Tech Support Rep Wins Standard LTD Insurance Appeal for Back Disorders

Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.

After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review of her medical records. The physician reviewer concluded that the medical records did not support a diagnosis of lumbar radiculopathy and that although she suffers with lower extremity radiating pain and paresthesia the imaging did not show ongoing nerve root compression or severe canal stenosis. They also noted all of her “normal” examinations by her physicians.

The physician reviewer noted that the records supported diagnoses of lumbar spondylosis, lumbar disc herniation, lumbar pain, and post laminectomy syndrome but that she would be capable of work activity with limitations and restrictions. Standard also cited a determination by its vocational consultant that with the restrictions and limitations suggested by the peer review physician that she could work in her own occupation.

Following submission of her appeal, the Standard overturned the decision after submission of records from her physical therapist and pain management physician evidencing that her conditions have progressively worsened and significantly impact her quality of life.

Also, submitted with her appeal was a recent physician report from her orthopedic spine specialist documenting radicular pain and back pain preventing return to full time work due to inability to sit, stand and walk for prolonged periods of time.


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