After Appeal Sun Life Finally Approves Disability Benefits for Data Engineer

Prior to filing for disability, our client was employed as a Manager of Data Engineering Analytics for Avanade. A job he loved and excelled at (and financially rewarding), our client was unfortunately forced to stop working in August 2017 due to significant heart issues. Fortunately, his employer provided him coverage under a Long Term Disability Insurance Policy with Sun Life Assurance Company of Canada should he ever be “unable to perform the Material and Substantial Duties of his Own Occupation.”

After stopping work on the advice of his treating physicians, our client applied for benefits under the LTD policy with Sun Life. Although benefits should have begun in November of 2017, by way of a denial letter of January 2018, Sun Life denied his claim. In support of its decision to deny these benefits, Sun Life stated that the “available records do not support a frequency of episodes requiring medical attention…” Sun Life pointed to the opinion of a physician consultant it had hired to perform a review of our client’s medical records. This reviewing consultant merely performed a paper review of medical records and never examined or met with our client. The reviewing consultant gave an opinion that our client only had restrictions of “no driving professionally, climbing, or lift/carry more than 25 pound ever.” Using the results of this review, Sun Life stated that “the available information supports the ability to sustain full time capacity” and that he would be able to perform his sedentary occupation.

Appeal by Attorney Palamara

After receiving the denial letter, the former employee of Avanade found our firm and spoke with Attorney Alexander Palamara. Attorney Palamara quickly reviewed the denial letter and knew there was a disconnect in the information provided to Sun Life and how Sun Life interpreted those records. After ordering the claim file and all medical records from the treating providers, it was quickly seen that Sun Life and its reviewing consultant overlooked much.

First and foremost, Sun Life failed to fully analyze all of our client’s relevant diagnoses and failed to apply the restrictions and limitations of these diagnoses to our client’s actual job requirements. In fact, Sun Life even overlooked the fact that a significant requirement of our client’s job duties included frequent travel.

A timely appeal was filed pointing out the inadequacy of Sun Life’s reviews and conclusions. In addition to pointing to the supportive medical documentation, the appeal also pointed to the history of support from multiple treating providers who each stated that our client would be unable to work and that his restrictions and limitations would be permanent. The appeal also pointed to an overabundance of objective physical findings that showed cardiac disease including multiple positive EKGs, Carotid Dopplers, and Echocardiograms.

Claim Finally Approval

On October 21, 2018, we received word from Sun Life that it was approving his Long Term Disability Claim. Sun Life made the conclusion that “he meets the requirements to be considered Totally Disabled…”. Shortly thereafter, our client received a sizable benefit check for nearly a year of benefits and remains on claim at the present time. Although our client is relieved to be finally on claim, he knows that the fight will continue as his policy’s definition of disability changes after 24 months of benefits. At that point, we will have to prove to Sun Life that he is “unable to perform with reasonably continuity any Gainful Occupation.” Thus, Attorney Palamara will continue to work on this claim to continue to prove to Sun Life that our client remains disabled and satisfies the requirements of the policy.

If you have been denied disability benefits by Sun Life or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schafer for a free consultation.

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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.

Reviews   *****

Ron K. (Georgia)

I was on disability with a major insurance company for five years without any problems, upon a field rep’s visit to my home, I let him know that I was planning to try to go back to work. I did try to go back to work but with my severe sleep apnea and depression and several medications that made me very tired, the work day became impossible, when I let the case manager know that I couldn’t work without getting very tired and having to take a nap after a few hours on the job, he told me that the claim would be reexamined. I waited 9 months without any monthly benefit benefits being paid to me, the company gave me several excuses and I was in a real pickle, I researched disability attorney’s since I was in the insurance business and was told that the very best in the business for representation of my issues was a firm called Dell & Schaefer.

I reached out to the firm and was put in touch with an attorney named Steve Jessup, from that point forward, my problems seemed to fall off my shoulders and into the firms hands, I can’t explain in words what this firm did for me and my family.

Steve Jessup & Gregory Dell began working on my case immediately and I felt confident with every action they took. The insurance company as most wanted to settle my case for pennies on the dollar, but with the skill of the two attorneys, I was able to settle my case for a once in a lifetime lump sum payment from the disability insurance company that will take care of me and my family for life. All I can say is that these guys were like a machine grinding away in the trenches agains the insurance companies attorneys and getting me a great settlement. I would highly recommend this firm for anyone who felt like I did up against bad odds with a large insurance company and no where to turn to.

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