Our client, Mr. L, formerly worked as a Sales Consultant for a global technology company. In September 2014 a number of medical issues following an ischemic stroke forced Mr. L to stop working and submit his claim for disability benefits under his employer’s long-term disability (LTD) policy, which was funded and administered by Reliance Standard. Under his employer’s disability policy he would be considered totally disabled if, for the first 36 months, he was unable to perform, with reasonable continuity, the material duties of his regular occupation. Thereafter, he would remain disabled if he was unable to perform the material duties of any gainful occupation.
Reliance Standard found Mr. L to be totally disabled and approved his STD claim through the 3-month maximum benefit period which ended in December 1, 2014. With the expiration of the STD benefits Mr. L’s claim was submitted for continued payment under Reliance Standard’s LTD Policy, with the same definition of disability. In July 2017 Reliance Standard informed Mr. L that his 36 month benefit period would end in December 2017. In December 2017 Reliance Standard approved Mr. L for continued benefits under the Any Occupation definition of disability. Then on in April 2018, after paying Mr. L’s LTD benefit for 39 months, further LTD benefits were denied because Reliance Standard had determined that Mr. L “purportedly” failed to provide satisfactory proof of continued total disability. After receiving the denial, Mr. L contacted Dell & Schaefer and discussed his case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in Reliance Standard’s denial letter and in the evidence it relied on and agreed to prepare and submit Mr. L’s ERISA appeal with the assistance of his appeal team.
The LTD appeal addressed all of Reliance Standard’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of Reliance Standard’s denial and significant inconsistencies with its medical reviewer’s findings. In particular, the appeal addressed the fact that Reliance Standard ignored objective medical evidence from Mr. L’s treatment provider’s establishing that Mr. L’s neurological exam was positive for expressive aphasia and loss of vision on the right; right upper extremity weakness in flexion contracture at the elbow; right upper extremity exhibiting very limited strength or movement; evidence of weakness at the right knee, hip and ankle; his gait required assistance for balance; testing confirmed right hyperreflexia; and finally, Mr. L suffered with slurred speech and hand paralysis. Most notably, however, was the fact that Mr. L’s wife, now his caretaker, requested that Reliance Standard conduct an Independent Medical Examination (IME) to establish his significant functional limitations. Yet, Reliance Standard refused to request an IME.
Just over six weeks later, and after reviewing both the appeal and hundreds of pages of exhibits and medical records, Reliance Standard overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Mr. L’s LTD benefits. Attorney Symonds continues to represent our client to best ensure that Reliance Standard will not terminate his benefits again. Feel free to call our disability attorneys for a free consultation regarding any matter relevant to your disability claim.