Osmose Senior Director With Cervical Spondylosis Wins Utah Voya Long-Term Disability Insurance Appeal
Voya Financial sent our client to a Functional Capacity Evaluation, paid for it, and then discarded the one finding that mattered most: he could not work an eight-hour day at any exertional level. He had given roughly four decades to Osmose Utilities Services, Inc., finishing as Senior Director of Business Development in Utah, a travel-heavy role that ended after a fall from a ladder left him with cervical spine trauma, a traumatic brain injury, and multiple orthopedic and neurological conditions.
Voya paid his long-term disability benefits for about a year, then cut him off. Watching an insurer walk back a claim it already approved is familiar ground for us, and we have dismantled this exact maneuver many times: commission the objective testing, then quote the one favorable phrase and bury the rest. Disability insurance attorney Alexander Palamara built the administrative appeal, and Voya reinstated the claim.
What went into that appeal, and why a carrier reversed its own termination, is worth understanding for anyone whose benefits were stopped on the strength of a single phrase in a report. If Voya or any other disability insurance company has terminated your claim, speak with one of our disability insurance lawyers. We represent claimants nationwide and charge no fee unless benefits are paid.
Table Of Contents
- 1. Why this case matters for every Voya claimant
- 2. A career built in the field, ended by a fall from a ladder
- 3. Voya paid the claim, then ordered its own Functional Capacity Evaluation
- 4. The evaluation Voya paid for concluded he could not work at all
- 5. How a checkbox signature became the backbone of a denial
- 6. The nurse review that confused survival with work capacity
- 7. Voya called the occupation light when the employer’s own job description did not
- 8. The evidence we built on appeal
- 9. Voya reverses itself and reinstates the claim
- 10. If Voya has terminated your long-term disability benefits, move now
Why This Case Matters for Every Voya Claimant
An FCE the insurer paid for is not automatically the insurer’s evidence. A Functional Capacity Evaluation, or FCE, is a standardized hands-on test of how much a person can actually lift, carry, sit, stand, and tolerate across a simulated workday. Voya ordered one, funded it, and received a report concluding our client could not sustain any occupation for eight hours. It terminated benefits anyway. If your carrier sent you for functional testing, request the complete report. The summary paragraph an adjuster quotes back to you is frequently not the report’s conclusion.
A physical demand category says nothing about whether you can sustain work. “Light” and “sedentary” describe how much weight a person can move in a single moment. Sustainable and predictable work capacity, the standard Voya itself applied when it finally reversed course, asks something different: whether a person can perform work reliably, on schedule, day after day, without unscheduled absences or collapse afterward.
A physical demand label does not answer whether that person can show up five days a week and stay productive. Voya’s entire termination rested on collapsing those two very different questions into one word. Build your record around sustainability and predictability, not exertional labels.
A checkbox your doctor signed can be corrected, and the correction can end the denial. Our client’s treating pain management physician signed an insurer form during a crowded clinic day, believing he was confirming receipt of a report rather than opining on work capacity. A detailed written clarification letter setting the record straight became one of the strongest documents in the appeal.
Your employer’s own job description is often the fastest way to defeat a vocational classification. Voya’s vocational consultant decided that a Senior Director of Business Development who spent his career traveling for a utility services company performed light level work in the national economy. The employer’s written job description required regular lifting to fifty pounds, occasional lifting to one hundred pounds, and frequent overnight travel in outdoor conditions. That document did more work in this appeal than any medical record.
A physical claim often has an undocumented cognitive layer, and proving it opens a second front the insurer cannot defend. Nothing in Voya’s file addressed our client’s memory, attention, or processing speed, even though his primary care physician had flagged memory complaints years earlier. Formal testing produced quantified, percentile-ranked scores that no paper reviewer could characterize as subjective complaint.
A Career Built in the Field, Ended by a Fall From a Ladder
Our client joined Osmose Utilities Services, Inc. as a young man and stayed for roughly forty years, finishing as Senior Director of Business Development with responsibility for telecommunications work across the utility sector. This was not a desk job in any meaningful sense. He worked out of his vehicle, not an office.
The role demanded a tremendous amount of driving and overnight travel, face-to-face negotiation with senior executives, contract management, and the kind of sustained concentration that lets a person hold a complex deal in his head while moving between three states in a week.
Twenty Feet Onto Concrete, Then Two More Years of Trying to Work
Then he fell more than twenty feet from a ladder onto concrete while hanging Christmas lights. He was hospitalized for about twelve days. The injuries were catastrophic: nine fractured ribs, four of them broken in multiple places, a hemothorax (blood collecting in the chest cavity around the lung), a torn left rotator cuff, severe trauma to five of his seven cervical vertebrae, and a traumatic brain injury.
He went back to work anyway, with accommodations, and pushed through for nearly two more years. Travel made everything worse. The pain, the fatigue, and the cognitive symptoms compounded each other until he could no longer keep pace. He stopped working and filed for benefits, ending a career spanning more than four decades with a single employer.
Findings Reproduced by Different Providers, Year After Year
The diagnostic picture documented across his medical record was extensive:
- Cervical spondylosis with radiculopathy, the age-related and trauma-related degeneration of the neck vertebrae, with the worn structures pressing on nerve roots and sending pain and numbness down the arms
- Spinal stenosis, cervical region (ICD-10: M48.02), narrowing of the spinal canal; cervical MRI documented moderate to severe four-level canal narrowing with moderately severe bilateral foraminal stenosis, meaning the bony passageways the nerves travel through had closed down on both sides
- Cervicalgia (ICD-10: M54.2) and low back pain (ICD-10: M54.50), with lumbar disc pathology and right L5 radiculopathy confirmed on imaging after a later fall down a flight of stairs
- Personal history of traumatic brain injury (ICD-10: Z87.820), producing persistent deficits in memory, concentration, word retrieval, and speech
- Left shoulder rotator cuff tear and left knee osteoarthritis, both treated with injections
- Hypertrophic cardiomyopathy with a murmur and non-sustained ventricular tachycardia, monitored by an implanted loop recorder
- Severe obstructive and central sleep apnea with a Mallampati class IV airway, plus chronic insomnia, driving fatigue that further degraded his cognition
Multiple examiners across multiple years documented the same findings: cervical tenderness, restricted range of motion in every plane, and positive Spurling’s tests on both sides. Spurling’s test reproduces a patient’s arm symptoms by compressing the neck at an angle. It is not a sensitive screening tool, but the research shows it is highly specific for cervical radiculopathy confirmed on electromyography, which means a positive result reproduced by different providers on different days is meaningful corroboration rather than a subjective complaint.
He received cervical epidural steroid injections, medial branch blocks, and radiofrequency neurotomies, and remained on hydrocodone, tramadol, and pregabalin throughout. Nothing restored his capacity. This is the record that cervical spine disability insurance claimants are told they need, and he had all of it.
Voya Paid the Claim, Then Ordered Its Own Functional Capacity Evaluation
Voya Financial, which issues these group policies through ReliaStar Life Insurance Company, reviewed the evidence and got it right the first time. It found our client disabled under the plan and paid long-term disability benefits for roughly a year.
The policy defined disability in two stages. During the regular occupation period, our client was disabled if he could not perform all the material and substantial duties of his own occupation as it is normally performed in the national economy. After that period ends, the standard tightens: he must be unable to perform the duties of any gainful occupation for which he is reasonably qualified by training, education, and experience.
In most group long-term disability policies the own occupation period runs 24 months from the start of benefits, after which the insurer re-evaluates the claim against the any occupation standard. Anyone on a group claim should find that date in the policy before the insurer does. That second standard is the one most group claims eventually die on.
About a year into payments, Voya exercised its contractual right to have our client examined and sent him for a Functional Capacity Evaluation. Then it terminated the claim. The denial letter, signed by Senior Case Manager Gail S, put it plainly: “In summary, it has been determined you have the ability to perform Light level work per medical records and a Functional Capacity Evaluation.”
Having once conceded that our client was disabled, Voya could only take benefits away on reliable evidence of medical improvement or restored function. It never identified any. Nothing in the file said he had gotten better. The file said the opposite.
The Evaluation Voya Paid For Concluded He Could Not Work at All
Here is what the insurer-arranged evaluation actually found. The physical therapist who conducted it confirmed valid effort, found his presentation credible, and identified no discrepancies between his reported symptoms and the objective findings. She recorded that he could handle material within a light physical demand category. She also answered the question Voya had specifically asked her: could he perform any occupation for an eight-hour day?
Her answer was: “He is unable to perform any occupation for an 8-hour day. Even with accommodations, he would not be productive with full time employment.”
On whether he could return to his own job, she was equally direct: “No, he is not able to return to his previous occupation.”
The functional detail behind those conclusions was devastating to any theory of full-time work:
- Cervical flexion of 20 degrees and extension of 2 degrees, against norms of 45 degrees in each direction, meaning he had almost no ability to look up or down
- Sitting tolerance of 46 continuous minutes; standing tolerance of 46 continuous minutes
- Walking for three and a half minutes before requiring rest
- Restrictions of no walking beyond three continuous minutes, no sitting or standing beyond forty-five minutes, no squatting, no bending, no unsupported kneeling, no climbing without support, no pace or productivity requirements, and the ability to lie down as needed throughout the day
- After a three-hour assessment, he had to lie down for the rest of the day and relied on family members to bring him a meal
That last item is the one that matters most and the one insurers most reliably ignore. Post-exertional collapse after three hours of testing is not a detail. It is direct evidence that sustained activity is not tolerable, and it answers the only question a disability policy actually asks.
How a Checkbox Signature Became the Backbone of a Denial
Faced with an evaluation that destroyed its position, Voya went looking for something to set against it. Its Senior Clinical Consultant, Janet A. T., RN, BSN, wrote to our client’s treating pain management physician, enclosed the FCE, summarized her own view that he retained the physical ability to sustain light level occupational activities, and asked him to check a box: did he agree?
He checked yes, wrote a note limiting lifting to ten pounds, and sent it back. Voya built a termination on it.
What Voya knew, or should have known, is what happened next. The physician issued a detailed clarification letter weeks later explaining that he had misunderstood the request entirely. His office had presented it to him as an urgent signature during an extraordinarily busy clinic day, and he believed he was confirming receipt of the FCE and his agreement with its findings. In his words: “I had read this as a request to confirm that I agreed with the findings of the FCE.”
He went further. He had strongly agreed with the report’s central conclusion that our client could not perform any occupation for an eight-hour day, and he disavowed the light-duty answer outright: “It was never my intention to state that he could return to work on light duty.” He asked that his error not be held against his patient.
That letter should have ended the termination on the spot. Voya kept relying on the checkbox instead.
Claimants ask us constantly whether a doctor can take back a form he already signed for the insurance company. He can, and he should, in a signed letter that explains what he understood the question to be and what his actual opinion is.
This is a pattern we see constantly, and it is why we tell every client that your treating doctor should never respond to a disability insurer without your knowledge. Insurers send these forms directly to busy physicians, framed to produce a one-word answer, and then treat that word as a medical opinion.
We ran into the identical tactic in a Hartford denial of a commercial pilot built on a single “light work” checkbox, where the treating surgeon’s clarification letter collapsed the denial and we won that claim back on appeal.
The Nurse Review That Confused Survival With Work Capacity
The medical analysis underlying Voya’s termination came from two reviews authored by Nurse T. A paper review, also called a file review, is an assessment in which the insurer’s reviewer reaches a conclusion from documents alone, without ever examining the claimant. Nurse T. never met our client. She is not a physician and does not specialize in orthopedics, neurology, spinal pathology, or pain management. She nonetheless substituted her judgment for that of both the treating physician and the licensed clinician Voya itself had hired.
She expressly acknowledged that the FCE found no eight-hour capacity even with accommodations, and that our client required the ability to lie down throughout the day with no productivity expectations. She then declared, without medical basis, that he could “sustain light level occupational activities.”
Her stated reasons do not survive contact with the record:
- That the absence of continuous heart rate monitoring invalidated the FCE. The evaluator documented valid effort using recognized validity protocols and found no discrepancies. Missing physiological telemetry does not erase that.
- That more diagnostic testing “would be expected” if impairment were real. Our client had already undergone MRI imaging, injections at multiple levels, medial branch blocks, and radiofrequency neurotomies. His primary care physician later confirmed in writing that further testing was unlikely to change anything.
- That his daily activities proved work capacity. This was the centerpiece, and it was the weakest link.
On that last point, Nurse T. seized on file references to gardening, walking, reading, watching television, and light yard work. The same employer statement she relied on documented severe intractable neck pain, headaches, upper extremity numbness, impaired concentration, and increased pain in the neck, head, and shoulder after any of those activities. It documented roughly eight hours per week of intermittent household and yard tasks, performed at his own pace, with rest whenever he needed it and no productivity requirement.
The question underneath all of this is one we hear every week: can a disability insurance company use your daily activities against you? It can, and it will. Which is why the record has to show not just what you did, but what it cost you afterward.
Eight hours a week of self-paced puttering is not forty hours a week of competitive employment. As attorney Palamara put it in the appeal, “This is not medical review; it is outcome-driven disregard of evidence.”
The tell came in her follow-up addendum. Conceding that both the FCE and the treating physician now agreed our client could not sustain full-time work, she wrote that this did not alter her conclusion. That is an admission that no amount of medical evidence would have changed the answer. We have forced this same reckoning before, including in a Hartford termination of an SAP advisor with cervical spondylosis decided by an internal non-physician reviewer, a denial we also reversed in full on appeal.
Voya Called the Occupation Light When the Employer’s Own Job Description Did Not
Voya’s vocational consultant classified Senior Director of Business Development as light level work in the national economy. Under the federal definitions used across disability adjudication, light work involves lifting no more than twenty pounds at a time with frequent lifting or carrying of objects up to ten pounds, and a good deal of walking or standing. Sedentary work, the lowest category, involves lifting no more than ten pounds occasionally.
The employer’s written job description told a completely different story. It required the employee to:
- Regularly lift or move up to fifty pounds and occasionally lift or move up to one hundred pounds
- Stand and walk regularly, with full range of mobility in the upper and lower body
- Climb, balance, stoop, kneel, crouch, and crawl
- Work in outdoor conditions including inclement weather, extreme heat and humidity, freezing temperatures, poisonous plants, insects, and allergens
- Travel overnight Monday through Friday across one or more states, on a frequent basis, with availability Monday through Saturday
Regular lifting to fifty pounds is medium work. Occasional lifting to one hundred pounds is heavy work. Neither is light, and no reading of the document makes it light. Voya reclassified a physically demanding travel-based executive role, exactly the kind of misclassification we see across executive and director disability insurance claims, into a category that happened to match the one phrase it had pulled from the FCE. That is an assumption, not a fact, and it did not survive the appeal.
The Evidence We Built on Appeal
Under ERISA, the federal law governing employer-sponsored benefit plans, an administrative appeal is the mandatory internal review a claimant must complete before filing suit, and it is the last chance to put new evidence into the record. The ERISA claims procedure statute, 29 U.S.C. § 1133, generally gives a claimant 180 days from the denial to file it. Whatever is not in the file when that appeal closes will usually never be seen by a judge.
Attorney Palamara used that window to build a record Voya could not argue around.
An Independent FCE Placed Him Below Sedentary, Not Light
Our client underwent a second Functional Capacity Evaluation, this one conducted over approximately four hours by two licensed physical therapists with no relationship to either party. The result was not light. The evaluators documented performance at a “Below Sedentary PDC level with modifications.” Below Sedentary means a person cannot meet the demands of even the least physically demanding job category recognized in the national economy. In practical terms, it means he cannot sustain a desk job.
The measured findings:
- Lifting floor to waist: 8 pounds occasionally. Waist to shoulder: 6 pounds. Waist to overhead: unable, zero pounds, due to limited bilateral shoulder range of motion
- Carrying: 8 pounds occasionally. Pushing and pulling: 30 pounds occasionally
- Sitting, standing, walking, and stair climbing: occasional only, meaning less than one-third of a workday
- Reaching, balancing, and twisting: seldom. Crawling, kneeling, crouching, and ladder climbing: unable
- Total capacity in an eight-hour day: less than two hours sitting and less than two hours standing or walking combined
- Grip strength roughly 75 percent below age-matched norms on the right and 69 percent below on the left, with pinch strength below normal across every position tested
- Pain severe enough to interfere with the attention and concentration needed for tasks constantly throughout the evaluation
- Neck Disability Index score of 70 percent, which falls in the “complete” category, meaning neck pain interferes with essentially every aspect of daily function
Validity testing confirmed “consistent and maximal effort” with negative symptom magnification and no inconsistencies. He required frequent seated rest breaks and held onto furniture to support himself. The evaluators noted an increasingly antalgic gait, a limp adopted to avoid pain, and a documented risk of falling. Objective functional testing of exactly this kind is what separates a defensible claim from a vulnerable one, and it is the core of proving that neck pain is disabling rather than merely diagnosed.
Cognitive Testing Found Memory in the Profound Impairment Range
Voya’s file contained no cognitive evaluation at all, despite the documented brain injury and years of memory complaints. Proving disability insurance claims involving cognitive limitations takes exactly the testing Voya declined to order. We commissioned a Cognitive Functional Assessment performed by a licensed clinical psychologist using standardized, validated instruments.
His general intelligence held up. His memory did not. On the Reynolds Intellectual Assessment Scales, Second Edition, his Composite Intelligence score was 101, squarely average, and his verbal reasoning was above average. His Composite Memory Index was 59, at the 0.3rd percentile, in the profound impairment range. Verbal memory fell in the borderline impairment range and nonverbal memory in the moderate impairment range. On one memory subtest he failed to meet the basal score for his age group entirely.
Executive functioning, measured on the Wisconsin Card Sorting Test, 64 Card Version, held up in the average to high average range under structured testing conditions. That is worth stating plainly, because it is the finding an insurer would seize on. The same test also produced a negative learning index, meaning he grew less efficient rather than more efficient with repeated exposure. That is the signature of cognitive fatigue, not preserved endurance.
In plain terms: a man whose reasoning ability remained intact could no longer reliably encode, retain, and retrieve information. He could still think. He could not remember what he had just been told, which is fatal to any job that involves following instructions, tracking commitments, or holding information across a workday.
The evaluator also documented what the numbers alone could not show. During the session our client:
- required supplemental oxygen through a nasal cannula
- spoke softly and with mild stuttering, at times difficult to hear
- produced tangential responses and needed redirection to stay on topic
- required repeated instructions and extended time before answering
- requested a break after the visually demanding portions of testing
- shifted constantly between sitting and standing because of pain
The Structured Inventory of Malingered Symptomatology, a validated screening instrument built to detect exaggerated or feigned symptoms, returned no evidence of feigned impairment. The evaluator added one more caveat that matters: the testing happened at home, at his own pace, with unlimited time and breaks available. In a rigid workplace environment his performance would very likely be worse.
We have made this same point stick against carriers who ignored obvious brain injury symptoms, including a Hartford denial of a clinical review coordinator with a traumatic brain injury built on the absence of neuropsychological testing the insurer never ordered, which we also won on appeal.
The Treating Physician Withdrew the Answer Voya Was Relying On
We submitted the pain management physician’s clarification letter in full. He reaffirmed that our client is fully and permanently disabled, cannot perform light duty work, and cannot return to his prior occupation regardless of how the physical demands are characterized. He explained the mechanism behind it: cervical spondylosis and spinal stenosis producing extreme pain, upper extremity weakness, fatigue, and difficulty concentrating, all documented across his own longitudinal treatment records.
A Second Treating Physician Documented Off-Task Time and Unscheduled Breaks
An Attending Physician Statement is the standardized form an insurer uses to collect a treating doctor’s assessment of diagnoses, restrictions, and work capacity. It is frequently the single most heavily weighted document in a claim file.
We obtained an updated one from our client’s primary care physician, who confirmed to a reasonable degree of medical certainty that he is fully and permanently disabled from all full-time employment, including light duty. Presented with the employer’s actual job requirements, he concluded our client could not safely or reliably perform that occupation even with accommodations.
He then supplied the detail that decides most claims: our client would be off task more than twenty-five percent of a typical workday because of pain and concentration difficulty, would require frequent unscheduled interruptions to manage symptoms, needs the ability to shift between sitting, standing, and walking at will, and sometimes requires an assistive device when pain or weakness flares. No competitive employer tolerates a worker who is off task a quarter of the day.
Voya Reverses Itself and Reinstates the Claim
The appeal made the argument the record demanded. As attorney Palamara wrote, “Having commissioned the FCE, Voya then rejected its central conclusions and substituted speculation for medical fact in order to justify termination.” He pressed the point further: the only plausible inference left by the file was that Voya terminated not because our client had improved, but because he was a high-earning claimant entitled to $9,522.00 per month, an obligation the company no longer wished to honor.
Voya referred the appeal to a physician medical consultant, the qualified review it should have obtained at the outset. Senior Appeals Consultant Sandra K then reversed the termination.
The reversal letter did not hedge. Evaluating the cervical and lumbar degenerative disc disease, the radiculopathy, the rotator cuff tear, the knee osteoarthritis, the cardiomyopathy, the cognitive impairment, the sleep apnea, and the depression collectively rather than one at a time, Voya concluded that our client “does not have sustainable and predictable work capacity for his own Light occupation or alternate sedentary occupations.”
Read that again. Not just his own occupation. Alternate sedentary occupations as well. That is the tougher any-occupation standard, conceded by the insurer, in writing. Voya also accepted the restrictions and limitations set out by the treating physician whose checkbox it had spent months leaning on.
Benefits were reinstated, and Voya issued a check for $66,654.00 covering the seven months it had wrongly withheld. Our client’s claim is being paid.
If Voya Has Terminated Your Long-Term Disability Benefits, Move Now
This claim should never have been denied. It was denied because an insurer commissioned the truth, did not like it, and pulled a single phrase out of context to justify a result it had already chosen. If that sounds like what happened to you, the fix is not a letter explaining that you are still sick. It is a record the carrier cannot read around.
You generally have 180 days from a denial letter to file your ERISA appeal. Miss it and you can lose both your benefits and your right to sue under 29 U.S.C. § 1132 permanently. The record you assemble in that window is usually the only record a federal judge will ever review.
Speak with one of our disability insurance attorneys for a free consultation. Established in 1979, we have helped tens of thousands of claimants collect more than $2 billion in disability insurance benefits, we represent clients in all fifty states, and we charge no fee unless we collect your benefits. Whether your denial came from Voya, ReliaStar, or any other disability insurance company, contact our office and let us review your claim today.
