Sun Life Approves Disability Benefits to Surgical Services Director

Prior to filing for disability our client worked as a Surgical Services Director for a large hospital system. Her occupation came with an incredible amount of responsibilities relating to the efficient and safe operation of the surgical department of a hospital- requiring her to not only have to be mentally alert, but also physically available on a moment’s notice throughout the hospital. This was a tall order for anyone, let alone someone with a long history of cervical and lumbar spine conditions with associated radiculopathy, arthritis, migraines and neuralgias. Eventually the pace of her job and the continued deterioration of her health left her unable to adequately perform her duties, which in turn left her with little choice but to file for disability benefits under her employer’s policy with Sun Life.

The Initial Denial of Benefits

Despite overwhelming support from her doctors and from her supervisors at work, Sun Life determined that our client was not eligible for benefits under the policy. The basis of the denial is due in large part how Sun Life often interprets its own policy, with specific attention to the definition of disability and “own occupation.” Our client’s policy had very standard language as it relates to disability- the inability to perform the Material and Substantial Duties of your Own Occupation. However, instead of reviewing one’s ability to perform the actual duties required of her job, Sun Life only took into consideration the physical demand level associated with our client’s occupation as set forth by the Department of Labor- or more commonly argued, the “national economy standard.” In this case, Sun Life stated that there was a lack of medical information to support our client’s inability to perform “Sedentary” work without any real consideration to her actual occupational duties.

The Administrative Appeal

Following the denial of her claim our client reached out to Attorney Stephen Jessup as he had previously represented and successfully secured disability benefits for a friend of hers. In reviewing Sun Life’s claim file Attorney Jessup’s attention was initially drawn to the concerns relating to Sun Life’s occupational review, which he felt created an unfair standard of disability that was not contained in the policy. However, knowing that Sun Life’s review of our client’s appeal would be heavily dependent on evidence with respect to her physical ability to work Attorney Jessup had her undergo a Functional Capacity Evaluation. The purpose of the FCE was to draw a correlation between our client’s diagnosis and her functional restrictions and limitations as they relate to work based on same. The results of the FCE did indicate our client retained some ability to work at a Sedentary demand level, but not on a full time basis or with reasonable continuity. In light of these findings Attorney Jessup gathered additional statements and letters of support from our client’s attending physicians to further undermine Sun Life’s doctor’s opinions. Armed with an abundance of additional objective medical evidence of disability Attorney Jessup submitted an appeal that was over 1000 pages of argument and medical information on our client’s behalf.

Following an appeal review that included Sun Life exercising its right to an extension of time to make a decision, Sun Life, faced with overwhelming evidence of disability and argument as to entitlement of same, overturned its denial of our client’s benefits. However, like many insureds, our client is not out of the woods yet as her policy contains a change in definition to the inability to perform the duties of “any occupation” after 24 months of long term disability benefits. Attorney Jessup continues to represent our client to best ensure that Sun Life will not be able to terminate her benefit at that time.

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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.

Dell & Schaefer Client Reviews   *****

Charles A. M.D.

I am very humbled to have the privilege to write this testimonial on behalf of Dell & Schaefer and more specifically, Mr. Cesar Gavidia. Unfortunately, after suffering from Essential Benign tremors for numerous years I lost a career for which I dearly loved. I was a dental implant surgeon whose accomplishments are quite humbling. I devoted my entire career to my patients, employees, colleagues and students. Upon discovery of my disability, I contacted Mr. Cesar Gavidia for professional guidance. Upon meeting Mr. Gavidia, I inquired of his knowledge, years of experience, colleagues and most importantly his “Passion” to represent each and every client.

What I discovered was a very sincere Gentleman with a tremendous depth of knowledge regarding my disability policies and many others aspects of business law. During the last five (5) years of my career I could have increased the benefits of my disability policy. However, I failed to do so. I thought I had all of the answers. I was wrong! I would encourage each and every reader to consult with an expert such as Mr. Cesar Gavidia prior to entering into a “Disability Insurance Contract”. Or at least shortly thereafter. You will be enlightened to learn the details and how they will affect you if you incur a career ending disability. You owe it to yourself and your family to understand your DISABILITY POLICY. Mr. Gavidia’s ability to explain the most important details was masterful. My initial conversation with Mr. Gavidia reminds me of our patients and how we sometimes would fail to explain things in laymen’s terms. And we wondered why our patients were confused? Now I know.

I would further suggest that you conduct an annual review of your policy with Dell & Schaefer to ensure your understanding and expectations to protect yourself and your loved ones. I am fortunate. I thought I had performed my “Due Diligence”. I had to a minimal level. Had I taken the initiative to contact this excellent group of experts, early on I could have protected my wife and children like a responsible spouse and father should. However, we are fortunate and blessed in that my disability insurance covers our very nominal financial requirements.

We have no additional funds for our children’s college nor do we live a lavish lifestyle. I simply receive the “minimum” to get by each month. I am very fortunate to have a “true expert” to take care of me and an insurance company, who to date has honored their contract. I thought I had performed my due diligence. In retrospect I was simply naive. While considered an “expert” in my profession with the highest accolades in the world I finally realized that it is impossible to know everything. My encouragement would be to focus on your passion and expertise and let those who are experts in their field help you.

I am very, very fortunate to have sincere and professional colleagues, Mr. Cesar Gavidia and his paralegal, Ms. Danielle Lauria help me through some very difficult times. I have returned to school and recently earned my MBA so I can “get back on my feet” and continue to help those who have blessed me so much. Dell & Schaefer helped me with this too. They encouraged me to do so when I thought the world had ended. In medicine we take an oath, “Do No Harm”. That should also apply to ourselves. Make sure you take care of yourself and your loved ones. You deserve it!

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