Denials of long term disability benefits commonly occur when the definition of disability changes from own occupation to any occupation. In a recent case handled by our law firm we were shocked that Reliance Standard expected our 63 year old client to be able to return to any occupation. Our client was employed as a Senior Clinical Research Associate for many years. She worked in a sedentary position, but due to several health issues including pulmonary hypertension, morbid obesity, chronic kidney disease, cardiomyopathy, heart failure, inflammatory arthritis, lumbar disc disease and diabetes mellitus she had to resign from her job. In addition, the medication she took on a daily basis to keep her alive caused multiple serious side effects which added to her inability to work in any gainful occupation. She applied for long term disability benefits and was approved and paid by Reliance for two years under the “own occupation” definition. After two years, Reliance terminated her benefits claiming that she was capable of working in “any gainful occupation” on a full-time basis. Our client’s treating physicians completely disagreed with Reliance’s position as it was their opinion that she was incapable of working with any reasonable continuity due to her chronic and severe medical problems and side-effects from her medications.
Reliance Standard failed to properly review medical records
Reliance Standard completely ignored our client’s vast medical records documenting several medical problems as well as her physicians’ opinions that she was incapable of working even in a sedentary capacity. In its denial letter, Reliance acknowledges several of our client’s medical problems including issues with heart failure, pulmonary hypertension, pulmonary emboli, chronic gastritis, diabetes and sleep apnea. The denial letter also addressed knee pain, degenerative joint disease, back pain, osteoarthritis and chronic kidney disease. However, Reliance stated in its denial, that despite her advanced age and all of her medical issues, the only restriction and limitation she seemed to have was her inability to get on a plane and travel. Other than that one restriction Reliance believed that she was perfectly capable of working in a sedentary position 8 hours a day, 5 days a week.
Reliance Standard ignored and disagrees with Social Security Disability Determination of Disability
Reliance Standard informed our client that she was required to apply for Social Security Disability, if she did not, they would automatically reduce her monthly benefits. Our client applied for SSDI and was immediately approved. Reliance took a set-off for the Social Security benefits she was receiving, but chose to ignore the Social Security Administration’s opinions that she was completely disabled from any gainful occupation as a result of the above-mentioned medical problems. Unfortunately, this is a common occurrence with insurance companies. Reliance encouraged and even assisted her in getting approved for social security disability income benefits in order to receive the benefit of a set-off, but then turned around and claimed that they do not agree with the Social Security Administration’s opinions that the claimant was disabled, as the SSA’s definition of disability differs from their own.
Dell & Schaefer submits an ERISA Appeal seeking payment of LTD benefits
Disability Attorneys Dell & Schaefer were retained in order to assist in appealing the denial of disability benefits by Reliance Standard. Prior to submitting an ERISA appeal for long term disability benefits, Attorney Rachel Alters obtained and reviewed the administrative record, obtained and reviewed all of her updated medical records and conferred with her client’s treating physicians. In her appeal attorney Alters submitted written opinions from her client’s treating physicians supporting her inability to work in a sedentary capacity. The evidence clearly indicated that it would be impossible for this 63 year-old markedly obese woman who had multiple severe medical issues to work in even a sedentary job with any reasonable continuity.
Based on the overwhelming medical evidence and appeal letter drafted by Attorney Rachel Alters, Reliance overturned its decision to terminate our client’s benefits, and paid all past due benefits. Our client remains on claim and we continue to handle her claim on a daily basis in order to improve her chances of another disability denial.
Our firm has represented thousands of disability insurance claimants at all stages of a claim for either short term or long term disability benefits. Contact us for a free consultation and review of your disability claim.