Dell & Schaefer Successfully Appeals Denial of Benefits to Fedex Employee
Author: Attorney Victor Peña
We get calls every day from claimants seeking help with filing an appeal against their disability carriers. Often, people call us after their appeals have been exhausted and the only option left is to file a lawsuit. Lawsuits can be costly and time consuming and, under ERISA, limited to recovering back benefits owed. It is not uncommon for a disability insurer to pay short term disability benefits for some time and then terminate benefits before reaching the long term disability phase. Where such a claim involves a permanent or long term disability it is important to contact an attorney before exhausting all administrative appeals at the short term level, mainly to ensure rights to long term disability benefits are preserved. In certain cases, exhausting all appeals at the short term level could prevent or make it difficult to recover long term disability benefits in a lawsuit.
Our Client, Mr. D, was denied disability benefits at the short term level, and unfortunately, has been suffering from a permanent long-term disability. Before going on disability, Mr. D worked as a District Human Resources Manager for FedEx and was forced to stop working due to various conditions he had been suffering from for several years. Mr. D had Type 2 diabetes, Chronic Obesity, Congestive Heart Failure, Neuropathy, and various other conditions. He suffered from worsening numbness in his feet and hands which made it difficult to walk and use a computer. His medications caused him to become very fatigued and drowsy throughout the workday. Over time his conditions worsened and his symptoms made it impossible to continue working.
Mr. D’s Claim for Disability Benefits
Mr. D’s employer had a group disability plan, which covered Mr. D in the event he became disabled. The plan paid short term disability benefits for 6 months and then long term disability benefits thereafter if the disability continued. Mr. D filed a claim with Aetna, the claims administrator for the plan, and after being out of work for over a month he received a letter from Aetna denying his claim for benefits. In the short letter, Aetna acknowledged the presence of Mr. D’s various conditions yet stated that they were denying the claim “because, [they] were unable to obtain any abnormal examination findings to support [Mr. D’s] claim.”
Mr. D immediately contacted our firm and spoke with Attorney Victor Peña. After the first discussion, it became clear to Attorney Peña that Mr. D was indeed disabled and needed help with his claim for short term as well as long term disability benefits. Fortunately, Mr. D had contacted Dell & Schaefer with enough time for Attorney Peña to gather the information needed to secure disability benefits. Additionally, Mr. D did not wait until after exhausting his appeals before contacting an attorney. This ensured that the proper steps could be taken to ensure the best chances of securing long term disability benefits.
Aetna Overturns Denial on Appeal
After collecting all pertinent information, Attorney Peña drafted the appeal in a way that made it simple for Aetna to see that Mr. D was totally and continuously unable to do any and every part of his job. Aetna overturned its short term disability denial and paid all back benefits owed to Mr. D. In his appeal, Attorney Peña demanded that Aetna also evaluate Mr. D’s eligibility for long term disability benefits. An approval letter for long term disability benefits followed.
Mr. D continues to be disabled and Attorneys Dell & Schaefer continues managing Mr. D’s claim for long term disability benefits. Mr. D’s decision to contact an attorney as soon as he received his denial letter played an essential part in securing his long term disability benefits. Had he chosen to file his own short term disability appeal and/or wait longer before contacting a lawyer, his claim may have ended with a different result.