Author: Charles F. Fuller
When a client comes to our office with a long term disability issue, we analyze the client’s case and take action that is needed to protect the client’s rights. Our representation is tailored to the client’s specific needs.
Recently, a client I will call John came to our office. He had been on and off long term disability several times over the past half dozen years due to ongoing back problems. He had had multiple back surgeries by the time he came to our office and was unable to do much of anything at all, physically. When John came to us, his disability benefits had been terminated. He had prepared and submitted his own administrative appeal to the disability insurance carrier, and it had been denied. Further, he had asked the disability insurance carrier to reconsider his appeal, and they denied that as well. The long term disability policy had a very short, one-year statute of limitations provision which was quickly approaching. In reviewing John’s case, it was apparent that John did not provide sufficient medical documentation to support his claim for ongoing disability benefits. John knew how terrible he felt and could not physically return to his job because he was unable to do much of anything other than rest throughout the day. The disability carrier took a different view. John contacted our office and we met with John and his wife. He brought in some medical records and claim documents which were reviewed. It was apparent that substantial information and documentation was needed to pursue his case.
It was going to take some time to obtain John’s complete medical records. Since the statute of limitations was nearing, we prepared a complaint prior to the expiration of the statute of limitations and filed it with the United States District Court for the District of Maryland. We continued to seek out John’s medical records. After obtaining all of the records, reviewing and summarizing them, we reached out to John’s doctors and obtained detailed reports as to his specific physical limitations, the reasons why he was physically restricted and their opinions as to why John could not return to his regular occupation or any other occupation. We prepared a supplemental appeal and submitted this to the disability insurance carrier. After many months, the disability insurance carrier wrote to us and advised that it was refusing to consider the supplemental appeal. It was the disability carrier’s position that John had exhausted his administrative appeal rights and they did not have to further consider his appeal. Based upon the disability carrier’s position, we filed an amended complaint to bring all of this information before the court, including the supplemental appeal with the very supportive medical evidence demonstrating John’s disability.
In the early stages of the litigation, we advised the court that we thought it would be appropriate to have the case remanded, or sent back down, to the disability insurance carrier for its consideration of John’s supplemental appeal. The disability carrier refused to voluntarily undertake this review. We filed a motion to remand the claim back to the disability carrier, asking the court to order it to review John’s supplemental appeal. The disability carrier opposed that motion and also filed a motion for summary judgment, contending that as a matter of law, the court must uphold the carrier’s decision. We vigorously opposed this action taken by the disability carrier. Ultimately, the court ordered the disability carrier to review the supplemental appeal and denied its motion for summary judgment. Subsequently, the disability carrier upheld John’s supplemental appeal and restored his benefits.
The above situation is the reason why it is very important to have competent legal counsel representing you should you have a long term disability claim. Although you know how you feel and that you cannot perform your job duties as a result, that is often not enough to successfully obtain benefits. The federal statute governing such claims, the Employee Retirement Income Security Act of 1974, as amended, (ERISA), is a very technical statute, and knowledge of that statute and its procedural roadblocks is important. Having an attorney both knowledgeable and experienced handling ERISA claims is often essential in such cases. We would be happy to speak with you about your claim.