On the Ortiz Legislation Agency, we perceive how devastating it may be to face a denial of long-term incapacity (LTD) advantages if you’re already battling vital well being challenges. Certainly one of our current instances is a testomony to our unwavering dedication to serving to purchasers safe the advantages they deserve.
The Problem
Our consumer, a former information administrator, turned disabled because of a mix of significant well being situations, together with myelofibrosis, PTSD, hypothyroidism, diabetes, main depressive dysfunction, reminiscence modifications, and adjustment dysfunction with anxiousness. Though Lincoln Nationwide Life Insurance coverage Firm initially permitted her LTD declare, it later ordered two peer assessment stories of her file.
Observe: A “peer assessment” in a long run incapacity declare is when an insurance coverage firm hires a physician or different medical skilled to assessment the claimant’s medical data and supply an “unbiased” opinion on the severity of the claimant’s incapacity and whether or not they’re eligible for advantages. A peer assessment report is commonly used to disclaim a declare based mostly on the reviewing supplier’s evaluation. Basically, it’s a second medical opinion from a physician indirectly concerned within the claimant’s care.
The primary reviewer, a consulting psychiatrist, opined that the accessible medical proof didn’t help a functionally impairing situation. The second reviewer, a medical physician, opined that the medical data purportedly didn’t help any restrictions or limitations.
Based mostly on these stories Lincoln concluded that the proof didn’t help her continued incapacity and terminated her advantages.
Our Technique
We refused to let this resolution to terminate advantages stand. We ready a complete enchantment, full with:
- Up to date medical data that clearly defined her ongoing limitations and restrictions.
- Residual Useful Capability (RFC) types from her treating physicians, confirming her lack of ability to work.
- Private statements from family members who witness her each day struggles firsthand.
- A reminder to Lincoln that Social Safety had already discovered her disabled, and that ignoring the opinions of treating physicians is a technique the courts don’t look kindly upon.
The Consequence
Lincoln Nationwide Life Insurance coverage Firm reversed its denial shortly after receiving our enchantment, with out even resorting to a peer assessment. They not solely reinstated her advantages but in addition discovered her disabled below the stricter “any occupation” definition—a significant victory for our consumer.
We Can Assist You By the LTD Appeals Course of
In case your long-term incapacity advantages have been wrongly denied or terminated, don’t face the insurance coverage firm alone. When the insurance coverage firm says no, we are saying combat again. Name us at the moment at (888) 321-8131 for a free session and allow us to provide help to get the advantages you deserve.
