Standard Overturns Decision to Deny Disabled Project Manager Long-term Disability Insurance Benefits After First Appeal

Terry had worked as a project manager for a large national health group earning over $85,000 annually, until type 2 diabetes left him disabled and suffering from peripheral diabetic neuropathy, severe chronic pain, fatigue and depression.

In addition to health insurance and other employee benefits his employer provided long-term disability insurance through Standard Insurance Company, based out of Portland, Oregon.

In 2010, Terry was forced to file a long-term disability claim with Standard Insurance Company (“Standard”) informing him that due to his debilitating disease he was no longer able to perform with reasonable continuity the Material Duties of his Own Occupation.

Soon after filing his disability claim Standard informed Terry that his claim was approved, which came as no surprise to him given the extent of his health issues.

Standard Terminates Long-term Disability Claim After 24 Months Claiming that the Disability was Due, In Part, to a Mental Disorder

The primary cause of Terry’s disability was and always had been type 2 diabetes and peripheral neuropathy. His pain had become so severe and had caused him to give up a successful career it was no surprise that Terry also began suffering acute depression symptoms related to the worsening of his physical state. Terry had also been diagnosed with bipolar disorder and anxiety, which complicated matters.

After paying his long-term disability claim for 24 months Standard informed Terry that it would no longer pay benefits beyond the 24 month period on account of his disability being “caused or contributed” to by a mental disorder. It was true that Terry suffered from mental illness, however, he had not claimed that depression nor any other mental illness was the sole or primary cause of his disability. Notwithstanding, Standard proceeded with the termination of Terry’s long-term disability claim on the grounds that his disability was caused or contributed to by a mental disorder. As part of their basis for denial, Standard cited the opinion of a hired medical consultant. That medical consultant attempted to minimize the extent of Terry’s physical disabilities while accentuating his mental disorders.

Following Submission of ERISA Administrative Appeal by Attorney Cesar Gavidia Standard Overturns Decision to Limit Long-term Disability Claim to 24 months

In response to Standard’s decision to terminate Terry’s long-term disability claim after 24 months, Attorney Cesar Gavidia and his appeal team began compiling the necessary evidence and implementing their plan of attack. Terry’s appeal served not only to detail and uncover all of the flaws and errors in Standard’s decision, but also to ensure a strong administrative record in the event that Standard decided to uphold its decision and the case were to proceed to federal court litigation.

Fortunately, a more expeditious and just result occurred. After receiving the appeal submitted by Attorney Gavidia and his appeal team, Standard overturned its decision and began paying benefits specifically for Terry’s type 2 diabetes, peripheral diabetic neuropathy and other physical complications.

Terry continues to receive monthly long-term disability insurance benefits from Standard while Attorney Gavidia continues to assist him with the ongoing and seemingly never-ending requests for health and status updates from Terry and his attending physicians.

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FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

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