Our client, a former Senior Vice President for a large national corporation, filed for disability after having suffered a massive stroke during heart surgery that left the entire left side of his body paralyzed and severely affected his ability to effectively communicate. His doctors were not sure if he would ever regain use of the left side of his body again and feared he may be wheelchair bound the rest of his life. While he was undergoing intensive physical and speech rehabilitation he filed a claim for short term disability benefits with Liberty Mutual under his employer’s disability policy. Liberty Mutual approved his claim for short term disability without issues and paid his benefit through the maximum benefit period for short term disability. It would seem that after all he had been through that our client’s claim for long term disability benefits would be quickly approved. However, as is often the case with Liberty Mutual, what should have been a clear cut case turned out to be nothing of the sort.
Long Term Disability Denial
After taking nearly two months to review the long term disability portion of the claim, Liberty advised our client on New Year’s Eve that it was denying his claim for long term disability benefits as it had determined that he was fully capable of returning to his former occupation as a Senior Vice President just several months after his stroke. In disbelief our client and his wife contacted our office and spoke with Attorney Stephen Jessup.
Attorney Jessup obtained a copy of the denial letter and was shocked to read Liberty’s findings that resulted in the denial of benefits. In denying the claim Liberty cited the medical evaluation performed by its doctor during the course of short term disability, which supported that our client would not be able to perform his occupational duties or meet the Department of Labor definition of Sedentary work. However a few months after this report was written Liberty’s new doctor disagreed with the short term disability doctor as well as our client’s treatment providers and determined that our client had an essentially clean bill of health and would be able to work in a light work demand level.
There was nothing in the medical records to support this position and the only difference between Liberty’s handling of the short term disability claim and the long term disability claim that Attorney Jessup could see came down to money. Liberty was not responsible for paying short term disability benefits so they had no problem paying benefits, but was responsible for the payment of long term disability benefits. This was a blatant abuse of discretion and a textbook example of a conflict of interest.
Attorney Jessup’s first course of action was obtaining a complete copy of our client’s claim file from Liberty. Contained in the claim file would be all medical reviews completed by Liberty along with the vocational information Liberty relied upon in determining our client’s occupational duties. After reviewing the claim file Attorney Jessup focused his attack on Liberty’s “interpretation” of our client’s occupation as a Senior Vice President.
As is common with Liberty disability claim reviews when reviewing the duties of one’s pre-disability occupation they reduced the material and substantial duties of our client’s occupation to be nothing more than the ability to perform at a Sedentary demand level. Liberty essentially held that to perform the duties of a Senior Vice President out client had to be nothing more than a warm body in a chair capable of lifting up to 10lbs occasionally. To come to this conclusion, Liberty only focused its attention on our client’s cardiology records and paid no mind to the extensive physical therapy records and medical support from his doctors as to his ongoing limitations.
Attorney Jessup developed a two prong attack to combat this position: (1) Attack the vocational review and Liberty’s inappropriate and bad faith interpretation of what were very clear policy provisions related to disability and (2) prove that regardless of the actual occupational duties required of him that our client did not possess the physical ability to work at a Sedentary demand level.
In preparing our client’s appeal Attorney Jessup had him undergo a Functional Capacity Examination with one of our experts to properly document his physical restrictions and limitations, which despite our client’s ability to regain use of the left side of his body, proved to be substantial. Attorney Jessup then took the results of the testing and prepared targeted questionnaires for our client’s doctors to further undermine the opinions of Liberty’s hired guns. Confident that the file supported medically necessary restrictions and limitations that would prove our client could not work Attorney Jessup then made argument as to Liberty’s vocational review.
It was argued in the appeal that Liberty created requirements for disability that were not found in the long term disability policy and that were in direct conflict with the actual definition of disability. Attorney Jessup prepared a detailed vocational report that set forth the actual material and substantial duties a Senior Vice President must be able to perform in order to effectively do the job. Needless to say the duties far surpassed the ability to perform minimal sedentary demand duties. Not sparing any blows, Attorney Jessup called out Liberty’s about face during the transition between short and long term disability benefits and noted the only reason for the long term denial was Liberty’s financial interest to avoid paying hundreds of thousands of dollars in benefits to our client.
Despite overwhelming evidence of disability in the appeal, Liberty still took nearly two months to approve our client’s claim for long term disability benefits. Even in approving benefits Liberty aggressively threatened to immediately offset our client’s benefit if he did not apply for Social Security. This type of behavior is all too common and is uncalled for from an insurance company that has a fiduciary duty to act in the best interest of its insured. Although our client does not have a great deal of time left on disability Liberty has made it clear that it will continue to demand information from our client.
Do you need help with Liberty Mutual?
If your claim has been denied by Liberty Mutual or you have questions regarding your claim please feel free to contact our office and speak to Attorney Jessup or one of our other disability attorneys to discuss your rights and assess how we may be able to assist you.