When our client, an attorney, originally hired us to help his with his ERISA long-term disability insurance claim, his claim for disability benefits had already been denied. He had been diagnosed with a cardiac condition and advised by his cardiologist to reduce stress and change his lifestyle in order to prevent further heart damage and possible heart failure. In keeping with his doctor’s orders, he took on a less strenuous legal role in the law firm where he worked and significantly reduced his hours. After the filing of an appeal and then a lawsuit, the denial was ultimately reversed and our client continued to work in the reduced capacity prescribed by his physician and the insurance company paid his benefits for many years.
Due to the nature of our client’s medical condition, it was determined by his cardiologist and the insurance company’s own reviewing physician that improvement was highly unlikely and that he would have to make an effort to keep his stress level low and limit his activity level. Despite these opinions, our client’s claim came under review last year and, based on comments in the medical records regarding our client’s decision to exercise and ride his back, his benefits were terminated. Without asking our client about his exercise regimen (which was mild and monitored by a trainer) or how long and often he rode his bike (not very far and only when feeling up to it) the insurance company determined that because he was now” active” he was no longer disabled and could return to his full time pre disability occupational duties.
DI Law Group immediately filed an appeal and advised the insurance company that if they did not immediately reverse the denial of benefits we would file a lawsuit. Based on the physician statements, legal rationale, and detailed review of the insurance company’s arbitrary and unreasonable review of the claim contained within the appeal, the matter was resolved to our client’s satisfaction.
If you, a friend, or family member have filed a claim and are still waiting for payment, have been denied short-term, long-term, or individual disability benefits, have an ERISA claim about which you have questions, or would like to file a disability claim with your insurance company and need advice, please feel free to contact DI Law Group or call our toll free number (866) 363-3628 for a free consultation.