Newfield Law Group recently secured the appeal of a disability insurance claim termination for a client who retained the firm following the termination of the claim. The evidence submitted in support of our client’s claim demonstrated that, as a result of TMJ or TMD (temporomandibular disorder), autonomic dysfunction/dysautonomia; POTS (Postural orthostatic tachycardia syndrome), chronic pain, and the resulting sequalae of these conditions and the resulting impact upon her cognitive and physical functionality supported ongoing impairment, and the overturn of our client’s disability insurance claim.
Our client had a complicated medical history, all of which culminated in her current disability. Her numerous medical conditions significantly impacted on her quality of life and prevented her from returning to the work that she loves.
After a short period of claim acceptance, her claim was suddenly terminated. She was engaged in rigorous efforts to overcome her illnesses and had hoped to return to work but despite all her efforts, simply was not able to return to work.
Having filing her claim on her own, and having initial success, her claim then was terminated. She engaged Newfield Law Group following the termination of her claim, which had occurred after being paid for several months, and despite having not made improvements in her functionality.
Her work, for McKinsey and Company, as a Consultant -Expert Associate Partner, was high level and demanding. With our appeal, we successfully argued that McKinsey was akin to working at an Ivy League school and that the significance of the work must be properly contextualized and considered, as our client was dealing with C Suite levels.
We successfully argued that instead of acting as a fiduciary and in her best interest, the insurance company erroneously and improperly:
(1) relied upon selective portions of medical records to the exclusion of more persuasive information,
(2) failed to undertake an appropriate investigation, relying upon biased and result-oriented paper reviews of the evidence performed by its in-house medical and vocational staff,
(3) failed to appropriately consider the demanding occupational requirements in evaluating her ability to perform her occupation,
(4) failed to perform a true and proper vocational analysis – instead relying upon generic classifications of physical/cognitive requirements,
(5) otherwise failed to afford our client a “full and fair” review of her claim due to its financial conflict of interest.
These numerous procedural irregularities and indicia of claim bias powerfully supported our arguments that the claim determination was arbitrary and capricious and was predicated upon a pre-determined result.
To succeed with her appeal, we attacked policy language which was silent on defining regular occupation – and were able to shape the issues favorably to ensure proper consideration of the vocational issues and occupationally relevant tasks and duties.
Newfield Law Group secured a medical expert review and secured powerful support from a cadre of treating medical providers, who addressed her functionality from a physical, cognitive, and emotional standpoint, and focused on her ability or inability to engage in her high level work and the demanding nature of her deliverables.
Our support addressed her issues of fatigue and pain, often difficult to document, and her other symptoms which contributed to her impairments. We provided medical literature that supported more than just the nature of her conditions, but also supportive medical literature addressing the expected functional impacts upon someone suffering from her conditions – to support HOW and WHY she was not able to perform her work.
Some of that literature powerfully explained the nexus between chronic pain and concentration and how this impact would prevent our client from engaging in her work on any regular, predictable, or sustainable manner, rendering her disabled under her policy.
We supplemented the medical and vocational support with powerful legal arguments and proof of how the insurer’s conflict of interest served to influence the claim handling and relying upon corporate earnings reports and press releases to further these arguments. Once the appeal was submitted, we provided a supplemental submission with an additional recently decided legal case that we argued was further proof of our client’s continued benefits. Shortly thereafter, we secured the appeal decision and an overturn of the claim termination.