Our client, Ms. V, had been employed as an IT Systems Analyst with Highmark Blue Shield, one of the ten largest health insurers in the U.S. and a licensee of Blue Cross Blue Shield, before pain from Rheumatoid Arthritis, caused her to file a disability claim under her Highmark Blue Shield Long-term Disability Plan. Highmark Blue Shield had contracted Liberty Mutual to insure and administer the disability plan.
The chronic pain resulting from her rheumatoid arthritis and the effects of strong medications used to control the disease and pain were overwhelming, not only physically but also emotionally. Unfortunately, when Liberty Mutual denied her claim for benefits it only added insult to injury.
Not knowing where else to turn, Ms. V searched the internet trying to find answers, and someone to help her appeal Liberty’s decision. After contacting and retaining Attorney Cesar Gavidia and Dell & Schaefer, Attorney Gavidia and his team began the process of gathering medical records, conferring with Ms. V’s treating physicians, obtaining letters of support from Mr. V’s family members, friends and co-workers and obtaining all the evidence necessary to not only draft Mr. V’s appeal, but also ensure a solid administrative record in the event the appeal was denied and the case were to proceed to litigation.
Approximately 45 days after the appeal was submitted, Liberty sent notification that Ms. V’s claim was approved for the remainder of the own occupation period, but that since it found Ms. V capable of performing a sedentary occupation it was not approving benefits beyond 24 months. Under the Liberty long-term disability plan, in order to qualify for benefits after 24 months one must be unable to perform any gainful occupation for which they are qualified by education training and experience.
Although more than sufficient evidence was submitted with the first appeal that Ms. V was disabled from any gainful occupation, Attorney Gavidia once again was forced to submit yet a second appeal challenging Liberty’s decision. Efforts once again paid off and shortly after the appeal was submitted Liberty overturned its erroneous denial of benefits for a second time.
Ms. V is currently on claim and receiving long-term disability benefits from Liberty Mutual. Attorney Gavidia and Dell & Schaefer are monitoring Liberty’s actions, and ensuring that all communications, information and documentation going to and from Liberty are consistent and accurate.