At Dabdoub Law Firm, we recently represented a client who sought disability income benefits under a policy provided by MassMutual Life Insurance Company. We took the initiative to draft a formal letter to MassMutual Insurance outlining our intent to contest their denial of our client's claim.
While our client has every right to pursue legal action, we've decided to give MassMutual the opportunity to review its eligibility for residual disability benefits accurately and impartially. Our appeal to MassMutual kicked off with a clear explanation of our client’s specific profession to avoid potential litigation. We strongly believe that if MassMutual fails to approve and pay our client's claim after thoroughly reviewing this information, we will have no choice but to proceed with legal action.
Unraveling Misunderstandings Surrounding Our Client's Job Requirements
In an unusual turn of events, MassMutual did not dispute that our client has medical restrictions and limitations preventing him from practicing as an emergency room physician. They concurred that our client could no longer safely engage in that profession due to his medical condition.
However, it seems MassMutual denied our client's benefits based on a misunderstanding about his unique professional status.
They incorrectly assumed that our client was involved in three separate professions before becoming disabled:
- Emergency Medicine Physician;
- Chief Medical Officer;
- Owner, Administrator, Supervisor, Operator of Veritas Medical Professionals – an emergency room physician staffing company.
MassMutual's medical reviewer, Dr. John Holbrook, MA, MD, FACEP, confirmed that our client is unable to work as an ER physician due to his health condition. According to Dr. Holbrook, our client's impairment precludes the practice of emergency room medicine.
Evidence Acknowledging the Permanence of Our Client's Disability
Dr. Holbrook also agreed that our client's disability is permanent and that his “condition is not expected to improve in the foreseeable future.” These medical opinions were formed based on a comprehensive review of all medical records and a detailed discussion with our client's treating physician.
Our client was diagnosed with De Quervan’s Tenosynovitis. An MRI scan of both his wrists provided objective medical evidence, showing tendon, fibrocartilage, and ligament tears, osteoarthritis, osteophyte formation, and tenosynovitis. Despite undergoing surgery in the hopes of recovery, our client experienced no relief from his symptoms. His physician, Dr. Huebner, placed several restrictions on our client due to these diagnoses and lack of improvement post-surgery.
These included:
- Inability to lift more than 3 pounds without pain;
- Severe wrist pain with any repetitive motion;
- Ability to handle objects for less than 2.5 hours per day;
- Limited ability to push/pull, less than five minutes daily.
Practicing emergency medicine was integral to our client's occupation from the outset until he had to relinquish it. Losing this capacity resulted in our client's inability to perform his contractual duties (providing patient care in the emergency room) as a chief medical officer and owner-operator.
It's clear that our client didn't suddenly choose to abandon his role in the ER or forsake the substantial income from his profession, for which he spent over a decade training. MassMutual agreed that he could no longer safely see patients in the ER, affirming that his medical disability is the sole cause for his career coming to an abrupt halt.
Help from a Lawyer with Expertise in Disability Insurance
Disability insurance law is complex. Hiring an experienced disability attorney is important. Because all disability lawyers at this law firm focus on disability insurance claims, we proudly offer significant expertise in disability insurance law.
The Dabdoub Law Firm has:
- Experience with every major disability insurance company;
- A proventrack record of success by winning major disability lawsuits; and
- Recovered millions of dollars in disability benefits for clients.
We never charge fees or costs unless our clients get paid. Our firm can help at any stage of your disability insurance claim, including:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; and/or
- Filing a lawsuit against your disability insurance company.
Because federal law applies to most disability insurance claims, our lawyers are able to represent clients across the country.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Consultations are free.
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