Our client came to us to pursue an accelerated appeal of her terminated claim, which was not governed by ERISA, as she was employed by a governmental entity. She only had 60 days to file her appeal. With 45 days to get her appeal assembled, we engaged an expert to conduct an evaluation, in an effort to objectively document the impairments our client sustained.
As a Security Manager for Information, our formerly high functioning client became was disabled as a result of her co-morbid conditions, including but not limited to her history of lung cancer resulting in partial lobectomy and lymph node removal, her post-chemotherapy brain fog, chemotherapy induced peripheral neuropathy, fibromyalgia, headaches, chronic pain, and other problems associated with these conditions.
These numerous conditions resulted in physical challenges and neurocognitive difficulties in her ability to perform her high level occupation. Her myriad of symptoms and functional restrictions and limitations, prevented her from performing the material and substantial duties of her regular occupation or any occupation with reasonable continuity on a full-time sustained basis. Her claim was managed by Matrix, a third-party administrator used by Reliance Insurance to evaluate claims for Long Term Disability (LTD). In its effort to reduce liability, Matrix engaged in a myriad of problematic conduct, where it erroneously or improperly:
- Failed to undertake an appropriate investigation, relying upon biased paper reviews conducted by its in-house medical staff and paid consultants, who never met or examined the insured but merely performed paper reviews of the insured’s medical records;
- Relied upon selective portions of medical records to the exclusion of more persuasive information;
- Failed to conduct a true and proper employability analysis before claiming the insured had the functional ability to return to work;
- Ignored the insured’s medically supported subjective evidence of impairment;
- Failed to consider the insured’s treating physician’s opinions regarding chemotherapy induced conditions, most prominently cognitive dysfunction and functional restrictions and limitations associated with these conditions;
- Failed to have the insured examined in person by a neutral third-party examiner despite the opposing opinions between the insured’s treating physicians and Matrix’s biased staff;
- Cherry-picked information to support its predetermined goal; and
- Failed to act in good faith and fair dealing as a neutral fiduciary
The severity of our client’s condition was confirmed by Social Security, who awarded benefits to our client for her disability, which was also ignored by Matrix.
Success on the appeal was predicated upon developing additional support, medically and vocationally, to demonstrate ongoing and continued impairment. This was accomplished through neurocognitive testing – which revealed significant deficits across a wide swath of testing of memory, executive functioning, speed of processing and other domains, to support impairments that would translate and support the claim.
We were able to take the updated medical support developed, along with the prior medical evidence, to rebut Matrix’s medical review, and when our vocational support was developed, success was ensured.
Our client is now receiving disability benefits and her past due money.