Dell & Schaefer successfully appeal denial by Liberty Life
Author: Attorney Victor Peña
Before going on disability our client was a hardworking and dedicated Business Coordinator for Hoffman La Roche who was greatly admired by her co-workers for her professionalism, tenacity and leadership. After working more than 20 years for Hoffman La Roche she was diagnosed with Breast Cancer and had to suffer through the overwhelming effects of chemotherapy. Following her treatment she was placed on Aromasin, an estrogen blocker which is known to cause severe debilitating side effects to many patients.
Our client was unfortunate to be among the group of patients who suffer the debilitating effects of an Aromatase inhibitor regimen. The resulting side effects, which included persistent and severe joint pain and stiffness, chronic fatigue, generalized body pains, chronic neuropathy, numbness and tingling in her hands and feet, headaches, tension, insomnia, memory loss and difficulty concentrating forced the Hoffman La Roche employee to stop working on February 7, 2011.
Unable to return to work she filed a claim for disability benefits with Liberty Mutual as well as with the Social Security Administration. Both claims were approved.
Denial of Benefits by Liberty Life
Liberty Life paid our client Long Term Disability benefits until March 21, 2013 when they terminated her benefits claiming she was no longer disabled. In support of its decision Liberty Life relied upon an internal review by one of its hired doctors and completely ignored her treating doctors’ opinions that she could not work due to continued complications from the Aromasin treatment.
First Level Appeal
Before retaining Dell & Schaefer our client decided to take on Liberty Life alone and submitted her own appeal of Liberty Life’s denial of benefits. After submitting her appeal she was forced to wait until September 17, 2013 when Liberty Life sent another letter denying her appeal. It was at this point that she realized she needed an experienced ERISA attorney to help her fight Liberty Life for her benefits.
Second Voluntary Appeal
Upon contacting our firm Attorney Peña immediately started working on her claim. Many disability policies allow only one appeal after a denial of benefits, after which, a lawsuit must be filed. Luckily for our client her policy allowed a second voluntary appeal.
In preparing the appeal Attorney Peña thoroughly analyzed Liberty Mutual’s complete claim file including the medical review conducted by Liberty Life’s hired doctors. During the analysis it became apparent that Liberty Life had failed to properly review and consider the side effects of our client’s Aromasin treatment. The appeal challenging Liberty Life’s denials included all the medical records from our client’s treating physicians including documented objective evidence supporting her claim as well as extensive medical literature surrounding the disabling symptoms caused by an Aromatase inhibitor regimen.
Liberty Life Overturns Denial and issues a check for unpaid benefits
After completing its review Liberty Life sent a letter reinstating benefits effective March 22, 2013. Liberty Life issued a check for all unpaid benefits dating back to the initial denial. The fight, however, did not end there—Liberty Life miscalculated the benefit amount and initially agreed only to pay unpaid benefits through September 2013, the date representing 24-months of benefits and the date the more stringent “any-occupation” definition of disability began.
Fortunately for our client, Dell & Schaefer remained on the case and immediately demanded that Liberty Life issue all unpaid benefits and approve our client’s claim under the more stringent policy language. Liberty Life has since then approved our client’s claim and will continue paying benefits as long as she remains disabled. Dell & Schaefer will continue managing the ongoing claim against Liberty Life to ensure our client has the best chance of remaining on claim for as long as she is disabled under the policy language.
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