Our client, Ms. H, formerly worked as a Medical Technologist for a National Clinical Laboratory. In July 2017 a number of medical issues, including psoriatic arthritis and osteoarthritis forced Ms. H to stop working and submit her claim for disability benefits under her employer’s long-term disability (LTD) policy, which was funded and administered by LINA. Under her employer’s disability policy she would be considered totally disabled if she was unable to perform, with reasonable continuity, the material of her regular occupation in the usual or customary way.
After paying Ms. H just 1 month of benefits under the Policy’s “own occupation” definition of disability, LINA denied continued LTD benefits on the basis that she allegedly no longer met the policy definition of disability. Specifically, LINA “concluded that she is not medically unable to perform the duties of her Own Occupation.” After receiving the denial, Ms. H contacted Dell & Schaefer and discussed her case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in LINA’s denial letter and in the evidence it relied on and agreed to prepare and submit Ms. H’s ERISA appeal with the assistance of his appeal team.
The LTD appeal addressed all of LINA’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of LINA’s denial and significant inconsistencies with its medical reviewer’s findings. In particular, the appeal addressed the fact that, LINA’s medical reviewer mischaracterized and misstated the record evidence to support her purported medical opinions. Further, Ms. H’s Attending Physician completed a report which confirmed that her pain was reasonable and supported by the objective testing as well as the fact that the side effects from her many medications limited Ms. H’s ability to work with reasonable continuity and affected her ability to concentrate, which was crucial to her continued success in her regular occupation as a Medical Technologist. And finally, LINA did not properly consider the requirements of Ms. H’s occupation, which required long hours of eye and hand coordination, and the ability to perform repetitive tasks with dominant hand constantly throughout the day.
Just over five weeks later, and after reviewing both the appeal and hundreds of pages of exhibits and medical records, LINA overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Ms. H’s LTD benefits. Attorney Symonds continues to represent our client to best ensure that LINA will not terminate her benefits again. Feel free to call our disability attorneys for a free consultation regarding any matter relevant to your disability claim.