Ms. “Jones” contacted DI Law Group after being advised by her representative at Liberty Mutual that her claim was being reviewed under the “any occupation” definition of her Long Term Disability Policy. At the time Ms. Jones became disabled she was a full time Registered Nurse whose primary duties involved the hands-on medical care of her patients. As the result of Fibromyalgia and Chronic Pain Syndrome, Ms. Jones was forced to stop working in 2015 and applied for disability benefits under her employer’s Long Term Disability Policy provided to her as a benefit of her employment with the hospital. After a lengthy claim review and several strong statements of support from her physician, Ms. Jones claim for LTD benefits was approved. Specifically, it was determined that as the result of her chronic pain she was unable to perform the duties of her occupation, an RN.
Ms. Jones’ Long Term Disability policy, like many group LTD policies, defines Total Disability one way for the first 24 months of disability and then applies a more general definition of disability after that. During the first 24 months that she was eligible to receive disability benefits, Liberty Mutual’s policy defined Total Disability as the inability to perform the material duties of your own occupation and required the insured to remain under the appropriate care of a physician. After LTD benefits have been paid for 24 months, the Liberty policy defines Total Disabiilty as the inability to perform the material duties of any occupation for which the insured is reasonably qualified based on education training and experience. Approximately 3 months before the end of the Own Occupation Period, Ms. Jones was advised that a medical consultant hired by Liberty reviewed her medical records and determined that she could do relevant sedentary work within the healthcare industry. Ms. Jones responded with a letter from her physician advising that due to chronic muscle pain, severe fatigue, overall body weakness, and other effects of Fibromyalgia, Ms. Jones lacked the ability to work full time in any occupation as she cannot work with any degree of continuity or reliability.
Liberty Mutual claimed they needed further clarification and thus scheduled an Independent Medical Examination for Ms. Jones to attend with a physician of their choosing located about 60 miles from Ms. Jones’ home. It was at that point that Ms. Jones realized Liberty was likely going to terminate benefits and she hired our firm to help her stay on claim. Our attorneys immediately contacted Liberty Mutual and requested a copy of the IME doctor’s CV, an explanation of the examination to be performed, and that they provide Ms. Jones transportation to and from the IME as the doctor’s office was almost 2 hours from her home with traffic and she cannot drive that distance. Liberty was also advised that an independent videographer would be present to document the examination so that any future issues could be addressed by the video. Our firm then worked with Ms. Jones to prepare a detailed summary of her medical records, symptoms, and limitations to be submitted to the IME doctor and Liberty Mutual prior to the IME examination. Additionally, we worked with her treating physician to prepare a detailed statement explaining Ms. Jones’ medical history, the objective findings that correlated with her reported complaints and limitations, and why in his opinion Ms. Jones could not work in her own occupation or any occupation. This information was submitted to both the IME physician and Liberty Mutual just prior to the IME and then a follow up letter was sent in which Ms. Jones documented her impression of the very brief examination and the doctor’s reluctance to let her speak about her problems. Approximately two weeks after the IME, Ms. Jones was advised that Liberty Mutual approved her claim at the Any Occupation level and that benefits would continue until she is no longer disabled. We continue to represent Ms. Jones and make sure that the medical information and forms submitted by her and her doctor provide sufficient proof of her ongoing eligibility for disability benefits under the terms of the Liberty Mutual LTD policy.
If you or a loved one are planning to file a disability claim, recently filed a claim and are awaiting a response, are on claim, have been denied benefits, or need to file a lawsuit against the insurance company please contact our firm for a free consultation. We handle cases nationwide and have worked extensively with a majority of the LTD carriers.