LTD Claim Approved by Lincoln for Former Biomet, Inc. Employee suffering from Meniere’s Disease
Author: Attorney Alex Palamara
Although it took two separate appeals to convince Lincoln to approve our client’s long term disability claim, we are happy to announce that our client, who previously worked as a Project Manager for Biomet, Inc., is now approved and fully paid. She recently received all the back benefits she should have been paid since December 20, 2015 and is now receiving monthly disability benefits.
It was a hard fought victory that began when she stopped working in June of 2015. It wasn’t by choice that she had to leave her high paying job for a great employer. Unfortunately for her, she suffered from the following conditions: Meniere’s disease, Vertigo, Chronic fatigue syndrome, orthostatic hypotension, Lyme disease, Multisystem disorder, Postural tachycardia syndrome (POTS), grade IV chondromalacia of the lateral aspect of the lateral femoral condyle, and Mast Cell Disorder. Even with all those diagnoses and objective medical documentation, Lincoln did not initially approve our client’s claim.
Denials By Lincoln, Appeals by Attorney Palamara:
By way of a April 20, 2016 denial letter, Lincoln initially denied the claim on the basis that an “external” medical peer reviewer (Dr. Joseph Rea) who was board certified in occupational medicine only found limited impairment. Unable to comprehend how her claim could rightfully be denied, our client found Dell & Schaefer to assist her with an appeal to challenge the wrongful denial. Attorney Alexander Palamara reviewed the claim and agreed that there was no question that the Project Manager for Biomet should be receiving benefits as she had objective documentation to prove her claim.
By way of an October 7, 2016 appeal, Attorney Palamara challenged Lincoln’s denial and explained to Lincoln why this claim should have been approved. Attorney Palamara not only summarized the objective medical documentation supporting the claim, he also gathered supportive statements from all her treating providers which all agreed she could not perform even a sedentary occupation. In fact, multiple doctors said she could not sit for more than one hour per day at work.
Unfortunately for our client, our initial appeal was not successful. By way of a denial letter dated January 4, 2017, Lincoln upheld its initial denial. This time Lincoln relied up on the review of an “independent” physician who is board certified in internal medicine, preventative medicine and occupational medicine (Dr. Ben Hur P. Mobo). This doctor found “minimal restrictions and limitations.”
Luckily, Lincoln provides a 2nd final administrative appeal to challenge their decision. Instead of filing a lawsuit, our client agreed that we had enough proof and that we should file a final appeal as Attorney Palamara knew there was a high chance of success based on the facts we had with the medical records. In fact, it was mindboggling how this claim wasn’t approved with the first appeal.
The second administrative appeal was filed in April 2017. This new appeal provided updated medical documentation that further proved our client’s claim. It also strongly challenged the reviews of Dr. Rea and Dr. Mobo. It also included updated letters of support from two treating physicians who both essentially said that it could not be clearer that our client is disabled from working. The appeal also noted that four separate physicians who had seen and treated our client multiple times all independently reached the conclusion that she could not work. It lastly argued that the paper reviews conducted by Lincoln must be outweighed by the evidence submitted from our client’s treating physicians.
Thankfully, our client’s claim was approved by way of a letter dated August 21, 2017. With the assistance and support of her treating providers and their medical records, Attorney Alexander Palamara was able to convey to Lincoln that our client is unable to perform each of the main duties of her own occupation. Even with the arsenal of three separate “independent” reviews (Lincoln had a third review conducted after the 2nd appeal was filed), we were able to strongly show our client’s limitations and restrictions through the objective medical documentation.
Our client is relieved to finally be on claim and was happy to receive the benefits that should have been paid since December 20, 2015. She knows that the fight will never end, but she also knows that Attorney Alexander Palamara will do whatever it takes to keep her on claim until she is able to return to work or until her policy expires.
If you have been denied disability benefits by Lincoln or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schaefer for a free consultation.