What You Should Know:
- A Florida claimant suffering from chronic symptoms associated with Factor V Leiden and May-Thurner Syndrome had her long-term disability (LTD) benefits terminated despite no improvement in her condition.
- Extensive medical documentation, including an independent Functional Capacity Evaluation (FCE), confirmed she is unable to perform even sedentary work.
- Treating providers concluded she is permanently disabled and unable to return to any occupation.
- Dabdoub Law Firm focuses exclusively on disability insurance claims and has successfully handled appeals involving complex vascular and chronic conditions across the U.S.
Matrix Terminated Long Term Disability Benefits Without Justification
After acknowledging the severity of her condition and approving benefits in October 2024, the insurance administrator terminated our Florida client’s long term disability benefits less than six months later. This decision came despite clear, ongoing symptoms stemming from Factor V Leiden and May-Thurner Syndrome, two conditions known to cause debilitating vascular issues, including chronic pain, swelling, and a high risk of blood clots.
The claimant’s condition worsened following two complicated pregnancies, and she was left largely bedridden with pain and fatigue. Her treating physicians and independent specialists agreed: she could not safely perform the basic duties of any occupation.
Background: Vascular Disorders That Cause Lasting Damage
The claimant’s disability stems from two rare but serious medical conditions:
- Factor V Leiden: A genetic mutation that increases the risk of developing abnormal blood clots (thrombophilia), especially in the legs (DVT).
- May-Thurner Syndrome: A condition in which a major vein in the pelvis is compressed, restricting blood flow and increasing the risk of clotting and chronic venous insufficiency.
Following her most recent pregnancy, she experienced chronic left leg pain, swelling, and a significantly reduced ability to stand, walk, or sit upright for extended periods. Even with accommodations, such as working from home, she was unable to function in any consistent or sustainable manner.
Functional Capacity Evaluation Confirms Disability
To supplement the medical record, the claimant underwent a two-day Functional Capacity Evaluation (FCE). An FCE is widely recognized by courts as one of the most reliable ways to assess physical functionality in a disability claim. In fact, courts have called it the Gold Standard for proving functionality in a long term disability claim.
The FCE Results:
- Sitting: Limited to 20 minutes at a time (occasional)
- Standing: Limited to 5 minutes at a time (rare)
- Walking: Limited to 2 minutes at a time (rare)
- Conclusion: “Not capable of sedentary work due to high pain levels, poor endurance, and existing past medical history.”
The evaluation was validated with internal reliability testing, which confirmed that the claimant gave full and consistent effort. A second, independent occupational therapy expert also reviewed the FCE and determined that it was a valid and accurate representation of her true functional limits.
Additional Key Findings:
- She was unable to meet the minimum standards for even occasional physical demands.
- Her inability to maintain a functional upright seated posture beyond 2.5 hours per day means she is not eligible for sedentary work.
- Any type of work would require standing, sitting, or walking far beyond her limited capacity.
Treating Physicians Support Total Disability
The claimant’s treating OB/GYN and vascular specialist both confirmed she is permanently unable to return to work due to her ongoing medical condition. Their medical opinions were consistent with the results of the FCE and documented symptoms, which include:
- Chronic left leg pain
- Post-thrombotic syndrome
- Poor circulation and increased clotting risk
- Need for frequent rest and leg elevation
- Inability to tolerate prolonged sitting or standing
These assessments directly counter Matrix’s assertion that she could perform sedentary work with “occasional breaks.”
Matrix’s Termination of Long Term Disability Benefits Contradicts the Evidence
In its denial letter, Matrix acknowledged that the claimant had restrictions, specifically, “no prolonged sitting or standing.” Yet, it still concluded that she could return to work in a sedentary occupation. This decision is both logically inconsistent and medically unsupported.
By definition, sedentary work requires the ability to sit for 6 out of 8 hours a day: a capacity that this claimant clearly lacks. Matrix’s attempt to dismiss the objective evidence ignored medical facts, disregarded the conclusions of treating and evaluating professionals, and contradicted their own description of the claimant’s restrictions.
Objective Evidence Overlooked by Matrix
- Validated FCE documenting inability to meet minimum sitting standards
- Medical opinions from two treating providers
- Clinical diagnosis of post-thrombotic syndrome and chronic vascular impairment
- Patient testimony supported by letters from family and colleagues
A Clear-Cut Case of Ongoing Total Disability
The combination of vascular disease, complications from pregnancy, and permanent physical damage has rendered our client unable to return to any gainful occupation. She is:
- Unable to sit, stand, or walk for more than a few minutes at a time
- Forced to spend much of her day lying down with her leg elevated
- Vulnerable to blood clots and serious complications from basic activities
- Medically restricted from participating in the physical or mental demands of the workforce
The record was consistent and well-documented. Matrix’s denial ignored this overwhelming evidence and instead leaned on subjective conclusions not supported by testing or medical judgment.
Why This Long Term Disability Claim Deserved Reinstatement
ERISA requires plan administrators like Matrix to conduct a full and fair review of all evidence. Courts have ruled that administrators cannot cherry-pick from the record or discount valid FCEs and physician opinions without justification.
In this case, a full and fair review leads to one conclusion only: the claimant remains disabled under the policy definition and is entitled to reinstatement of benefits.
Help from a Lawyer with Expertise in Disability Insurance
This law firm was built to be a disability insurance law firm.
That focus means:
- All of our lawyers specialize in disability insurance claims;
- We have experience with every major disability insurance company;
- We have won important long term disability lawsuits.
Our disability lawyers can help you 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.
Hiring an experienced disability attorney is important. Because federal law applies to most disability insurance claims, our lawyers do not have to be located in your state.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Pay no fees or costs unless you get paid.