Dell & Schaefer Successfully Appeals Denial Of Benefits To Claimant With Trigeminal Neuralgia

Ms. R contacted our firm after her claim for Long Term Disability (“LTD”) benefits was denied by Principal Life Insurance Company.

Before becoming disabled, Ms. R worked as a Litigation Support Assistant for a large, busy law firm. Ms. R had been experiencing head pain for several years with the symptoms first appearing in August 2012 and gradually worsening over time. In July 2015 her symptoms became so severe that her doctor advised restricted work activity. As of July 2015 Ms. R was experiencing severe head pain that was causing cognitive impairments and limiting her concentration. Eventually, the pain and resulting impairments became so severe that Ms. R was forced to stop working in September of 2015.

Following her leave from work, Ms. R filed a claim for disability benefits under her employer sponsored disability plan. Principal Life Insurance Company, the claims administrator, reviewed Ms. R’s claim for benefits and after months of reviewing Ms. R’s medical history, medical records, and reaching out to Ms. R’s treating physicians Principal denied the claim concluding there were no restrictions of work ability supported.

Given her debilitating condition, Ms. R was in no position to handle her appeal alone so with help from a friend she reached out to our firm for a free consultation. Ms. R spoke with us and we agreed to take on her case.

After reviewing the denial letter it became apparent that Principal had committed predictable errors. It also appeared that Ms. R’s doctors had been less than helpful. While her doctors were supportive and advised Ms. R to stop working the same doctors were not adequately documenting the medical records or properly responding to Principal’s requests. As a result, Ms. R’s claim had been denied.

We immediately began working on Ms. R’s appeal. Our team gathered all medical records and reviewed Principal’s claim file for inconsistencies. After reviewing Principal’s claim file along with the denial letter it also became apparent that those who made the decision to deny Ms. R’s LTD claim did not fully understand the nature of Ms. R’s condition. Ms. Russo has been suffering with what is considered to be one of the most painful afflictions known to the medical practice. According to the Facial Pain Association Trigeminal Neuralgia (TN) is a disorder of the fifth cranial (trigeminal) nerve. The typical or “classic” form of the disorder (called TN1) causes extreme, sporadic, sudden burning or shock-like facial pain in the areas of the face where the branches of the nerve are distributed—lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. The “atypical” form of the disorder (called TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than TN1. Both forms may occur in the same person, sometimes at the same time.

According to TNA Facial Pain Association:
“The trigeminal nerve is one of 12 pairs of nerves that are attached to the brain. The nerve has three branches that conduct sensations from the upper, middle, and lower portions of the face, as well as the oral cavity, to the brain. More than one nerve branch can be affected by the disorder. Rarely, both sides of the face may be affected at different times in an individual, or even more rarely at the same time (called bilateral TN).

The intense flashes of pain associated with TN can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. Often, people with TN avoid social and daily activities such as eating and talking out of fear of an attack. Many people have been known to lose their jobs due to the debilitating pain.”

Ms. R suffers from a severe case of TN with attacks worsening over time. The symptoms eventually became so severe that she could no longer function in the workplace.

Unfortunately, like many chronic pain conditions which are difficult to prove, Principal did not fairly consider the effects this pain would have on Ms. R’s ability to work and did not believe the medical records adequately supported work restrictions.

We focused the appeal on educating Principal’s claim analysts on Ms. R’s condition and on gathering the right evidence to construct an effective appeal. We worked with his appeal specialist in drafting physician questionnaires that were specific to Ms. R’s condition. The responses from Ms. R’s treating physicians were overwhelmingly positive as they were now being asked the right questions.

As is the case in many disability claims, insurance companies will send general questionnaires to treating physicians that do not elicit the right responses to adequately review a disability claim. This is often a problem when a claim is based on a rare condition such as Trigeminal Neuralgia.

After submitting the appeal, we worked closely with the claims analyst handling Ms. R’s appeal. During the appeal review, Principal requested that Ms. R undergo an independent medical evaluation. Unlike many disability policies, the policy at issue did not contain a provision requiring Ms. R to undergo such an evaluation during the appeal review. Given the nature of Ms. R’s condition, we decided an IME would not be helpful to Ms. R’s claim and could only serve to allow Principal to build evidence against Ms. R’s claim.

After a lengthy review, Principal made a decision on Ms. R’s appeal and overturned its initial decision to deny the claim. Principal paid all back benefits owed and reinstated Ms. R’s claim going forward.

Ms. R continues to be disabled and remains on claim. Attorneys Dell & Schaefer continues managing her claim with Principal.

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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

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

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