Our client from Chicago, IL, was a successful engineer. In spring 2018, doctors discovered a herniated disc in her cervical spine, and she underwent surgery. She returned to work on a “modified work from home” scheduled in November 2018. However, the procedure did not provide enough pain relief and she received additional treatments, including injections, physical therapy, and prescription medications.
As her pain continued to worsen, our client spent her last day at the office in late January 2021. She submitted a short-term disability (STD) claim with Sun Life Assurance Company of Canada (Sun Life). In the meantime, she used her sick pay and PTO as an income source and worked on an “as-needed basis.” In March 2021, her PTO and sick leave ran out and her employer offered to pay her hourly while her STD claim was still pending.
Our client had to stop working completely in July 2021. Sun Life only approved her STD benefits in September 2021, effective through March 2022. Since her condition had not improved, she submitted a claim for long-term disability (LTD) benefits in September 2021.
In December 2021, Sun Life extended her STD benefits for the maximum period, through late April 2022. The insurance company acknowledged her physical pain and cognitive impairment.
In March 2022, Sun Life unexpectedly terminated our client’s STD benefits, based on a wrongful claim from a consulting nurse that considered our client’s condition did not prevent her from working. Shocked by this unfair turn of events, this engineer from Chicago reached out to Dabdoub Law Firm to help her appeal the termination.
Our Client Submitted Extensive Medical Evidence of Her Disability
Medical records demonstrate that, despite targeted a C6/7 discectomy and arthroplasty with neurosurgeons in May 2018, our client continued to experience severe chronic pain. Even medications and follow-up treatments did not alleviate her issues. She reported aggravating symptoms to her primary care physician during November 2018, February 2019, and May 2019 visits. She experienced flare-ups if she missed one dose of her prescription painkillers.
A CT myelogram of her cervical spine in June 2019 showed multilevel mild degenerative changes in her cervical spine. This medical imaging appointment resulted in a spinal headache that required a trip to the ER a few days later.
After ineffective conservative therapies, our client underwent an epidural blood patch. In January 2021, she received a cervical epidural steroid injection (CESI). However, those treatments did not improve her pain or cognitive issues.
Her treating physicians provided disability claim statements and short-term disability medical updates to confirm our client’s lasting disability in 2021.
Our client supported her appeal with additional evidence, including:
- A Functional Capacity Evaluation (FCE) that concluded she was unable to work full-time due to her inability to stand and walk
- An Independent Medical Examination with a physiatrist that concluded that her “chronic pain issues as a result of chronic right C7 radiculopathy, chronic pain regimen, continue as a primary barrier towards workability”
- A Peer Review report with a board-certified interventional pain medicine physician that concluded that “given the severity of [her] injuries surgical history, and debilitating side effects it is unlikely that she would be able to retain any type of gainful employment”
How much more medical evidence does Sun Life need to acknowledge our client’s disability and restore her STD benefits and approve her LTD claim?
Sun Life Had No Valid Reason to Terminate Our Client’s STD Benefits
The Employee Retirement Income Security Act of 1974 (ERISA) mandates all insurance providers to act in the best interests of the participants and beneficiaries. However, Sun Life breached its fiduciary duty when it disregarded the overwhelming evidence of our client’s disability that qualified her for STD and LTD benefits.
It used incomplete information and took it out of context to avoid paying the benefits it owed her, such as her continuing work on an “as-needed basis” when she tried to keep her finances afloat while Sun Life took forever to review her STD claim.
It misused piecemeal statements by her treating physicians to falsely demonstrate that she could continue full-time employment. It also used the same medical reports to approve and terminate her benefits, uncaring that it made no sense.
Dabdoub Law Firm thankfully managed to obtain a different decision from Sun Life. The insurance provider restored our client’s STD benefits and approved her LTD claim in the fall of 2022.
Disability Insurance Companies Have Lawyers. Shouldn’t You?
We created Dabdoub Law Firm to focus on disability insurance and have developed expertise in this complex area of the law.
Our expertise in long-term disability claims means our clients have the backing of attorneys who:
- Are experts in disability claims;
- Fought all major disability insurance companies and know their tactics;
- Have a track record of success;
- Won major disability lawsuits that created good law; and
- Recovered millions of dollars in disability benefits.
All our lawyers commit every day of their legal career to helping people get disability benefits from Lincoln, Aetna, LifeMap Assurance Company, UNUM, Northwestern Mutual, CIGNA, and other insurance providers.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help. Our attorneys help clients nationwide.
Contact us today at (800) 969-0488 to get experienced disability lawyers on your side with:
- Submitting a disability insurance claim,
- Appealing a long-term disability denial,
- Negotiating a lump-sum settlement, or
- Filing a lawsuit against your disability insurance company.
Call Dabdoub Law Firm today at (800) 969-0488 or fill out our online form to schedule a free consultation with a disability attorney.
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