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Successful Internal Appeal of ERISA Long Term Disability Claim with Anthem

July 20, 2012

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We are pleased to announce yet another successful disabilty appeal. The appeal team at the Law Office of Shawn E. McDermott was successful in obtaining long term disability benefits for a client insured by Anthem Life and Disability Insurance Company. Ms. D. suffered from severe chronic neuropathic pain, degenerative disc disease, cervical and lumbar spondylosis, and severe sacroiliitis. After approving Ms. D. for short term disability benefits for six months, Anthem denied her long term disability benefits, claiming she could perform the duties of her own occupation and was therefore not disabled under its policy. In making its determination, Anthem ignored the support of Ms. D.’s treating physicians, and relied instead upon the opinion of an external reviewing physician who did not consider Ms. D.’s substantial pain complaints. Anthem Life, just like all other group disability insurance carriers, make a habit of ignoring the opinions of the physicians who know the patient best, and instead favor the opinions of paid physicians who have only performed a limited review of the insured’s medical records.

Ms. D. contacted our firm for assistance in preparing an ERISA long term disability appeal. We obtained several pieces of supporting evidence in support of Ms. D.’s disability, including, among other things, a functional capacity evaluation, and opinion letters from her treating physicians, demonstrating how the information Anthem had relied upon was flawed and incomplete. After putting this material into a coherent appeal and submitting it to Anthem, the adverse benefits determination was overturned and Ms. D. was granted long term disability benefits.

If you need assistance in submitting a thorough, well-prepared ERISA disability appeal, or require assistance with a claim under your private long term disability insurance policy, please fee free to contact our office for what is usually a free, initial review of your claim.

Categories: Disability, ERISA Claims, Insurance

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