Disability Benefits Appeal Victory
November 20, 2017
On November 17, 2017, our firm received notice that our client’s privatized disability appeal had been reversed, reinstating his hard earned benefits.
This case involved a retail manager who had worked at a couple of national retailers for more than 30 years. All the time, our client had paid premiums to have benefits should he ever become disabled. In the past few years, his body started to give way and after numerous surgeries on several parts of his body, doctors made the finding that he had reached a point where he could no longer perform his job as described by his employer and that he was permanently disabled. The insurance, that he had faithfully paid, was now going to be essential to his future. The insurance company paid the benefits for a period of time, but soon began trying to find ways to deny the benefits.
Our client followed every requirement and attended every check-up, and still the insurance company did not want to live up to their end of the policy. In April of 2017, our client received the devastating news the insurance company was terminating the payment of his benefits. Shocked and unable to be medically cleared to work at any job, our client came to us for help.
Michael Mogenson was lead counsel on the case, but this was a true team effort for our firm. We filed the appeal for our client and began digging into the insurance file to see what possible justification the insurance company could be relying upon to make such an egregious decision. What we found was the company had been trying to disqualify him for months by having him regularly followed. They were trying to expose him as a fraud. The problem for the insurance company was that he truly was and is disabled. When that didn’t work, the insurance company requested a new review by a doctor who had never even treated our client. For that review we discovered that only a small portion of our client’s actual medical file was sent to the new reviewing doctor. Based on the partial file (with none of the relevant records of disability) the new doctor determined our client was magically no longer disabled.
Our firm hired an expert and had our client fully examined once again. After the filing of the appeal and being put on notice of our findings in the insurance file, the insurance company also had an expert re-examine him. Both had the same finding: our client was and is disabled and hence, entitled to the benefits of the policy for which he paid.
This case took more than 7 months to get resolved. Thankfully our client didn’t just accept the insurance company’s decision. Thankfully he sought our help and thankfully, we were able to provide him the justice that he so rightfully deserves.