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 help Principal claimants nationwide?

We represent Principal clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Principal disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Principal. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Principal.

How do you help Principal claimants?

Our lawyers help individuals that have either purchased a Principal long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Principal:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

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.

Dell & Schaefer Client Reviews   *****

Josh C.

After suffering with the symptoms of ME/CFS for nearly 3 years, I was finally diagnosed with ME/CFS in August of 2011. I filed a claim and was approved by my disability insurance carrier initially. After a little over one year of not working, I started seeing some minor improvement. I told my doctor about the improvement and my carrier took that as news that I was now ready to return to work, which was far from the truth. My doctor told me not to go back to work yet, knowing it would only set me back and reverse my progress. My insurance carrier did not care and they made me attempt work. If I didn’t follow their rules they were going to drop me. I had no idea what to do or what my rights were in my disability contract. I called Greg Dell.

Greg gave me great advice. He spent a great deal of time on the phone with me answering all my questions, explaining all my options and recommending the best course of action. He was able to explain things to them that just made sense. I have been working with him for well over a year. He could articulate what I and my doctors were saying that I was not able to on my own. Anyone with ME/CFS knows how incredibly hard and difficult it is to try and explain your symptoms and limitations to someone.

Greg actually gets it and is who you want in your corner when you’re dealing with an insurance company that is not your friend. Greg was able to get me back on total disability with no work requirement. Unfortunately the work I had to do for those months in between did set me way back in my recovery, but that only makes me wish I had gone with Greg from the get go instead of waiting for a crisis that could have been prevented.

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