Our client, a 52 year old with a long medical history, came to us to appeal the termination of his short term disability claim and the development of support for his long-term disability claim from New York Life. He had worked for Schlumberger, a global technology and energy company as a Maintenance Mechanic, an occupation that required significant levels of physicality.
Having a history of orthopedic problems and medical concerns, with objective diagnostic findings at multiple levels in his lumbar and thoracic spine, he was shocked that his claim had been terminated. We were not surprised, given the backdrop of these types of claims, New York Life in the disability claim arena, and the industry as a whole – with the current trends of increased denials and claim terminations.
We turned his frustration into action and developed powerful support from his Board Certified treating doctor, explored further testing to objectively document his functional deficits and impairments, and developed an array of collateral evidence and medical support through literature and materials.
We then submitted his appeal and provided the company with significant collateral support, including a host of personal statements from friends, co-workers, and family members, along with the statement of our client to provide additional support for the claim, and to corroborate the deficits in his functionality which were objectively documented through testing and other clinical evidence.
His statement was persuasive, and it identified what his day to day was like – extremely limited – and how activity exacerbated his difficulties. We articulated how medication would not allow him to think, and without medication, his pain was crippling. This double-edged sword was compelling and helped to demonstrate the nature and severity of his challenges and impairments.
This powerful collection of materials served to overcome the biased and typical review of a claim that we have been seeing most insurance companies develop. He recouped the payments due from the wrongful termination of his short-term claim and is now receiving long term disability benefits as per the terms of his group disability insurance policy. We continue to be his advocate on his claim, ensuring that no further efforts are made at terminating his claim.
Cynically, we know this will continue in the future, as the insurance companies are not penalized for this conduct. Newfield Law Group, with its formula for ERISA appeal success, is pleased to have been successful in securing benefits for our client and ensuring some level of security for him and his family.