Dell & Schaefer successfully appeals denial of benefits to maintenance technician
Author: Attorney Victor Peña
Before going on disability, our client, Mr. C, was working as a Maintenance Technician for a residential community. His job required him to spend the majority of his time outdoors. Naturally, Mr. C’s job often required him to work through extreme heat or cold and otherwise exposed to the weather. Mr. C used tools ranging from common hand and power tools, such as hammers, hoists, saws, drills, and wrenches to precision measuring instruments and electrical and electronic testing devices. A certain level of coordination and manual dexterity was required to effectively handle the day-to-day tasks required of his job as maintenance tech.
Disability and Claim for Short Term Disability Benefits
Unfortunately, Mr. C was had been suffering from a number of conditions including Systemic lupus Erythematosus, Severe Raynaud’s, and Sjogren’s. His various medical conditions would cause him to experience Severe Sensitivity to Sunlight, chronic headaches, fatigue, and muscle and joint pain among other symptoms. His symptoms were aggravated with changes in the weather and his overall condition began to regress and worsened with age.
Initially, despite his symptomatology, Mr. C was able to work using sun blocker and gloves to protect his skin from the elements and with the help of certain medications to alleviate some of his symptoms. However, eventually Mr. C’s symptoms worsened to the point that his doctor restricted Mr. C to working indoors only.
On November 1, 2013 Mr. C was forced to stop working as he was no longer able to continue working. With the help of his treating physician, Mr. C filed a claim for short-term disability benefits, which was initially approved. Lincoln National, the insurer responsible for making claims determinations, paid benefits to Mr. C until January 4, 2014. By way of letter dated December 19, 2013, Lincoln Financial Group, denied Mr. C’s continued claim for benefits contending he no longer qualified for benefits.
First Appeal and subsequent denial
Mr. C took on the burden of appealing Lincoln’s denial of benefits. With his appeal, he included medical records supporting his claim including x-rays of his hands and statements from his doctors corroborating his disability. Unfortunately, Lincoln denied Mr. C’s appeal by letter dated March 6, 2014. Lincoln acknowledged that Mr. C’s doctors had advised him to avoid working outside but explained that “reasonable solutions” for this problem would be “warm clothing, gloves in cold weather, and wearing UV protective clothing with a hat and sunscreen in the outdoors.”
Mr. C contacts Attorneys Dell & Schaefer
Luckily, Mr. C had a second appeal available under his policy and he contacted Attorney’s Dell & Schaefer to assist him with his claim. Attorney Victor Pena took on the task of handling Mr. C’s second appeal. Attorney Pena was able to sift through the medical records and Lincoln’s claim file to determine the best course of action. The appeal presented additional medical records supporting Mr. C’s disability and tactically addressed the errors made by Lincoln during its review.
Within two months of submitting the appeal, Lincoln overturned its decision and paid all back benefits owed. Dell & Schaefer remains on Mr. C’s claim ensuring that Mr. C has the best chances of remaining on claim and receiving long-term disability benefits for as long as his disability continues.
Read more about Lincoln Financial disability claims on this page.