medical issues, including chronic pain, fibromyalgia, chronic fatigue, neuropathy, bilateral hip pain, bilateral hip bursitis and bilateral knee osteoarthritis forced Ms. A 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 Sun Life. Under her employer’s disability policy, after 24 months she would be considered totally disabled if she was unable to perform the main duties of “any occupation” for which she was qualified by education, training and experience and with additional consideration of her functional limitations and transferable skills.

After paying Ms. A for 24 months under the Policy’s “own occupation” definition of disability, Sun Life denied continued LTD benefits on the basis that she allegedly no longer met the policy definition of disability. Specifically, Sun Life stated that “the medical evidence does not support that [Ms. A] would be precluded from performing the Material and Substantial Duties of any Gainful Occupation.” After receiving the denial, Ms. A contacted Dell & Schaefer and discussed her case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in Sun Life’s denial letter and in the evidence it relied on and agreed to prepare and submit Ms. A’s ERISA appeal with the assistance of his appeal team.

The LTD appeal addressed all of Sun Life’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of Sun Life’s denial and significant inconsistencies with its medical reviewer’s findings. In particular, the appeal addressed several inconsistencies and misinterpretations of medical information submitted by Ms. A’s primary treatment provider and the extent to which Ms. A was functionally limited. The appeal also questioned the findings of an Employability Assessment/Transferable Skills Analysis conducted by Sun Life based on misinterpretation of the APS submitted as well as the failure to evaluate whether Ms. A could perform a sedentary occupation with “reasonable continuity,” which the medical record confirmed she could not.

Just over two months later, and after reviewing the appeal and hundreds of pages of exhibits and medical records, Sun Life overturned its decision to terminate benefits and negotiated a reasonable settlement of Ms. A’s long-term disability benefits claim.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us