Nurse With Knee and Back Disorder Wins Hartford Disability Appeal
We represent a General Duty Nurse who was denied long term disability benefits as Hartford improperly determined that she was able to work her medium duty job on a full time basis. The medical and occupational documentation submitted with her appeal that we filed on her behalf, as well as the documentation and evidence previously submitted by her physicians, clearly establish that due to chronic severe low back and knee pain stemming from diagnosis of lumbosacral radiculopathy, lumbar spondylosis, osteoarthritis of sacroiliac joint, lumbar degenerative disc disease, and chondromalacia patellae, she is unable to perform the essential duties of her occupation as a General Duty Nurse.
We worked in conjunction with her treating physicians to provide additional support showing that she was not physically or cognitively capable of performing her job duties on a part time of full time basis. Her treating doctor specifically stated in her medical records as well as in his attending physicians’ statement documenting her worsening symptomatology to include severe left knee pain and low back pain with decreased range of motion and radiation to buttock and left leg. In an Attending Physician Statement form dated December 28, 2020, Dr. Bouvier confirmed that she was “unable to complete job functions”, noting physical restrictions and limitations stemming from her medical conditions that would impact her ability to perform the essential duties of her own medium exertion occupation or any occupation for that matter. Dr. Bouvier noted that treatment and evaluation for her debilitating condition was ongoing and additional medical evidence would be forthcoming. Her doctor opined that she was permanently disabled as a result of her medical condition with a poor prognosis for recovery. He further documented in his corresponding office note that she “should be fully disabled b/o end stage pain issues from the LBP with radiculopathy”. In addition, he noted that: “She has failed rehab in its many forms and has had to have long term narcotics for pain relief that has left her with cognitive issues associated with long term narcotics. The LBP is NOT amendable or fixable with surgery”.
While such examinations are provisioned for in the policy, the Hartford did not as much as request an Independent Medical Examination or a Functional Capacity Evaluation to determine extent of impairment and how it would impact her ability to perform her physically demanding occupation. If the Hartford had exercised its due diligence in affording her a complete, fair and thorough review, it would have been clear that she was in fact disabled and unable to perform the essential duties of her occupation. Therefore, we had her undergo an FCE to determine her physical capabilities. A Functional Capacity Evaluation (FCE) performed on September 8, 2021 further demonstrated her to be totally disabled. It was confirmed that her occupation as a general duty nurse fell within the medium exertional demand category; however, the FCE demonstrated her residual physical capacity to fall below sedentary. Limiting factors noted during testing included inadequate strength, increased pain, and loss of balance and safety concern. In Attending Physician Statements (APS), both Dr. Bouvier and Dr. Khan agreed with the findings of the FCE and confirmed based on their ongoing treatment and evaluation of our client that the findings were a true and valid representation of her functional abilities.
We were successful in having her denial overturned and our client will now be receiving the backpay she was owed along with future monthly benefits until she is able to return to work full time.
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