Prior to submitting a claim for disability insurance benefits to Liberty Mutual, our client had been a long haul truck driver for many years. Over the years the hours of prolonged sitting and repeated physical activity necessary to performing her job started to take a physical toll on her body. She developed severe chronic lower back pain with associated radiating pain and numbness into her legs. Eventually the pain and discomfort was physically too much to bear and given the nature of her job as a truck driver she posed a risk not only to herself while driving an 18 wheeler, but also to the people she shared the road with.
Faced with a difficult decision, she applied for short term disability benefits. Liberty Mutual initially approved her claim for short term disability benefits, but within a few months denied her claim, stating that “there was no objective evidence of functional restrictions and limitations severe enough to prevent her from returning to work as a truck driver”. She immediately appealed this decision on her own. After filing the appeal she contacted Disability Attorneys Dell and Schaefer. Due to the time that had elapsed since the filing of the appeal and the associated deadlines for Liberty Mutual to render a decision, there was little that could be done at that point. Attorney Stephen Jessup advised her to immediately apply for Long Term Disability benefits as a way to potentially preserve the possibility of another appeal. Shortly after she applied for long term disability benefits, she received a second denial of her claim for short term disability benefits, and a denial of her application for long term disability benefits.
With the second and final denial of her claim for short term disability benefits, she exhausted all of her administrative remedies under the short term disability plan and her only option left was to file a lawsuit in an attempt to secure her short term disability benefits. However, due to the denial of her claim for long term disability benefits, she still had the right to file an ERISA administrative appeal as to the LTD decision. Attorney Jessup knew that the largest obstacle in submitting the appeal of the denial of long term disability benefits was the fact that her claim for short term disability benefits was denied, and that the short term disability benefits coincided with the elimination period for the long term disability policy. In essence, with the denial of short term disability benefits there had already been a de facto determination that she was not disabled through the elimination period as required by the long term disability policy.
Attorney Jessup secured the claim files for both the short and long term disability claims in order to evaluate and analyze the information that Liberty Mutual utilized to render its adverse decisions. Our client was sent for additional medical testing that would strengthen her claim and provide evidence of functional restrictions and limitations that Liberty Mutual claimed was lacking. Coordinated efforts were undertaken with her treatment providers to consolidate medical information and opinions into focused, detailed reports and opinion letters. After all of the information had been compiled, Attorney Jessup submitted her appeal in advance of the 180 deadline.
Based upon the overwhelming medical evidence in support of disability provided in the appeal, Liberty Mutual overturned its denial of her claim for long term disability benefits, reinstated her claim and forwarded all benefits owed. Attorney Jessup is now currently working on securing the outstanding short term disability benefits still owed to our client.
An ERISA administrative appeal of a long term disability denial must be skillfully drafted and organized in order to have any chance of success. Before filing an administrative appeal of an insurance company denial of benefits one should consult with an attorney to ensure they are protecting their rights. For a free consultation to see how we may be able to assist you with your claim please contact us.