Sun Life ignored its own medical expert’s opinions supporting registered nurse’s inability to work in a sedentary occupation due to severe rheumatoid arthritis

Sun Life reinstated LTD benefits after Dell & Schaefer appealed wrongful termination of LTD benefits of registered nurse suffering from rheumatoid arthritis demonstrating Sun Life ignored the overwhelming volume of objective evidence supporting the claim for total disability including their own peer review physician’s opinions that the claimant could not perform sedentary work.

At the time of the onset of the claimant’s disabling symptomology the claimant was employed as a Neonatal Intensive Care Unit nurse. Due to her severe rheumatoid arthritis and other disabling conditions, she was unable to sit or stand for significant periods of time, had extreme difficulty using her hands and fingers for typing and was unable to lift in any capacity, therefore, rendering her disabled from working in a sedentary capacity.

According to the claimant’s treating rheumatologist she had the following restrictions and limitations:

Lifting – Limited to 10 pounds
Sitting – Occasional (up to 33 % of the day)
Walking – Occasional (up to 33 % of the day)
Standing – Occasional (up to 33 % of the day)
Bending – Never
Squatting – Never
Climbing – Never
Twisting – Never
Pushing – Never
Kneeling – Never
Crawling – Never
Reaching – Never

Sun Life’s Board Certified Physician in Physical and Rehabilitation conducted a medical file review of the claim and concurred with her restrictions thus establishing that she does not meet the physical demand level of sedentary work. Sun Life’s physician in his review also states that he felt that the claimant should have the following additional restrictions:

Repetitive simple and hand grasping – Never
Reaching at and below shoulder / desk level – Never
Hand manipulation – Never

Sun Life ignores its own peer review physician’s opinions

Sun Life terminated the claimant’s LTD benefits ignoring the treating physician’s recommendations that she not perform even sedentary work due to the severity of her rheumatoid arthritis, as well as its own peer review physician’s opinions that clearly indicated she was incapable of sedentary work due to severe rheumatoid arthritis. Sun Life claimed in its denial letter that she could work in other occupations such as; a Nurse Consultant, Medical Case Manager, Discharge Planner or Utilization Coordinator on a full-time basis. Based on the permanent restrictions placed on her by her treating physicians as well as Sun life’s peer review doctor, the claimant would not be an eligible candidate for ANY of the positions Sun Life claims she was qualified and capable of performing.

Definition of Sedentary work

Sedentary work requires the ability to lift no more than 10 pounds at a time and occasionally to lift or carry articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met. “Occasionally” means occurring from very little up to one – third of the time, and would generally total no more than about 2 hours of an 8-hour workday. Sitting would generally total about 6 hours of an 8-hour workday.

Lifting/carrying and pushing/pulling: If an individual is unable to lift 10 pounds or occasionally lift and carry items like docket files, ledgers, and small tools throughout the workday, the unskilled sedentary occupational base will be eroded.

Standing and walking: The full range of sedentary work requires that an individual be able to stand and walk for a total of approximately 2 hours during an 8-hour workday.

Sitting: In order to perform a full range of sedentary work, an individual must be able to remain in a seated position for approximately 6 hours of an 8-hour workday, with a morning break, a lunch period, and an afternoon break at approximately 2-hour intervals.

Sun Life is surely well aware of the physical functional requirements for and the definition of “sedentary” capacity as it relates to disability. The fact that Sun Life attempted to represent that it was their peer review physician’s opinion that the claimant could perform “sedentary” level work on a full time basis is evidence that its decision-making process is clearly arbitrary and capricious.

Sun Life eventually overturned its decision to terminate her claim after reviewing the appeal prepared by Attorney Alters of Dell & Schaefer. The claimant received all of her past benefits and is currently on claim.

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Dell & Schaefer Client Reviews   *****

Ravindra P.

I have been a client of Dell & Schaefer for the 6 months and they have already successfully taken my disability claim to approval. It is privilege to write this testimonial. I am a professional myself, a physician and to me these are some of the core strengths of Steve Jessup and his team.

Listening to the client: Attorneys at Dell & Schaefer really listen to you explain your special situation and undoubtedly every one of us has a special circumstance and specific wishes as to what we want. Most of the time attorneys and in general most professionals these days, will listen to you a couple of minutes and then file you away in a category or a bin and chalk out a plan for you in their mind and stop listening to you and start thinking about the next thing that they have to do. That is why these interactions are so often exasperating for the client.

As a physician I used to try and teach medical students that any well trained monkey can read a few books and do a particular thing in a particular situation, it is however extremely essential that you determine what the situation is and no one understands the situation better than your client or patient. I spoke to a couple of attorneys at D&S, initially with someone who took my call and then Steve who was assigned to me and it was impressive that they really tried to get what I was trying to convey, what my special and unique situation was (and whose isn’t?) and what I wanted.

Shock and Awe: At Dell & Schaefer they don’t go in halfway prepared. Their philosophy is to get well prepared and go in guns blazing. They will make you work on your mission until all anticipated difficulties have a contingency plan before even the adversary is intimated of the challenge. I believe it was Sun Tzu who said that the best battles are won before they are fought. Frequently you are a small David pitted against a Goliath adversary with deep pockets and a much larger time horizon. But you do have an advantage, that of time for preparation. The adversary does not know of the battle until you tell them and then the clock starts ticking. At Dell & Schaefer they make full use of your advantage by preparing your case with utmost thoroughness before the engagement.

Art of the possible: Legal action, just like life, is the art of the possible. I have dealt with 5 other attorneys in my career and only one of them apart from Dell & Schaefer understood this. A professional’s job is to tell you what the score is, what possibly can occur in the future and what measures can be taken to favorably change the future. And the last one is possibly the most vital. You don’t want your attorneys telling you all the time why things cannot be done, how laws are stacked against you, how global warming is melting the icecaps, how the oil is running out and how dogs sometimes eat homework assignments. You want them taxing their brains to see what can be done in best manner possible, so the future, which is not yet written, changes favorably for you. Attorneys at D&S get this and consciously incorporate it in their work ethic.

They say that there are four professionals in your life who should also be your friends. Doctor, Lawyer, Accountant and Banker. There is a deeper side to this sound bite that some people get and some don’t. I live at the other end of the country from where Dell & Schaefer work and play, but the world is small and getting smaller and perhaps someday I can add to my stock of friends.

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