Our client, Mr. D was a partner at a large accounting Firm for 9 years. Unfortunately, he began to experience severe and debilitating symptoms and was ultimately diagnosed with Multiple Sclerosis (“MS”). Mr. D had difficulty accepting the diagnosis and sought a second and third opinion. Unfortunately, both physicians confirmed that he suffered from MS. As reality set in, Mr. D fell into a deep depression. With the help of his family, his therapist, and his MS specialists, Mr. D overcame his depression and focused on his family, his work, and maintaining his health.
Over the next few years, Mr. D’s symptoms grew progressively worse. His physician recommended that he look into a clinical trial. In order to be approved for the clinical trial, Dr. D had to undergo numerous MRIs, all confirming that he suffered from MS. He was approved for the clinical trial and the progression of his symptoms was closely monitored by several MS specialists.
At this point, Mr. D was experiencing severe tremors in his hands, had balance issues, and suffered from severe cognitive impairments. His symptoms began to significantly interfere with his functionality at home and at work. He began missing more and more days at the office, was forgetting appointments, and suffered from extreme fatigue. Ultimately, Mr. D’s condition deteriorated to the point that he could no longer perform the duties of his occupation and had to cease working. He applied for Short Term Disability benefits with Standard Insurance Company and was approved. When this ended, he applied for Long Term Disability benefits. He expected Standard to quickly approve his claim, as his Long-Term Disability policy contained the exact same definition of Disability as his Short-Term policy, the inability to perform the material duties of his occupation. Moreover, he was approved for Social Security disability benefits, as the Social Security Administrative determined that he was unable to maintain gainful employment in any occupation. However, this time Standard denied his claim, asserting that its medical reviewer determined that he did not actually suffer from MS, but instead was only mildly limited in functioning due to Carpal Tunnel Syndrome (“CTS”). Mr. D was confused as his physicians never diagnosed him with CTS and CTS simply did not explain his severely debilitating symptoms. He took the denial correspondence to his physicians to review. While he knew what Standard asserted was false, he secretly held out a glimmer of hope that his physicians would agree. They of course did not agree and Mr. D found himself sliding back into the depression he had years before overcome. His physicians encouraged him to contact our Firm, Disability Insurance Law Group. That is when he hired us to submit his appeal.
We ordered Mr. D’s claim file from Standard and discovered that Standard’s medical reviewer was a physician frequently hired by Standard and other insurance companies to perform these “independent” reviewes. In fact, this same reviewer had been criticized by judges in multiple court cases for rendering biased and unsupported conclusions finding claimants not disabled. An evaluation of those cases revealed that this reviewer had a disturbing pattern of challenging the diagnoses of claimants. With this, we obtained all 11 of Mr. D’s MRI reports supporting his diagnosis of MS. We then interviewed all 7 of his physicians and obtained sworn statements from each which detailed the evidence supporting Mr. D’s diagnosis of MS, explained why Standard’s reviewer’s report was medically unsound, and discussed Mr. D’s severe limitations. With Mr. D’s permission, we then interviewed and obtained sworn statements about Mr. D’s limitations from his family members, friends, and co-workers. Finally, we videotaped our interview of Mr. D, who explained his limitations, showed his severe hand tremor when attempting to write, drink a glass of water, or simply button his shirt. He explained the financial devastation of Standard’s failure to pay his Long-Term disability benefits and discussed the emotional pain of Standard’s denial. Mr. D noted that after reading that Standard’s physician opined that he was misdiagnosed with MS, he developed a glimmer of hope, only to be let down once again.
With this information and his extensive medical records, we prepared a comprehensive appeal of Standard’s decision which thoroughly analyzed the medical information, dissected the medical review report, and discredited the medical reviewer. In less than a month, Standard overturned its decision and paid Mr. D all back benefits owed to him. He continues to receive Long-term disability benefits today.