McDermott Law is pleased to announce another success on behalf of a client whose ERISA long-term disability (LTD) and waiver of life insurancepremium (LWOP) denials have now been overturned by First Reliance Standard Life Insurance Company. Our client suffered from several conditions as a result of Interstitial Lung Disease, requiring a bilateral lung transplant.
Despite the fact that First Reliance Standard had approved Mr. H for long-term disability, the insurance company terminated his benefits claiming he was no longer disabled. First Reliance Standard based its determination on medical reviews by one of its in-house nurse case managers who, as is typical, had never seen nor examined Mr. H. It used language we routinely see in denial letters. Specifically, it faulted Mr. H’s medical records with not including objective exam findings that demonstrate how his conditions would impair his ability to carry out his ability to perform a sedentary occupation. Our office has seen this exact same language in many other insurance denials. As is often the case, First Reliance Standard completely disregarded the opinion of our client’s treating physicians, instead relying on its own flawed evaluation.
Mr. H contacted our firm requesting assistance in filing the ERISA-required internal appeal of First Reliance’s adverse benefits determinations. We gathered the necessary evidence in support of his cliam which we believed demonstrated Mr. H’s obvious disability. In addition to making several compelling arguments on how First Reliance overlooked certain evidence—either mistakenly or perhaps intentionally—in terminating the LTD & LWOP benefits, we obtained a Functional Capacity Evaluation from a well-respected therapist to submit with the appeal and also provided supportive letters from Mr. H’s treating physicians. Following First Reliance Standard’s review of a thorough appeal submitted by our office, it determined the original decision to terminate benefits was wrong, and reinstated his long-term disability and life waiver of premium claims. He has now been provided all past due benefits and is currently receiving monthly payments on an ongoing basis. We will continue to manage his claim moving forward.
We have seen many, many legitimate claims terminated by disability insurance companies even though that same insurer agreed the person had been disabled for years. Insurers such as First Reliance Standard, who are protected by the ERISA laws meant to have just the opposite effect, suffer no real consequence for denying claims, no matter how legitimate. Thus, the importance of hiring an experience attorney in this narrow area of the law cannot be understated.
If your long-term disability or life insurance claim is denied, please contact our office before submitting your own appeal. We typically provide a fee initial consultation.