Chuck A is 61 years old and was a freight truck driver for a large international shipping company, where he worked for 23 years until the spring of 2017, when he was forced to stop working due to the debilitating effects of severe intractable pain of the neck, back, arms, and legs resulting from a host of conditions including trigeminal nerve paresthesia, cervical spondylosis, multiple lumbar spondylosis, lumbar radiculopathy, arthritis, COPD, chronic pain syndrome, post-laminectomy syndrome of the lumbar and cervical regions, lumbar neuritis, arthropathy of the knee, and lumbar stenosis with neurogenic claudication. Despite several surgeries to the lumbar and surgical spine, Chuck has been unable to obtain meaningful relief of his severe, debilitating pain.
When Chuck was forced to stop working, he applied for long term disability (LTD) benefits through his employer’s disability plan, which is administered by Aetna. Under the terms of the plan, Chuck was entitled to receive LTD benefits for up to 12 months if he was unable to perform the material duties of his own occupation. Because Chuck’s medical conditions prevented him from working in his own occupation as a freight truck driver, Aetna awarded him LTD benefits, which it paid until October of 2018.
However, the terms of his employer’s disability plan dictate that after 12 months of receiving LTD benefits, Chuck was only entitled to continue receiving benefits if he could prove that he was disabled from performing any gainful occupation for which he “is, or may reasonably become qualified based on education, training, or experience” and was unable to earn 60% or more of his pre-disability earnings. As a result, Aetna terminated Chuck’s benefits after 12 months, based on a vocational review that concluded that he was able to perform certain other occupations for which he was qualified by his education and experience.
This transition from an “own occupation” to an “any occupation” definition of disability after an initial 12-24 month period of paying benefits is common in employer-sponsored LTD plans. Like Chuck, many claimants see their benefits terminated when this change in definition takes place. It can be very difficult to prove that a disability prevents a claimant from working in any occupation.
Fortunately, Chuck contacted O’Ryan Law firm to assist him in appealing Aetna’s termination of his benefits. By the time Chuck contacted us, there was just under a month before the 180 day deadline to file his appeal. We requested a 90 day extension of time to file the appeal, but Aetna denied it. In the next few weeks, we gathered as much information as possible to support Chuck’s claim, and were able to compile and submit an appeal to Aetna that was so thorough and compelling that Aetna approved the appeal and reinstated Chuck’s benefits less than three weeks later.
If your long term disability benefits have been terminated because an insurance company claims you aren’t disabled under an “any occupation” standard, call O’Ryan Law Firm for a free consultation.