What to Know:
- A former medical assistant was diagnosed with multiple debilitating conditions including chronic fatigue, tremors, and fibromyalgia.
- After initially approving LTD benefits, Hartford terminated her claim, alleging she could return to work.
- A comprehensive Functional Capacity Evaluation (FCE) and strong provider support confirmed she is unable to work in any occupation.
- Dabdoub Law Firm focuses exclusively on disability insurance claims and helps professionals nationwide win their cases.
Former Medical Assistant Appeals Disability Benefit Termination
A woman in Florida who worked as a medical assistant was forced to stop working due to a long list of serious medical conditions. While her long term disability claim was initially approved by Hartford Life and Accident Insurance Company, her benefits were later terminated when the insurer claimed she could return to work in “any occupation.”
The claimant filed an appeal challenging this determination and submitted extensive medical and non-medical evidence proving her continued disability.
Diagnosed with Multiple Disabling Conditions
The claimant’s health rapidly declined following a spinal cord stimulator removal that led to a spinal infection, along with a subsequent COVID-19 diagnosis and chronic Epstein-Barr virus. She was already experiencing tremors and fatigue, but her condition worsened significantly afterward.
Her diagnoses include:
- Chronic fatigue syndrome and fibromyalgia
- Tremors and muscle weakness
- Hypothyroidism
- Vertigo, dizziness, and hearing loss
- Degenerative disc disease and arthritis
- Suspected inflammatory spondyloarthropathy
Despite ongoing treatment, the medical evidence confirms remains unable to engage in full-time or part-time employment.
Objective Testing Confirms Disability
To support her LTD appeal, the claimant underwent a two-day Functional Capacity Evaluation (FCE) administered by a licensed physical therapist. The results were then reviewed and validated by an independent occupational therapist.
Key findings included:
- She did not meet the minimum functional level necessary for even sedentary work
- She was unable to sit for more than one-third of a typical workday
- The evaluation was deemed valid and consistent with her reported symptoms and medical records
After reviewing the FCE findings, her primary care provider confirmed the testing represented her patient’s functional limitations and further confirmed that she e is unable to sustain full-time employment in any capacity.
Imaging and Diagnostics Support Functional Limitations
The appeal also included years of imaging results and diagnostic tests, such as:
- MRI findings showing degenerative disc disease in the cervical, thoracic, and lumbar spine
- EMG studies indicating chronic radiculopathy
- CT scans and ultrasounds confirming arthritis, vascular irregularities, and joint deterioration
These objective records align with her reported pain, weakness, and inability to perform physical tasks consistently.
Personal Statements Corroborate Limitations
The claimant submitted statements from individuals close to her, including a friend and a sibling who assist her with daily tasks. They described:
- Tremors impacting her coordination and dexterity
- Debilitating pain requiring physical assistance for basic movements
- Significant dizziness and weakness following head tremors
These firsthand accounts help illustrate the daily impact of her medical conditions and corroborate the reported restrictions and limitations further supporting her inability to work.
Hartford’s Reversal Lacked Justification
The long term disability appeal strongly contested Hartford’s termination of benefits, which relied heavily on its own internal physician review. Notably, even Hartford’s reviewing doctor acknowledged the claimant’s serious chronic conditions and lack of improvement, yet still concluded she had no restrictions on work hours.
This contradiction, along with Hartford’s failure to properly weigh the FCE and treating provider opinions, formed the basis of the appeal.
A Clear Case for Reinstating LTD Benefits
This appeal presents compelling evidence includingmedical records, imaging, provider support, personal statements, and validated functional testingthat the claimant remains disabled under the terms of the LTD policy. There is no doubt she is unable to perform any occupation, let alone her prior role as a medical assistant. Given the weight of the evidence, it is clear she was entitled to ongoing LTD benefits.
Let Us Help With Your Disability Insurance Claim
At Dabdoub Law Firm, we focus exclusively on disability insurance cases. Whether you need help with:
- Filing a new claim for long-term disability
- Appealing a denial or termination of benefits
- Negotiating a lump-sum settlement
- Litigating your case in court
We have the experience, the results, and the national reach to help.
Call for a free consultation with a disability insurance attorney. No fees or costs unless we win.