We recently received notice that another administrative appeal of the denial of a client’s LTD claim has been successful.
When a claim for LTD benefits is denied, pursuant to the ERISA regulations the claimant must file an administrative appeal of the denial decision with the entity that denied the claim, usually an insurer. This is part of the requirement that the claimant exhaust their administrative remedies before suit can be filed.
In this claim, despite ongoing treatment our client continued to experience disabling Migraine headaches on a regular basis multiple times per week. When she experiences these headaches she is disabled from any activity. As a result of the ongoing headaches she experiences severe difficulty with focus and concentration. Her headaches are aggravated by routine physical activity. She also experience phonophobia and photophobia and nausea. As a result of her medical condition, the client has functional limitations related to any activity including sitting, standing, and routine computer usage.
The firm prepared a comprehensive administrative appeal that included medical records, treating doctors opinions, and medical journal articles as part of the successful appeal.
This case demonstrates the importance of a properly prepared administrative appeal, especially in light of difficult case-law in this circuit regarding medical conditions where there is no objective medical test available to verify the subjective complaints of pain.
If your claim for LTD benefits has been denied, please contact SMDA to see if we can help get your benefits reinstated.