On the Ortiz Legislation Agency, we not too long ago had the privilege of serving to a shopper who had been unfairly denied his long-term incapacity (LTD) advantages. Our shopper turned disabled resulting from a mixture of debilitating medical circumstances, together with lengthy COVID syndrome with shortness of breath and dizziness, persistent fatigue syndrome, persistent migraines, dyspnea on exertion, cervical radiculopathy, anxiousness, gentle obsessive-compulsive dysfunction, sleep apnea, and mind fog.
His insurance coverage firm, MetLife, denied his declare when the definition of incapacity modified from the lack to carry out his “personal occupation” to the lack to carry out “any occupation.” The denial was primarily based on an “impartial” peer assessment by a doctor who claimed that our shopper may work with mild restrictions. This conclusion blatantly ignored sturdy medical proof and testimony from our shopper’s treating physicians who clearly acknowledged that he was unable to work resulting from his close to fixed fatigue, mind fog, migraines, dizziness, and different signs.
The peer assessment doctor dismissed these statements as “extreme,” undermining the credibility of the very medical doctors who know our shopper finest. That’s when our shopper turned to us for assist.
How We Fought Again
We knew this case required a strategic strategy to carry MetLife accountable underneath ERISA (the Worker Retirement Revenue Safety Act). Right here’s how we fought for our shopper:
- Exposing Flaws within the Evaluate Course of: We painstakingly uncovered the failings in MetLife’s reliance on a paper assessment by a physician who had by no means examined our shopper. We emphasised the load and credibility of the treating physicians’ opinions, which had been primarily based on years of constant care.
- Demonstrating Subjective Signs: We emphasised the significance of our shopper’s subjective signs—corresponding to fatigue, mind fog, and dizziness—and the impression that they had on his means to work. Subjective signs can’t be ignored, particularly when supported by medical proof and constant remedy data.
- Pointing to SSDI Approval: Our shopper’s current approval for Social Safety Incapacity Insurance coverage (SSDI) additional validated his lack of ability to work. We ensured that MetLife didn’t ignore this essential proof.
Confronted with a compelling enchantment that uncovered their errors and ERISA violations, MetLife reversed its determination and reinstated our shopper’s advantages. This victory ensured that he may deal with managing his well being with out the added stress of economic uncertainty.
Want Assist with a Denied Lengthy-Time period Incapacity Declare?
In case your long-term incapacity advantages have been unfairly denied, you don’t must battle the insurance coverage firm alone. On the Ortiz Legislation Agency, we concentrate on serving to individuals such as you get the advantages you rightfully deserve. Name us right this moment at (888) 321-8131 or fill out our on-line contact kind for a free case analysis.
