Dell & Schaefer Successfully Appeals Denial of Benefits to Former Inventory Control Specialist
Author: Attorney Victor Peña
Pre-disability and initial disability claim
Our client contacted us for assistance with her claim against Liberty Mutual after receiving a denial of her Long Term Disability (“LTD”) benefits. Ms. M had been working as an inventory control specialist with her employer until June 2014 when her doctor advised her to stop working due to various medical conditions including pseudoarthrosis, post-laminectomy syndrome, chronic low back pain, chronic pain syndrome, peripheral neuropathy, bilateral SI joint pain, general osteoarthrosis, and fibromyalgia. Ms. M received short term disability benefits until January 2015 at which point she became eligible to receive long term disability benefits. Unfortunately, in February 2015, Ms. M received a letter from Liberty Mutual denying LTD benefits and stating that Ms. M was not disabled and could return to work.
According to Liberty Life’s denial letter, the decision to deny Ms. M’s claim for LTD benefits was based primarily on the peer review performed by Liberty Life’s physician consultant, Dr. Mark Kaplan. Based on his review of only the paper medical records, Dr. Kaplan opined that Ms. M would be capable of sitting for 30 minutes continuously for up to 8 hours per day, standing for 10 minutes continuously up to 30 minutes per day, walking for 10 minutes continuously up to 30 minutes per day, lifting and carrying up to 10 pounds occasionally, pushing and pulling up to 10 pounds occasionally, and driving a car for 30 minutes continuously up to 1 hour per day. Dr. Kaplan restricted Ms. M from total balancing, climbing ladders, working at unprotected heights, total kneeling and pedaling. He indicated she was restricted to performing repetitive bending, twisting or squatting up to 4 times per hour, and lifting or reaching above shoulder level and below waist level up to 4 times per hour.
Based on the opinion of Dr. Kaplan, Liberty Life concluded that Ms. M had full time sedentary work capacity and, therefore, could perform the material and substantial duties of her own occupation.
Ms. M. Contacts Attorneys Dell & Schaefer
Unsure what to do, Ms. M contacted our firm for help fighting Liberty Life. Attorney Victor Peña reviewed Ms. M’s denial letter and discussed her claim with her. Mr. Peña and his appeals team immediately began working on Ms. M’s appeal and requested a complete copy of the claim file from Liberty Life. Upon review of the claim file it became apparent that Liberty Life did not understand the nature of Ms. M’s condition and the effect of her conditions on her ability to work.
Appeal by Dell & Schaefer
The appeal prepared by Attorney Peña and his appeals team pointed out the errors in Liberty’s review. Liberty Life had overlooked or completely ignored all of the objective and diagnostic evidence found in the medical records and relied solely on the single contrary opinion of Dr. Kaplan, which interestingly did not seem to support the purported “sedentary” work capacity Liberty Life states Ms. M had the ability to perform.
The great weight of the medical evidence in fact supported that Ms. M has less the sedentary work capacity and, therefore, is unable to perform the material and substantial duties of her own occupation.
To provide additional objective evidence corroborating Ms. M’s disability, we had Ms. M undergo a Functional Capacity Evaluation (“FCE”). As suspected, the report revealed that Ms. M’s ability to engage in competitive employment is unlikely.
Liberty Life’s review of the appeal and decision to overturn its denial
The appeal was submitted to Liberty Life by letter dated August 24, 2015. By September 3, 2015, less than 2 weeks later, Liberty Life notified our office that the denial had been overturned and a check for back benefits would be issued.
Mr. Peña will continue handling Ms. M’s claim against Liberty Life.