Initial Denial, Initial Appeal, Benefits Reinstated and Benefits Terminated
After receiving full payment of short term disability benefits, a hospital admissions clerk with Catholic Health System, Inc. suffering from morbid obesity, osteoarthritis, and chronic back pain was denied long term disability benefits despite her ongoing medical problems and their accompanying restrictions. In its initial denial letter dated August 19, 2015, Liberty relied upon a single “peer” review by a hired physician to support its denial. Liberty quoted the opinion of the hired physician and concluded there was no objective documentation of any internal medicine restrictions and limitations. As such, Liberty concluded that the hospital admissions clerk did not meet the definition of disability.
In response to Liberty’s first denial, Attorney Alexander Palamara filed an appeal setting forth the objective evidence which supported our client’s claim and argued the opinion of the peer reviewing physician incorrectly contradicted the opinions of our client’s treating physicians and that the peer reviewer even improperly obtained statements from a staff member in our client’s treating physician’s office to support his opinion. Attorney Alexander also set forth the numerous physical conditions our client was suffering from which had been ignored by Liberty.
Two months after filing the first appeal, Liberty overturned its denial and commenced the payment of long term disability benefits. However, a mere 5 months after awarding our client benefits, liberty requested updated medical records from our client’s treating physician. Since our client’s condition was stable, our client only needed periodic follow ups and a follow up visit had not been scheduled until after the time when Liberty requested updated medical records. Unfortunately, Liberty was impatient and terminated our client’s benefits yet again.
New Appeal by Dell & Schaefer
After receiving the new denial letter dated September 30, 2016, Attorney Alexander Palamara immediately jumped back into action and filed a second appeal on behalf of our client. In this new appeal, Attorney Palamara once again set forth the objective evidence which supported our client’s claim and arguing that the second denial was improper since she remained under the care of her physicians and did not require frequent visits due to the stable nature of her conditions and the difficulty she has in ambulating to attend doctors appointments. Additionally, newly updated medical records were obtained and submitted in support of the second appeal.
Less than one month after filling the second appeal, our client was once again awarded the long term disability benefits she was entitled to and remains on claim to this day.
This claim and the positive outcome is another example of how important it is to have ongoing experienced representation to handle your claim because insurance companies will likely make several attempts to deny a claim during a period of disability. Attorney Palamara and Dell Schaefer are well equipped to handle any denial and successfully obtain benefits due to a thorough understanding of our client’s medical conditions and treatment.
If you have been denied disability benefits by Liberty or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schaefer for a free consultation.