Nurse Wins The Standard LTD Insurance Appeal for Chronic Pain

Prior to filing for disability, our client was a Registered Nurse employed as a Senior Case Manager for United Healthcare. Our client was a dedicated employee who enjoyed her work until chronic pain, frequent headaches, and resulting cognitive dysfunction forced her to stop working in July of 2018. Fortunately, her employer provided disability insurance coverage under two policies: UnitedHealth Group’s self-funded Short Term Disability Policy and a Group LTD Policy which was administered and insured by The Standard Insurance Co. Initially, our client was found to be totally disabled under the terms of the STD policy but not for the maximum benefit period. Following the filing of an appeal by Attorney Palamara, her benefits for short term disability were reinstated and paid through the maximum benefit period which ended in January  of 2019.

While her STD appeal was pending, our client filed for LTD benefits under the governing LTD Policy with the Standard. Unfortunately, despite being awarded her maximum Short Term benefits following the STD appeal by Attorney Palamara, The Standard denied her claim for long term disability benefits. In the LTD denial letter, The Standard claimed her illnesses did not preclude her from performing her nursing duties, and as a result, the Standard felt that she did not meet the Definition of Disability.

The Standard’s decision to deny benefits rested almost exclusively on a paper review and opinion by a physician consultant, who never examined or met with our client. The physician consultant noted inconsistencies regarding our client’s functional abilities and disregarded much of the relevant medical information concerning her multiple chronic impairments. Citing the physician consultant’s review, Standard concluded that the medical evidence did not contain any objective findings to support restriction and limitations and that our client could return to her past work as a Nurse Case Manager.

Appeal by Attorney Palamara

After receiving the denial letter for the long term disability claim, Attorney Palamara quickly reviewed the denial letter and knew that Standard did an improper job of reviewing her claim. After ordering the claim file and all medical records from the treating providers, it was quickly seen that Standard and its reviewing consultant overlooked ample objective evidence of her chronic pain and disabling conditions.

First and foremost, Standard and its physician consultant did not examine our client to have an opportunity to observe her decreased sensation, as well as her impaired grip and motor strength. It also did not interview our client to ascertain or quantify the extent of her chronic pain complaints. Attorney Palamara also highlighted a multitude of additional functional restrictions that were supported by the medical records but not considered by Standard.

LTD Claim Approval

On July 24, 2020, we received word from Standard that it was approving our client’s Long Term Disability Claim. In its correspondence, The Standard advised that its Administrative Review Unit completed its review of the claim and determined that it was reasonable to conclude that our client continues to satisfy the applicable definition of disability. Shortly thereafter, our client received a sizable benefit check for nearly a year and a half of benefits and remains on claim at the present time. Although our client is relieved to be finally on claim, she knows that the fight will continue as her policy’s definition of disability changes after 24 months of benefits. At that point, we will have to prove to Standard that she is “unable to perform with reasonably continuity the Material Duties of Any Occupation.” Thus, Attorney Palamara will continue to work on this claim to continue to prove to Standard that our client remains disabled and satisfies the requirements of the policy.

If you have been denied disability benefits by Standard or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schafer for a free consultation.