Liberty Mutual Overturns Denial of Disability Benefits Following Submission of an ERISA Appeal

Liberty Mutual Initially Approves Disability Claim After Finding Total Disability From Own Occupation

Our client, John, was working as a Chemical Supervisor for Arkema, Inc., a French specialty chemicals and advanced materials company, when in 2015 he was forced to stop working due to chronic pain in his cervical and lumbar spine relating to degenerative disk disease and post laminectomy syndrome.

John filed his own claim for long-term disability with Arkema’s long-term disability insurer, Liberty Mutual claiming that on account of his severe and crippling upper and lower back pain he was unable to perform with reasonable continuity the material and substantial duties of his own occupation. After having the medical records reviewed by its in-house medical consultant, Liberty Mutual agreed that he was disabled from his Own Occupation as a Chemical Supervisor and approved his long-term disability claim.

Liberty Mutual Refers Long-term Disability Claim to its Vendor, Allsup, to Assist in Claim for Social Security Disability Benefits

During the course of the disability claim, Liberty Mutual strongly urged John to apply for social security disability benefits. It informed him that it was not only a requirement of the disability plan that he apply and pursue social security disability through every appellate level if denied, but it suggested that a favorable determination by social security disability could help in his disability claim. As urged by Liberty Mutual, John applied for social security disability.

Liberty Mutual Terminates the Disability Claim After Paying Benefits for 24 Months

As the Own Occupation time period neared its end, Liberty Mutual began conducting its review to determine whether John was disabled from Any Occupation. Through its third-party vendor, MES Peer Review Services, Liberty hired Dr. Mark Reecer a physical medicine and rehabilitation physician to conduct a review of John’s file. After only reviewing John’s medical records, Dr. Reecer determined that John was capable of working eight hour shifts, 40 hours per week in a sustained capacity. After receiving Dr. Reecer’s opinion, Liberty Mutual promptly terminated John’s disability claim.

Although hired with less than three months to compile all of the necessary medical documentation and legal evidence, Attorney Gavidia was able to create an ERISA Administrative Appeal, which resembled more a legal brief filed to a US Appellate Court rather than a document submitted to the Appeals department of a disability insurance company.

In the Appeal Attorney Gavidia attacked the credibility of Dr. Reecer and the accuracy of his report and also challenged the vocational review, which he argued misrepresented the physical functional demand requirements of the occupations which Liberty Mutual alleged John was capable of performing.

After receiving Attorney Gavidia’s Appeal, Liberty Mutual overturned its decision to terminate John’s disability benefits and reapproved his claim.

Attorney Gavidia and his legal team continue to manage John’s disability claim, so as to ensure that John continues to meet the proof of loss requirements of the policy so long as he remains disabled, and to monitor Liberty Mutual’s activities so that John never again experiences an unnecessary interruption to his disability claim and monthly disability benefit payments.



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FAQ

Do you help Liberty Mutual claimants nationwide?

We represent Liberty Mutual clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Liberty Mutual disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Liberty Mutual. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Liberty Mutual.

How do you help Liberty Mutual claimants?

Our lawyers help individuals that have either purchased a Liberty Mutual long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Liberty Mutual:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Pat (Florida)

My experience with Dell & Schaefer, especially attorney Cesar Gavidia and his staff was excellent. I contacted Dell & Schaefer when I needed help as my disability insurance carrier terminated my benefits at the 2 year mark of my disability. I spent about 2 months putting together what I thought may be a decent appeal of that decision. However, the further I got into the workings and gaining some understanding of how the appeals worked under ERISA, I realized there was a lot at risk and only had one shot at it. I sought advice from an immediate family member who is also an attorney and was advised “get a firm that specializes in this type of work, then get the best”. Hence my decision to chose Dell & Schaefer.

Upon acceptance of my case, I felt that I was the center of attention for Attorney Gavidia. I had already used up 1/3 of the 180 days allotted to file the appeal working on my own so we were in a bit of a time crunch. Hundreds of pages of medical records the detail of the termination of benefits, my disability policy and several other different documents were delivered to attorney Gavidia. In short order those documents were reviewed and our strategy of appeal was discussed and developed. Necessary appointments and evaluations were coordinated and our appeal was submitted before the 180 days had expired. At the 45 day mark my insurer requested a 45 day extension on the decision. I was advised by Mr Gavidia’s assistant Michal who reassured me that this happens in most appeals. At the 90 day mark we received a favorable decision on the appeal, benefits were reinstated and back pay was awarded, but the story was not over.

After the initial termination of benefits by my insurer, I was alienated and expressed my desire with attorney Gavidia to try and find an amicable separation for all parties. Attorney Gavidia tactfully used some facts and disputes of the initial claim to open conversation with the insurer’s attorneys. He developed a dialog proposing, although I remain totally disabled as defined by my plan, a lump sum buy out of my future monthly disability benefits. Attorney Gavidia was successful in reaching an agreement that was acceptable to all parties and made sure that I had the final say on acceptance or not.

Thus, working with Dell & Schaefer I had my benefits, which had been terminated, restored, received back-pay for benefits that were withheld and missed, and successfully and satisfactorily “divorced” from my insurance provider in the form of a lump sum buy-out of my future disability benefits.

***** 5 stars based on 165 reviews

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