Standard Insurance denied a disability claim of a lawyer who had a highly successful legal career, despite becoming a paraplegic at a young age as the result of an injury. He achieved partnership level and attained national recognition from his peers – not easy for an able-bodied person to do.
In addition to the paraplegia, he suffers from many additional medical problems, some of which are directly related to his paraplegia and others that are not. After undergoing a total shoulder replacement in July 2011, he was unable to return to work.
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The surgery did not go well, and he needed long-term in-home rehabilitation immediately following the shoulder replacement, hospitalization for a life-threatening infection, and hospitalization for neurocardiogenic syncope episodes, where he loses consciousness as the result of significantly reduced blood circulation in the brain.
When his condition deteriorated to the point where he was simply no longer able to perform the duties of his profession, he filed a claim for disability insurance benefits. Standard Insurance’s callous response was that nothing about his condition had changed so there was no need for him to stop working.
Two doctors, an internist and an orthopedist, were assigned to conduct a paper review of his condition. The internist reviewed a total of eight office visit notes from a cardiologist, infectious disease doctor and a hematologist. An orthopedist received an equally limited number of office notes. Both doctors received incomplete medical records and were asked to make a decision on his condition, even though neither doctor had an opportunity to review all of our client’s medical records. More than 2,600 pages of medical records were completely and deliberately ignored. An in-person medical exam was never conducted.
We worked closely with our client and his medical providers to establish how his treatments and medications impacted his ability to function at his profession. We made sure to carefully detail how his change of condition and side effects from his treatment left him unable to work, even on a part time basis. Our aggressive representation and highly detailed medical reports offered the necessary insight into the many functional deficits that he faced.
Our appeal of his disability denial was successful, and he is now on claim and has received the benefits that had been denied.
Many of our clients were hard working and dedicated professionals who did everything they could to continue to work. If you have been working despite your disability, but can no longer perform the duties of your profession, give our office a call to learn how we can help you protect yourself and your family.
Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.
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