Our client last worked as a RN at a local hospital when she developed significant orthopedic problems following hip replacement surgery. She filed a claim for LTD benefits with the insurance company who provided group disability insurance through her employer, Oakwood Hospital. The insurer paid her disability claim for the first 24 months and then terminated her benefits claiming she was capable of working in a sedentary capacity.
After the insurer denied the administrative appeal filed by the firm, SMDA filed suit to compel the disability insurer to reinstate her LTD benefits. On the eve of the date the Court was to consider the party’s briefs the insurance company threw in the towel and voluntarily agreed to reinstate the client’s LTD benefits and pay the attorney fees incurred. This result is a clear lesson that it is critical that the administrative appeal be handled correctly as the administrative record in this case was overwhelmingly favorable to the client. The insurance company realized there was little chance of convincing the Court that it was correct in terminating her benefits.