Service Manager Wins Illinois Mutual LTD Insurance Appeal for Back Disorders

Our client was a service manager for Tire Kingdom, due to years of working on his feet he developed chronic back pain and shooting pain down his legs. Also, he had begun experiencing worsening memory and post-concussion headaches and orientation problems likely from some earlier head injury. Due to these surmounting problems, he was forced to stop working and sought a disability claim under his individual disability insurance policy with Illinois Mutual Life Insurance Company.

The Illinois Mutual Policy was an Individual Disability Insurance Policy that Insured for Own Occupation at the Time Disability Began

He had purchased his disability insurance policy with Illinois Mutual in Florida from an insurance broker years before he began experiencing any of his physical problems. The Policy insured him in his own occupation at the time that disability begins, which for him was a Car Service Center Service Manager. It was smart of him to purchase this particular type of insurance policy considering the physical nature of his occupation, particularly the own occupation extension rider providing specific coverage for total disability preventing him from performing the substantial and material duties of his occupation.

Physician Consultant for Illinois Mutual Reviews Medical File and Determines that Restrictions and Limitations are Not Supported

After our client submitted his claim for LTD benefits, Illinois Mutual determined that he was totally disabled from his own occupation as a service manager, however, only made the determination under a reservation of rights, which means that the did not fully accept liability and pending a complete medical review.

Illinois Mutual assigned a board-certified orthopedic surgeon to review the medical file. The physician consultant determined that the medical records did not support any specific restrictions and limitations, which prompted Illinois Mutual to then communicate that it was stopping his disability payments and requiring recommencement of his premium payment which had been on waiver.

Upon being hired we contacted Illinois Mutual requesting a copy of their claim file. They complied with the request and expressed that they would promptly begin a reconsideration review of the claim. As part of the reconsideration Illinois Mutual wanted to conduct an Independent Medical Examination by a physician of their choosing. We informed them that in order to ensure integrity and validity of the IME we were requesting that Illinois Mutual and the IME Physician allow us to video record the exam. The first physicians that Illinois Mutual contacted refused to allow for video recording, however, it was able to ultimately find one that would allow recording of the examination.

The IME examination and report ultimately supported that our client’s restrictions and limitations caused by his disabling condition prevented him from performing the substantial and material duties of his occupation. Shortly after receiving the report from the IME examiner, Illinois Mutual informed us that it was overturning its decision and approving our client’s for total disability.