Prior to becoming disabled, our client had worked at Grady Management, Inc., a well-respected full service real estate firm in Maryland, since April of 1978. For 37+ years, our client worked for Grady and worked his way up to become the Vice President of Priority Engineering Services. Obviously his work at Grady was more than a job, it was his life. Unfortunately for our client, serious medical conditions interrupted his continued employment and he was forced to stop working in June of 2015.
What caused him to stop working was the fact that our client suffers from hypercoagulopathy disorder which is a disease that is characterized by an increased tendency of the blood to form clots. Other diagnoses include deep vein thrombosis, pulmonary embolisms and he has even suffered from multiple cerebrovascular accidents (strokes). These issues have left him suffering from short term memory loss and impaired cognitive functioning, among other issues.
After 37+ years, our client was forced to stop working. Fortunately, Grady Management provided its employees with coverage under a Long Term Disability Insurance policy and fortunately that policy was with Symetra Life Insurance Company. After leaving work and applying for benefits, Symetra initially approved his claim and in fact paid his claim for a little over two years. Unfortunately, continued benefits were denied by way of a denial letter dated November 1, 2017.
Symetra’s Denial Letter
Symetra’s Policy with Grady Management contained typical policy language that included what is known as the “change in definition of disability.” In this policy (like most group insurance policies with all insurance providers), in order to initially receive benefits a claimant must prove that he or she is prevented “from performing with reasonably continuity the material and substantial duties of your regular occupation…” However, after benefits are paid for 24 months, what it means to be disabled changes. After 24 months of benefits, the claimant then must prove that he/she is prevented “from performing with reasonable continuity the material and substantial duties of any gainful occupation.” As it is clearly tougher to prove that one cannot perform “any gainful occupation”, this is the time period when most insurance companies deny previously approved claims.
This situation was not unique. Armed with the new definition of disability and armed with the opinion of an “Independent Physician Consultant” who performed a review of the medical records, Symetra determined that as of November 1, 2017, the claimant was not disabled from any gainful occupation. Specifically, Symetra stated that he did “not have any restrictions or limitations and that (he had) a full work capacity.” Symetra even stated that there was “no objective physical impairment preventing you from performing any occupation.”
Knowing that Symetra’s conclusions were wrong and knowing that he had no ability to perform any gainful occupation, the claimant knew he needed assistance to fight this denial and he found Attorney Alexander Palamara of the Dell & Schaefer law firm.
Appeal by Attorney Palamara
After reviewing the denial letter, the claim file and all of the medical records, it was clear to Attorney Palamara that there was no way this honorable man who worked for 37+ years for the same company could possibly perform any gainful occupation. Attorney Palamara reached out to numerous treating physicians and each of them could not have been more supportive of the fact that their patient should be deemed completely disabled no matter what the definition of disability should be. Our appeal focused not only on the significant and overwhelming volume of objective evidence that showed each of his diagnoses and their accompanying symptoms and complications, our appeal also utilized the support of the treating physicians who wrote statements that said that our client “has had a history of mini strokes and multiple medical problems that affect his memory and cognition.” The treating doctors opined that “due to his cognitive impairment (our patient) is totally disabled.”
Thankfully, on the 90th day after the appeal was filed, Symetra reached out to our firm and notified us that our client’s claim was reapproved and that all retroactive benefits would paid as well as ongoing monthly benefits. While our client is happy to be back on claim and getting the benefits he deserves, he knows that the fight will continue. He also knows that Attorney Alexander Palamara will do whatever it takes to keep him on claim. If you have been denied disability benefits by Symetra or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schafer for a free consultation.