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Reliance Standard Insurance Company Overturns Decision to Deny Long-term Disability Benefits to Pediatrician With Ovarian Cancer

Attorney Cesar GavidiaAuthor: Attorney Cesar Gavidia

Prior to her disability Dr. Julie worked as a pediatric physician for a nationally recognized health system based in Florida. In 2015, Dr. Julie received a diagnosis of ovarian cancer and underwent a total abdominal hysterectomy and chemotherapy. Although the chemotherapy and treatment likely saved her life, she remained suffering from residual neuropathy in her hands and feet, as well as chronic and severe fatigue.

As a result of her debilitating symptoms, Dr. Julie was forced to stop working and submit a long-term disability claim with her employer sponsored group long-term disability insurer, Reliance Standard Insurance Company. After receiving her claim application and attending physician reports declaring her totally disabled from her own occupation as a pediatrician, Reliance Standard approved the disability claim.

However, after only paying benefits for 2 months, Reliance Standard terminated her disability claim, and stated that her impairments from her own occupation were no longer supported.

Dr. Julie’s occupation as a pediatrician required working at a medium physical demand level. It required her to often exert 20 to 50 pounds, which most often occurred when she was lifting and carrying child patients. It also required critical thinking and analysis when treating children, who often presented with a wide variety of acute and chronic health issues. Given her chronic peripheral neuropathy and fatigue caused by her chemotherapy treatment it was absolutely clear that Dr. Julie was unable to work in her own occupation.

Dr. Julie was referred to Dell & Schaefer by a local attorney she had contacted. Although the attorney handled employment matters, the handling of a long-term disability insurance claim was outside of her field of expertise. Dr. Julie hired Attorney Cesar Gavidia and his team to address the denial of her disability claim. Although there was the strong likelihood that Dr. Julie’s claim was not governed by ERISA, since her employer was a public hospital, Attorney Gavidia determined that the best and safest course of action was to submit an administrative appeal to Reliance Standard addressing the arbitrary denial.

In addition to submitting evidence of her disability by way of her medical records, Attorney Gavidia and his team attacked the fact that Reliance Standard failed to perform an accurate vocational assessment of Dr. Julie’s occupational duties. The Appeal also addressed that Reliance Standard made no attempt to contact Dr. Julie’s treating physicians to discuss the extent of physical and cognitive restrictions and limitations, nor did Reliance Standard perform a functional capacity examination (FCE) or Independent Medical Examination (IME) to assess her physical functional limitations. It was clear that Reliance Standard’s decision to deny Dr. Julie’s long-term disability claim was not supported on the basis of any reasonable or substantiated medical evidence.

Soon after the Appeal was submitted, Reliance Standard notified Dr. Julie that its prior adverse decision to deny her claim was being overturned. Soon after receiving notice that Reliance Standard had overturned its decision and reopened her claim, Dr. Julie was approved for social security disability benefits as well. Although the initial battle was won, Reliance Standard’s requests for medical records, claim forms and attending physician statements continue. If the requests are not fulfilled in a timely manner, Reliance Standard threatens to terminate the disability claim. Attorney Gavidia and his team remain involved so as to ensure that Reliance Standard does not again arbitrarily deny Dr. Julie’s disability claim.

Feel free to contact Attorney Cesar Gavidia to discuss any questions that you may have regarding your long-term disability insurance claim.