Kirsti K was an Administrative Assistant for a large manufacturing company for several years until late 2016, when she was in a severe car accident in which a semi tractor-trailer ran a red light and struck her vehicle, ejecting her several feet from the vehicle onto the roadway. As a result of the accident, Kirsti suffered severe and debilitating injuries, including a broken wrist that required surgical repair.
Kirsti missed almost three full months of work after the accident and subsequent surgery, but was able to return to work late in 2016. However, upon returning to work, Kirsti struggled to maintain her previous levels of productivity. Over the next few months, she also began to develop increasingly severe lower back pain, a large lumbar hematoma, painful keloid scarring from her wrist surgery, and psychological impairments including depression, anxiety, and post-traumatic stress disorder (PTSD).
By May of 2017, Kirsti’s condition had deteriorated to the point that she was forced to once again leave work. She underwent numerous injections to treat her lower back pain, but experienced little meaningful relief. She also underwent extensive psychological counseling and therapy, in addition to physical therapy. Unfortunately, her conditions remained severe and continued to prevent her from returning to work.
When Kirsti stopped working in May of 2017, she filed a claim for long term disability (“LTD”) benefits under the Aetna Life Insurance Company (“Aetna”) LTD policy provided by her employer’s group benefits plan. However, despite acknowledging Kirsti’s conditions, Aetna denied her LTD claim, arguing that Kirsti’s conditions were not impairing her to the extent that she was unable to perform the material duties of her occupation.
Initially, Kirsti did not plan to appeal the denial of her LTD claim. However, when her attorneys for the personal injury case arising from her accident sent her for an independent medical evaluation, the evaluating physician concluded that she was unable to work and should be considered disabled. With only about a month remaining before her appeal was due, Kirsti contacted O’Ryan Law Firm to assist her with filing her appeal.
Although the deadline to file Kirsti’s appeal was fast-approaching, we obtained a copy of her claim file and gathered as much information as possible in order to strengthen her appeal before the deadline. We submitted her appeal, along with extensive supporting medical records, treating physicians’ statements, and a copy of the independent medical evaluator’s report, in addition to photos of Kirsti’s injuries.
After reviewing our appeal and the supporting documentation we had gathered and submitted, Aetna overturned its previous denial of Kirsti’s LTD claim and began paying her benefits, including full back benefits dating back to the date she first became eligible under the LTD policy. If you are disabled and have been denied benefits, please contact the O’Ryan Law Firm for a free consultation.
 According to the American Academy of Dermatology, a keloid scar is a type of raised scar that grows much larger than the original wound. Keloids can become painful and may decrease the ability to use the part of the body on which they form. See https://www.aad.org/public/diseases/bumps-and-growths/keloids.