I recently wrote an article regarding the relationship between Rheumatoid Arthritis (RA) and Cognitive Dysfunction that discussed increasing medical literature to support verifiable cognitive deficits due to arthritic conditions. As noted in the article, when people think of RA the first thing that comes to mind is usually severe pain and swollen joints. However, within the context of a claim for disability insurance benefits, to stop there would be doing a disservice to the debilitating effects RA can have on someone suffering from the condition and who has a disability insurance claim. Such is the case with a client of ours.
Our client, a former HR Manager for a large corporation diagnosed with Rheumatoid Arthritis who was suffering from resulting fatigue, pain and cognitive issues, filed a claim for long term disability benefits with Hartford with the assistance of Attorney Stephen Jessup. His claim for benefits with Hartford was initially approved with little difficulty from Hartford. Soon thereafter the Social Security Administration had determined that he was also disabled under its criteria for disability. As our client was only eligible for a few years of benefits from Hartford and in light of the award of both LTD benefits and SSDI benefits, he reasonably expected that his claim with Hartford would be secure and decided to handle his ongoing claim with Hartford on his own. However, after only fifteen months of paying benefits Hartford notified our client that it was terminating his claim for disability benefits following an review of his file by an “independent peer review” doctor who had determined that there was a lack of clinical evidence to support our client’s ability to perform at his sedentary demand level occupation.
Following the denial of benefits he contacted Attorney Jessup to once again represent him and take over the handling of his claim for benefits and the filing of his administrative appeal. Upon review of the denial letter and claim file Attorney Jessup recognized the “independent” peer review doctor Hartford had used to deny our client’s claim as she was a doctor used often by Hartford for such purposes. The peer review doctor’s medical opinion differed from that of our client’s treating physician in that the peer review doctor had determined that based upon the available medical evidence our client could perform at a sedentary demand level. In rendering this opinion the peer review doctor overlooked the true nature of our client’s medical limitations and failed to consider the actual duties of our client’s occupation when rendering any opinion as to his ability to work.
As an HR Manager our client’s occupation was certainly sedentary in that he worked what would be considered a desk job. However, he did not get compensated by his employer because of his ability to sit at a desk all day – he was paid due to his ability to meet the incredible cognitive demands of his occupation. He was paid to think, process information, and make critical decisions based on his evaluations. When Attorney Jessup reviewed the vocational report contained in Hartford’s claim file it was noted that our client’s occupation had “highly complex job duties.” Although Hartford recognized that his occupation was cognitively demanding, it completely ignored this fact when relying on its doctor’s opinion as to his physical ability to work and the resulting denial of benefits.
Although our client did suffer from pain and fatigue common to RA, his main complaint, as set forth in his medical records, was his inability to concentrate and perform a gamut of other associated cognitive skills. Admittedly, he could endure the pain in his daily life, but he was in no position to be able to execute the “highly complex duties” of his job. To drive this point home Attorney Jessup arranged for our client to undergo neuropsychological testing, which verified cognitive decline and limitations that could only be associated to his physical medical condition. Armed with objective medical evidence to support our client’s complaints Attorney Jessup prepared his administrative appeal addressing Hartford’s improper denial of benefits based upon the nature of the medical and occupational reviews performed.
Based on the strength of the appeal, Hartford approved our client’s claim in less than three weeks. This was one of the first cases that Attorney Jessup handled where the primary medical restriction stemming from a diagnosis of RA was a verifiable cognitive limitation, although based on advancing medical research we do not believe it will be the last.
Attorney Jessup continues to represent our client as his claim transitions from the own occupation period to the any occupation definition of disability. We are confident given the strength of the appeal submitted and our client’s medical file that Hartford will continue to issue his benefits for the remaining balance of his claim.
If you have a current claim or are thinking about filing a claim for disability benefits due to a diagnosis of Rheumatoid Arthritis, please feel free to contact our office to discuss with one of our disability attorneys any questions you may have.