Previously employed as a Store Manager for Victoria’s Secret, our eventual client was forced to leave her position on July 8, 2009 due to numerous issues with her back, neck, hands, arms and feet. Her conditioned included severe and progressive Chronic Low Back Pain with Radiation to the Lower Extremities, Lumbar Degenerative Disc Disease, Lumbar Post Laminectomy Syndrome, Lumbar Strain, Lumbar Scoliosis, L5/S1 Disc Bulge, Lumbosacral Neuritis, Peripheral Edema, Left Breast Infiltrating Ductal Carcinoma, Left Renal Nephrolithiasis, Bilateral Hip Pain, Left Hip Bursitis, Bilateral Buttock Pain, Groin Pain, Sacroiliitis, Left Knee Pain, Bilateral Foot Pain, Chronic Neck Pain, Cervical Spine Degenerative Disc Disease, Cervicalgia, Type 2 Diabetes Mellitus, Peripheral Vascular Disease, Hypertension, Hypercholesterolemia, Headaches/Migraines, Dizziness, Insomnia, Memory Loss, Depression and Anxiety.
Luckily for our client, her employment provided her with Long Term Disability (LTD) insurance coverage with Reliance Standard under the Limited Brands, Inc. Long Term Disability Policy. For the first 12 months of her claim, this policy would provide for disability benefits should our client prove to the insurance company that she is unable to perform the material duties of her regular occupation. After benefits are paid for 12 months, benefits will only continue if she was then able to prove that she cannot perform the material duties of any occupation that her education, training or experience will reasonably allow. This is what is known as the “change in definition of disability” and is present in most ERISA Group Disability Insurance Policies.
After first leaving work our client applied for and was approved for LTD benefits by Reliance Standard. Reliance Standard paid her LTD benefits from August 7, 2009 through August 6, 2010 under the “regular occupation” definition of disability. From August 7, 2010 through August 31, 2013, the insurance company also paid her under the “any occupation” definition of disability. Unfortunately for our eventual client, by way of a letter dated October 3, 2013, she was informed by Reliance Standard that her claim would be closed beyond August 31, 2013.
In its denial letter of October 3, 2013, Reliance Standard informed our client that it “determined that (she) retained the ability to perform the material duties of Any Occupation.” Reliance Standard opined that “there are no noted complications or ongoing medical conditions that would support” her doctor’s given restrictions, and also argued that the “medical information does not provide a clear indication of a condition to the severity that would preclude (her) from working.” As such, Reliance Standard denied any benefits beyond August 31, 2013 and closed her claim.
Claimant Contacts Dell & Schaefer
Prior to even receiving the denial letter of Reliance Standard, the client came into contact with Attorney Alexander Palamara of Dell & Schaefer on September 30, 2013. Within a few days thereafter, Reliance Standard’s denial letter was received and within a few days after that, the client hired Dell & Schaefer to represent her on her claim. This early contact allowed her lawyers to have the luxury of potentially using the full 180 day period ERISA provided to file the strongest appeal possible to overturn Reliance’s Decision.
The Administrative Appeal
Armed with a history of supportive physicians and objective findings, the administrative appeal filed by Lawyer Alexander Palamara was easily able to document the errors of Reliance Standard’s review and its overall conclusion.
On July 10, 2014, Reliance Standard informed Attorneys Dell & Schaefer that its administrative appeal was successful and that the client would be placed back on claim. A back benefit check for the period of September 1, 2013 through the present would be forthcoming, as well as monthly disability benefit checks thereafter.
The lawyers of the law firm of Dell & Schaefer will continue to work on her claim to assure her receipt of benefits until her policy expires when she turns age 66 and 4 months.
If your claim has been denied or if you have a fear that Reliance Standard or any long term disability insurer might be planning to deny your claim, please do not hesitate to call Attorneys Dell & Schaefer for a free consultation to discuss your case.
– What is an “any occupation” definition of disability?
– How does a disability insurance company determine my Regular Occupation?