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Jefferson Pilot’s denial of long-term disability benefits to a quality control manager is reversed

Our client, a Texas resident, contacted Attorneys Dell & Schaefer following her initial application denial and first appeal of her disability denial by a prior law firm. This woman, suffering from chronic neck and back problems, a stroke, depression, headaches, and memory loss, had been a quality control manager for a large corporation. The client was unable to perform an work and was seeking total disability benefits.

The client’s disability policy defined Totally Disabled as “unable to perform each of the main duties of her occupation because of an injury or sickness.” Jefferson Pilot had her medical records reviewed by a nurse and came to the conclusion that our client could perform sedentary work. Jefferson Pilot unilaterally determined that our client’s job was sedentary, despite a letter from our client’s employer stating that her job required the ability to perform light to medium duty task.

Within three months of Dell & Schaefer being retained, we were able to resolve the claim in our clients favor and recover all of the benefits that had not been paid for the previous 16 months. Through a detailed analysis and dissection of Jefferson Pilot’s reasons for denial of our client’s claim, Dell & Schaefer was able to prove our client’s entitlement to long-term disability benefits. The successful appeal required the coordinated efforts of a vocational rehabilitation expert and our client’s treating physicians. Furthermore, Jefferson Pilot was advised of potential ERISA violations which prevented our client from receiving a full and fair review of her claim.

In addition to paying all back benefits owed, our client requested that Dell & Schaefer approach Jefferson Pilot and determine whether the insurer was interested in a lump-sum cash buyout of the remaining value of her policy. The carrier was interested and a lump-sum buyout of the policy in exchange for surrender of the policy was negotiated to our client’s satisfaction. The lump-sum buyout terminated any further relationship between the client and Jefferson Pilot. For additional information about lump-sum buyouts please visit the lump-sum buyout section of our website.

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