Sun Life Overturns Its Previous Denial of LTD Benefits for Massachusetts Teacher

Our client, Ms. L, formerly worked as a Technology Teacher for a public high school in Massachusetts. For many years Ms. L suffered from chronic debilitating effects of multiple physical conditions and ailments, including most notably severe degenerative joint disease and osteoarthritis, which left her with debilitating physical pain and occupational impairments. Ms. L was unwilling to give up his career and worked as long as she possibly could. As a result of her serious medical conditions and associated restrictions and limitations, Ms. L was forced to stop working in January 2019 and apply for disability benefits under her employer’s Long Term Disability (LTD) Policy, which was administered and funded by Sun Life. However, Sun Life denied LTD benefits after it determined that the medical evidence does not support Ms. L’s claim that she was precluded from performing the material and substantial duties of her own occupation.

After receiving the denial, Ms. L contacted Dell & Schaefer and discussed her case with Attorney Jay Symonds, who identified several significant issues in Sun Life’s denial letter and in the evidence it relied on and agreed to prepare and submit Ms. L’s ERISA appeal with the assistance of his appeal team.

The appeal addressed all of Sun Life’s short-comings and reasons for denial. In particular, the appeal argued that Sun Life’s occupational analysis confirmed that Ms. L’s position as a high school teacher required standing and walking to a significant degree (6 hours in an 8 hour day) and was considered to be “light duty”. And review of the claim file confirmed that Sun Life had in their possession clear objective testing – an MRI – of Ms. L’s afflicted joint(s) that was positive for nondisplaced degenerative tear surrounding the soft tissue and an underling bone marrow edema; advanced tri-compartmental cartilage loss as well as a subsequent X-ray that was positive for advanced degenerative changes with joint space narrowing in the medial compartment. Clearly, the objective testing did not support the ability to perform light duty work requiring extensive standing/walking.

The appeal next argued the significant disparity in Sun Life’s medical reviews versus Ms. L’s treatment providers. Specifically, from a medical standpoint Sun Life’s denial relied exclusively on a “specialist review” completed by Sun Life’s own in-house nurse whose credentials and experience were unknown. Conversely, Ms. L’s claim was supported by all of her treatment providers, which included three (3) different board certified orthopedic surgeons, all of whom were clinical instructors at Harvard Medical School and maintained full-time clinical practices at Massachusetts General Hospital. What’s more, unlike each of these three experts, Sun Life’s nurse did not actually examine Ms. L or even speak with her.

Finally, the appeal noted that the record evidence clearly establishes that Sun Life operated under a significant financial conflict of interest in its purported investigation of and determination on Ms. L’s LTD claim. Sun Life’s attempt to avoid significant financial liability by claiming Ms. L could return to her light occupation by relying on unsupported and unreasonable medical record reviews by an in-house nurse consultant made clear that Sun Life operated under a significant and ongoing financial conflict of interest in deciding Ms. L’s claim.

Just over nine weeks after filing her appeal, and after reviewing hundreds of pages of exhibits and medical records, Sun Life overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Ms. L’s LTD benefits. Attorney Symonds continues to represent our client to best ensure that Sun Life will not terminate her benefits again. Feel free to call our disability attorneys for a free consultation regarding any matter relevant to your disability claim.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

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.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us