Senior Insurance Company Trial Lawyer with Multiple Sclerosis Wins Appeal
Our client was a 45 year old senior litigation attorney for one of the major long term disability insurance carriers in the United States. This particular insurance company is well known for unfair claim denials, but our client did not think they would deny a legitimate disability claim from one of their own. Unfortunately, he learned he was wrong.
When his long term disability claim was denied, he asked several claims representatives in the company where he should turn for legal representation. Within a few days, he and his wife were in the offices of Turley, Redmond, Rosasco & Rosasco, LLP. We reviewed his Summary Plan Description and the denial letter. After reviewing the denial, it was clear that the claims representative handling the case knew little about the symptoms of multiple sclerosis and mischaracterized the physical requirements of our client's job.
We then mapped out a strategy to win the claim on appeal. This included obtaining expert vocational reports and a neuro-psychological evaluation to bolster the evidence in the file. After submitting a lengthy legal brief detailing the errors in the original denial, the insurance company reversed its original decision and granted our client substantial retroactive and continuing future monthly long term disability benefits.
Physician with Lumbar Herniated Disc Retains Long Term Disability Benefits
Our client was a 53 year old physician with both a private disability income policy and an ERISA group policy sponsored by her medical practice. The combined monthly benefit is over $15,000 per month. The client came to us after the insurance company for her private policy informed her that they had a "surveillance tape" of her doing "activities inconsistent with her disability claim". In addition, the insurance company was harassing her orthopedic surgeon to fill out endless forms - so much that he politely suggested that his friend find a new doctor.
The client came with her husband, also a physician, for an initial consultation. We reviewed both the private and the ERISA policies. We also reviewed her medical records - which did not contain much "objective evidence" of disability. For instance, she had undergone a total of four lumbar MRI exams, but only one film showed a "small herniated disc". After we were retained, we immediately sent her to a new doctor who was not intimidated by the insurance company and submitted better medical reports.
The insurance company countered by sending the claimant (along with the surveillance tape) to an IME (insurance medical exam). Troy Rosasco personally accompanied the client to the IME and took notes during the exam. After listening to the client's subjective complaints of pain, and reviewing all the medical evidence we had supplied, even the insurance company doctor conceded that she could not work full time. She continues to receive ongoing monthly benefits today. By the way, what did the "revealing surveillance tape" show? Nothing more than the client lingering over a meal in her favorite Italian restaurant!
Vice President with Auto Immune Disorder Wins After Initial Application
Our client was a 47 year old Senior Vice President for Marketing with a Fortune 50 consumer products company. She had struggled for 8 years to continue working with her disability. Having heard the horror stories of unfair long term disability claims denials, she decided to consult Turley, Redmond, Rosasco & Rosasco, LLP prior to going out of work.
At her initial office consultation, we reviewed her medical history. Given her medical condition, we were amazed she was able to work for as long as she had, but she was a single mother with college age children. Unfortunately, her disease is progressive and she simply could no longer put in the 60 hour weeks expected of her position.
We reviewed her long term disability policy and explained the "definition of disability" that we were required to prove to win her claim. We discussed whom her current treating physicians were and whether she thought they would write letters supporting her disability. We then created an action plan prior to leaving employment. After she stopped working, we discussed the pros and cons of our firm filing her initial application for her directly, or having her submit the claim on her own with our assistance. Eventually, the client decided to have our firm submit the application, medical and vocational evidence as one complete and cohesive package. Her claim was approved in less than 45 days.
Communications Technician with Kidney Failure Wins After One TR&R Letter
In a shockingly unfair decision, the insurance company terminated benefits to a 35 year old Florida man with end stage renal failure who was receiving kidney dialysis three days per week! Prior to his disability, he had worked for one of the national cell phone carriers. Because the client had already been approved for Social Security Disability benefits which were an offset to his LTD benefit, he was receiving only $300 a month in long term disability benefits. He could barely pay his rent - and certainly could not afford to pay a lawyer out-of-pocket. This is the classic "economic denial" case, in which the insurance company turns down a legitimate claim betting that the claimant will not be able to afford a lawyer to appeal.
Recognizing the obvious injustice to this very sick man, we took the case on a "contingency fee" even though we knew we might lose money on the case due the relatively small amount of benefits in dispute and the work involved. That $300 meant a lot to our client and we just could not stand by as the insurance company stripped him of this much needed income. We needed to call the insurance company's bluff.
We immediately sent a letter to the insurance company requesting a copy of the entire claims file to see how they arrived at their erroneous decision. Within one week, the insurance company contacted our office to inform us that they were "re-reviewing the file" and requesting that we take no further legal action until the new review was complete. One week later, much to our client's relief, his benefits were fully restored.
Financial Director with Heart Disease Stress Claim Wins at Initial Application
Our client was a 61 year old financial executive and CPA who had a history of coronary bypass surgery, but thankfully never had a heart attack or congestive heart failure. Never the less, his job was extremely stressful as he was responsible for all the financial reporting for his publicly traded company. His cardiologist told him the "stress on your job will kill you if you don't stop."
Worried about both his health and the potential of being granted long term disability benefits by his company, the client and his wife came to our office for an initial consultation. After reviewing his disability policy and medical history, we told him there was no reason he had to work himself into an early grave. We worked with the client "behind the scenes", including completing his application and obtaining proper medical reports. His claim was approved within one month. He is now enjoying time with his grandchildren and occasional fishing.