Our client, a 56-year old Registered Nurse at one of the top 25 ranked best hospitals in New York State, retained the services of our firm to fight for her wrongfully terminated disability claim – after Reliance Standard found her disabled for the past 5 years and paid her benefits.
Our client was diagnosed with multiple complex co-morbid conditions including but not limited to, chronic fatigue syndrome, fibromyalgia, chronic pain, osteoarthritis, diabetes mellitus type 2, hyperglycemia, hypertension, vitamin d deficiency, obstructive sleep apnea, obesity, shortness of breath, dyspnea, back pain, joint pain, muscle weakness, and cognitive deficits and numerous symptoms associated with each.
As a result of the complexity of her disability and impairments, her physicians and specialists advised her to stop working. Reliance found our client to be disabled over the course of the five-year “own occupation” definition of disability.
However, once her policy transitioned into the “any occupation” juncture, Reliance sought to find an opportunity, and thereafter, terminated her claim, despite NO change in her functionality.
She found our firm through a website search and as we always do, our firm took an aggressive and relentless approach against this large insurance company. Our robust appeal revealed Reliance’s biased approach in the handling of our client’s claim and its complete failure to properly consider the overwhelming evidence in her medical records which supported her ongoing disability and inability to work in any gainful occupation.
Through our evaluation of the file materials, our appeal focused upon Reliance’s multiple clinical reviews over the course of her claim, wherein its medical staff always found in favor of our client’s disability and inability to work – but Reliance avoided ANY consideration of these opinions over the course of several years.
Instead, in seeking to terminate the claim, Reliance only considered favorably one scant file review which only noted our client did not meet the change of definition at the any occupation date; and her claim would be closed based on a biased and inaccurate employability analysis.
Once we submitted our comprehensive appeal, Reliance retained the services of a well-known paid pro-insurer consulting physician who is known for providing IME reports in support of the insurance company who write their paycheck rather than in favor of the claimant.
There is typically very little that is independent about these examinations. However, in this case, this backfired on Reliance as its consulting IME physician found significant restrictions and limitations which were then reviewed by a vocational expert who opined there were significant vocational barriers pertaining to work function.
Despite this, Reliance somehow tried to skew the evidence to show that our client did not meet the definition of disability. Upon our review of the materials to prepare to file for litigation, we encountered numerous discrepancies in the materials. the conclusion did not match the evidence.
We immediately got Reliance to recognize the internal inconsistency, and that Reliance’s own employee found that our client was incapable of working in any gainful occupation.
Recognizing an inability to avoid liability, Reliance immediately reversed its decision and put our client back on claim. She was paid a lump sum in arrears and continues to receive her benefit check on a monthly basis from Reliance.