A major disability insurance company denied the ongoing long-term disability benefits of a 55-year-old formed assembly plant supervisor after conducting surveillance that found the individual was active for less than 3 hours over 3 separate days. The activity included driving to a fast-food restaurant and walking outside his house. He sought my assistance to appeal this denial.Working with the claimant, I obtained all of his updated medical records from his surgeons and pain management providers. The client had previously undergone 2 separate back surgeries, including a multi-level fusion, as well as a multi-level neck fusion. He also had hip replacement surgery. The client’s underlying condition was chronic degenerative disc and joint disease.I appealed the insurer’s decision which included a video interview of the client and his spouse to discuss the client’s pain, daily activities, and life changes. The video and appeal also addressed the surveillance video showing minimal activity, which the client explained was pretty much all he could do during the day.
Nevertheless, the insurer denied the administrative appeal. The client’s policy provided for a second administrative appeal, which the client chose to accept so that additional medical records could be included. However, this appeal was also denied.
I filed suit in Federal District Court in the Eastern District of Louisiana for the client. Eventually, I was able to negotiate a confidential settlement for my client. My client was extremely satisfied with the result.
