O’Ryan Law Firm recently filed an appeal for Long Term Disability benefits against Liberty Life Assurance Company of Boston (Liberty Mutual) for wrongfully denying a participant’s benefits. The client was a long time employee of a large financial institution and was forced to stop working due to coronary artery disease, hypertension, diabetes, and ischemic cardiomyopathy. The client underwent a coronary bypass in 2010 and had a dual-chamber cardioverter defibrillator implanted in 2015. He suffers from shortness of breath, fatigue, chest pain, and experiences confusion. The high level of stress with the client’s occupation exacerbated the symptoms correlated to his illness. This stress exposed him to a possibility of a severe cardiac event or even death.
Despite the client’s treating physicians providing objective medical proof that he was unable to continue working full time due to his condition, Liberty Mutual hired a contracted physician to review his claim file. The hired contracted physician contended the client could perform a Sedentary occupation on a full time basis. In addition, the hired contracted physician erroneously claimed the client’s treating physician could perform a Sedentary occupation on a full time basis. When in fact, the treating physician never released the client to return to work full time.
Liberty Mutual originally approved the short term disability claim in full, but then turned around and denied his long term disability benefits based on the hired contracted physician review. In an attempt to solidify the client’s denial, Liberty Mutual hired a private investigator to perform surveillance. The private investigator failed to observe any real activity for four entire days, which was consistent with the client’s limitations. Liberty Mutual cited the following definition of “Disability” within the long term disability denial letter:
“Disability” or “Disabled” means:
- that during the Elimination Period and the next 24 months of Disability the Covered Person, as a result of Injury or Sickness, is unable to perform the Material and Substantial Duties of his Own Occupation; and
thereafter, the Covered Person is unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation.
“Own Occupation” means the Covered Person’s occupation that he was performing when his Disability or Partial Disability began. For the purposes of determining Disability under this policy, liberty will consider the Covered Person’s occupation as it is normally performed in the local economy.”
“Partial Disability” or “Partially Disabled” means the Covered Person, as a result of Injury or Sickness, is able to:
1. perform one or more, but not all, of the Material and Substantial Duties of his Own Occupation or Any Occupation on an Active Employment or a part-time basis; or
- perform all of the Material and Substantial Duties of his Own Occupation or Any Occupation on a part-time basis; and
- earn between 20.00% and 80.00% of his Basic Monthly Earnings.
Since the client was released to work up to 12 hours by his treating physicians and he was still a part-time employee with his company, O’Ryan Law Firm submitted a Partial Disability Appeal on his behalf. Our office submitted the appeal on April 3, 2017 and Liberty Mutual’s decision to deny our client’s benefits was overturned on May 31, 2017. O’Ryan Law Firm was successful on appeal without the need to pursue litigation. We are currently managing this claim on a month to month basis on behalf of the client.