Mr. Z was employed by the public works department of a local municipality. Initially, his LTD insurer approved and paid his claim for LTD insurance benefits finding he was Totally Disabled. After paying benefits for 24 months, the Insurance Company denied Mr. Z’s claim “because there is no medical evidence substantiating the fact that you are unable to work in a sedentary occupation.” Mr. Z then hired SMDA.
SMDA prepared an administrative appeal confirming Mr. Z has been diagnosed with degenerative disc disease, L3-4 disc herniation impinging the Left L3 nerve root, L4-5 disc bulge with annular tear, L5-S1 diffuse disk bulge with annular tear to the left with impingement of the bilateral nerve roots. As a result, he had severe back pain on a daily basis. His back pain was aggravated by any physical activity. As a result of his medical condition and the severe and disabling back pain it caused he was unable to sit or stand for any period of time. As a result, he was unable to perform the material duties of any occupation, which involve sitting, standing, walking, lifting or carrying. Mr. Z was also approved for Social Security Disability benefits.
SMDA was recently able to reach a pre-lawsuit settlement with Mr. Z’s LTD insurance carrier which included the resolution of all future benefits. In other words, the insurance company paid a significant sum of money for both Mr. Z’s past due benefits and his future benefits. This type of settlement has numerous advantages, not the least of which is to terminate the need for the client to have any future contact with the LTD insurance company. The claim settled pre-suit in large part because the insurance company realized that it likely faced an adverse court decision due to the administrative appeal prepared by SMDA. If you have a claim for LTD benefits that has been recently denied give SMDA a call to see if we can help.