On the Ortiz Regulation Agency, we perceive how devastating it may be to face a denial of long-term incapacity (LTD) advantages while you’re already battling important well being challenges. One in all our current circumstances is a testomony to our unwavering dedication to serving to shoppers safe the advantages they deserve.
The Problem
Our shopper, a former information administrator, turned disabled on account of a mix of great well being situations, together with myelofibrosis, PTSD, hypothyroidism, diabetes, main depressive dysfunction, reminiscence modifications, and adjustment dysfunction with anxiousness. Though Lincoln Nationwide Life Insurance coverage Firm initially authorised her LTD declare, it later ordered two peer evaluate studies of her file.
Observe: A “peer evaluate” in a long run incapacity declare is when an insurance coverage firm hires a health care provider or different medical skilled to evaluate the claimant’s medical information and supply an “impartial” opinion on the severity of the claimant’s incapacity and whether or not they’re eligible for advantages. A peer evaluate report is commonly used to disclaim a declare based mostly on the reviewing supplier’s evaluation. Basically, it’s a second medical opinion from a health care provider indirectly concerned within the claimant’s care.
The primary reviewer, a consulting psychiatrist, opined that the obtainable medical proof didn’t help a functionally impairing situation. The second reviewer, a medical physician, opined that the medical information purportedly didn’t help any restrictions or limitations.
Primarily based on these studies Lincoln concluded that the proof didn’t help her continued incapacity and terminated her advantages.
Our Technique
We refused to let this determination to terminate advantages stand. We ready a complete attraction, full with:
- Up to date medical information that clearly defined her ongoing limitations and restrictions.
- Residual Useful Capability (RFC) types from her treating physicians, confirming her lack of ability to work.
- Private statements from family members who witness her day by day struggles firsthand.
- A reminder to Lincoln that Social Safety had already discovered her disabled, and that ignoring the opinions of treating physicians is a technique the courts don’t look kindly upon.
The Outcome
Lincoln Nationwide Life Insurance coverage Firm reversed its denial shortly after receiving our attraction, with out even resorting to a peer evaluate. They not solely reinstated her advantages but additionally discovered her disabled below the stricter “any occupation” definition—a significant victory for our shopper.
We Can Assist You Via the LTD Appeals Course of
In case your long-term incapacity advantages have been wrongly denied or terminated, don’t face the insurance coverage firm alone. When the insurance coverage firm says no, we are saying combat again. Name us right this moment at (888) 321-8131 for a free session and allow us to aid you get the advantages you deserve.
