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 grew to become disabled as a consequence of a mix 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, nervousness, delicate 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 based mostly on an “unbiased” peer overview by a doctor who claimed that our shopper may work with gentle restrictions. This conclusion blatantly ignored robust medical proof and testimony from our shopper’s treating physicians who clearly said that he was unable to work as a consequence of his close to fixed fatigue, mind fog, migraines, dizziness, and different signs.
The peer overview 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 Assessment Course of: We painstakingly uncovered the issues in MetLife’s reliance on a paper overview by a health care provider who had by no means examined our shopper. We emphasised the load and credibility of the treating physicians’ opinions, which had been based mostly on years of constant care.
- Demonstrating Subjective Signs: We emphasised the significance of our shopper’s subjective signs—resembling fatigue, mind fog, and dizziness—and the impression they’d on his capability 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 latest approval for Social Safety Incapacity Insurance coverage (SSDI) additional validated his incapability to work. We ensured that MetLife didn’t ignore this vital proof.
Confronted with a compelling enchantment that uncovered their errors and ERISA violations, MetLife reversed its choice and reinstated our shopper’s advantages. This victory ensured that he may give attention to managing his well being with out the added stress of monetary 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 should combat 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 at present at (888) 321-8131 or fill out our on-line contact type for a free case analysis.
