LINA Approves LTD Claim after Client Seeks Legal Assistance

A Client Billing Associate ceased work when she could no longer perform the material duties of her job as a result of her disabling medical conditions, including lumbar post laminectomy syndrome, neuropathic pain, neuroforaminal encroachment at the L5-S1 vertebrae, among others. She applied for short term disability (“STD”) benefits which were approved by Life Insurance Company of North America (“LINA”).

Just prior to exhausting her STD benefits, the Associate applied for long-term disability (“LTD”) benefits. LINA determined that she did meet the LTD Policy’s definition of disability and approved her claim.

Just four (4) short months later, LINA terminated the Associate’s LTD benefits stating she no longer met the definition of disability under the Policy. LINA terminated her claim because her treatment provider was in surgery at the time the nurse case manager called to obtain activity restrictions and because the provider failed to provide a response to LINA’s request letter within six days. LINA’s termination ignored the medical evidence which revealed that her symptoms increased since the date it originally approved her benefits. It also ignored the fact that the Associate had to undergo another surgery as a result of the increase in her symptoms.

Without knowing the importance of the internal appeal, the Associate appealed the termination of her benefits without legal counsel. LINA then upheld their original decision. The associate submitted a second appeal, providing additional medical documentation in support of her disability claim. Again, LINA upheld its adverse benefit determination. LINA ignored all documentation and information from the associate, her treating medical providers, and others showing she was incapable of performing the material duties of her occupation.

After exhausting her appeals, the Associate contacted the disability attorneys at McDermott Law, LLC. A lawsuit was filed on her behalf, which claimed that the termination of benefits was not substantially justified, was arbitrary and capricious, was unsupported by substantial evidence, constituted abuse of any discretion allowed, and was wrongful under all circumstances.

McDermott Law, LLC was able to negotiate a resolution of the claim prior to briefing her case.

If you have been unsuccessful in submitting your own appeals, let an experienced Denver disability lawyer at McDermott Law, LLC help get you the benefits you deserve in the litigation process.

Call (303) 964-1800 or Email McDermott Law, LLC
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