Our client, Mr. S, formerly worked as a Store Manager for a large national retail chain. In August 2016 Mr. S suffered from multiple Transient Ischemic Attacks (“TIAs”) or mini-strokes which left him with debilitating physical and cognitive impairments. Mr. S made several attempts to return to work failed but continued to suffer slurred speech, headaches, pressure in the back of his head and memory loss, had difficulty training employees and kept repeating himself. Finally, as a result of these conditions and the restrictions and limitations associated with them, Mr. S stopped working completely in April 2017 and, thereafter, failed to regain his premorbid cognitive level of functioning which was crucial to his continued success in his high intellectual career as a Store Manager.
Reliance Standard found Mr. S to be totally disabled and approved his STD claim through the 180 day maximum benefit period which ended in January 2017. With the expiration of the STD benefits Mr. S’s claim was submitted for continued payment under Reliance Standard’s LTD Policy, with the same definition of disability. After paying his LTD benefits for two years as a result of his physical and cognitive impairments; by letter in January 2019, Mr. S was informed that his LTD benefits were denied because Reliance Standard had determined that “[b]ased on the documentation provided, it appears that your Total Disability is caused by or contributed to by a Mental Nervous Disorder” even though Mr. S had no history of, nor had he received treatment for an alleged mental illness associated with his disabling neurological conditions. After receiving the denial, Mr. S 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. S’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 Reliance Standard’s incorrect application of the Policy’s Mental Nervous Disorder provision, which caps disability payments at 24 months even if an individual continues to be disabled. The appeal first confirmed that Mr. S’s initial claim and Reliance Standard’s subsequent approval were based on cognitive disorders, slurred speech, ocular pain, memory loss, and headaches all associated with his strokes. It wasn’t until 18-months into his claim that a nurse consultant, without review by a physician specializing in vascular neurology, unilaterally reclassified his condition as “depression.” The appeal next clearly established that Mr. S continued to be disabled and unable to perform his own occupation as a Store Manager due to his extensive chronic headaches and significant cognitive impairment. Mr. S’s treating neurologist confirmed this in her multiple objective assessments over the years. On appeal Reliance Standard requested that Mr. S undergo a Neuropsychological Independent Medical Examination (“IME”). After assuring that the appropriate safeguards were in place to protect the independence and credibility of the IME process, Mr. S attended the IME. The results of the IME confirmed that Mr. S suffered from disabling Vascular Neurocognitive Disorder, which also put him at greater risk for Neurodegenerative Disease.
Just over nine weeks after filing his appeal, and after reviewing hundreds of pages of exhibits and medical records as well as conducting an IME, Reliance Standard overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Mr. S’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.