What You Should Know:
- A highly compensated executive in Ohio was forced to stop working due to debilitating chronic pain, neurological impairment, and cognitive decline.
- Despite comprehensive treatment and ongoing care from multiple specialists, Symetra denied his claim for long-term disability benefits.
- Extensive medical evidence, including an FCE, IME, CFA, and physician letters, supported the claimant’s inability to perform even sedentary work.
- Dabdoub Law Firm focuses exclusively on disability and life insurance claims and has helped clients across the U.S. fight wrongful LTD denials like this one.
A Career Cut Short by Chronic and Progressive Disability
Our client, a former Chief Technology Officer earning over $300,000 annually and living in Ohio, was forced to leave his role in early 2024 due to progressively worsening symptoms. These included:
- Complex Regional Pain Syndrome (CRPS)
- Neuropathy and radiculopathy
- Post-laminectomy syndrome
- Lymphedema
- Cognitive decline linked to both chronic pain and prescribed medications
Despite undergoing spinal surgery, trigger point injections, nerve blocks, and daily opioid therapy, his pain persisted and intensified. As his condition deteriorated, he became unable to perform the cognitive and physical demands of his high-level occupation.
Symetra Denied His LTD Claim Despite Strong Medical Evidence
Symetra acknowledged our client’s serious diagnoses but denied his long term disability claim based on a paper review conducted by third-party consultants who never examined or spoke with him. Their opinion: the conditions were not disabling.
This long term disability denial failed to account for:
- Years of documented, progressive decline
- Letters of support from multiple treating physicians
- A history of intensive treatments including surgeries and opioid medication
- Functional and cognitive evaluations confirming disability
Objective Testing Confirmed Disability
To strengthen a chronic pain appeal, there are several pieces of evidence that can be gathered to prove disability. First and foremost, treating provider support is crucial for a long term disability claim. Couple with that, we gather independent tests and reports from specialists in chronic pain that add layers of credibility to reported symptoms and objective evidence of impairment.
With this appeal, we submitted new, independent assessments including:
- Functional Capacity Evaluation (FCE)
Conducted over two days, the FCE concluded the claimant is:
- Limited to sitting for just 2 hours in an 8-hour day
- Unable to stand more than 2.5 hours or walk more than 1 hour per day
- Below average in grip strength and gross dexterity
- Unable to perform tasks requiring forward or overhead reaching
- In need of full reclining breaks during daily activities
- FCE Validated by Independent Expert
An independent occupational therapist with expertise in FCEs reviewed and confirmed the FCE’s validity, noting:
- Severe impairment across all tested domains
- Unreliable ability to perform even sedentary work
- Symptoms consistent with claimant’s self-reports and treatment history
- Independent Medical Examination (IME)
A board-certified pain management specialist found:
- Confirmed diagnoses of CRPS, spinal stenosis, radiculopathy, and neuropathy
- Cognitive symptoms including memory loss and difficulty processing
- Prescription for 180 MMEs of opioids daily
- Clear recommendation against returning to any type of work
- Cognitive Functional Assessment (CFA)
A licensed psychologist found:
- Executive dysfunction and slowed processing
- Impaired memory and reasoning
- Cognitive decline interfering with ability to manage complex tasks
- A complete inability to perform the duties of a CTO or any similar role
- Treating Providers Strongly Supported Disability
Physicians across multiple specialties, including neurology, family medicine, pain management, and podiatry, confirmed the claimant’s:
- Permanent disability from work
- Limited ability to sit, stand, focus, or use his hands
- Progressive decline in physical and cognitive functioning
- Poor prognosis for recovery
- Declarations from the Claimant and Family
Both the claimant and his spouse submitted personal statements describing how disability has upended their lives:
- The claimant described overwhelming pain, loss of independence, and deep emotional toll.
- His spouse shared the burden of caregiving and the heartbreak of watching her partner deteriorate physically and mentally.
- Together, their stories underscored the day-to-day realities Symetra’s denial ignored.
Symetra’s Fiduciary Duties Under ERISA
Symetra’s denial appeared to disregard its fiduciary responsibilities under ERISA. Plan administrators are required to:
- Conduct a full and fair review of all evidence
- Act solely in the best interest of claimants and beneficiaries
- Avoid relying on conflicted, biased file reviewers
Yet, Symetra denied this claim without an in-person evaluation and failed to consider independent, objective evidence supporting total disability.
Why Symetra Got It Wrong
Symetra’s decision failed because it:
- Relied on incomplete and one-sided evidence
- Ignored updated medical records, evaluations, and physician support
- Mischaracterized the claimant’s ability to perform full-time sedentary work
- Dismissed profound physical and cognitive limitations that make sustained work impossible
The Outcome
Faced with overwhelming medical evidence, including FCE, IME, CFA, updated treatment records, and support from treating providers, Symetra was given the opportunity to reverse its denial. Symetra reviewed the appeal and the wealth of supporting evidence and concluded, rightfully, that our client was disabled from working.
The claimant, represented by Dabdoub Law Firm, presented a bulletproof appeal that highlighted:
- Objective proof of physical and cognitive disability
- A clear inability to meet the demands of his occupation or any work
- A worsening medical trajectory supported by medical professionals
Disability Insurance is All We Do
At Dabdoub Law Firm:
- We focus exclusively on disability and life insurance law.
- We’ve taken on every major insurance company and know how to beat them.
- We represent clients nationwide and have a track record of success in federal court.
- We are a litigation powerhouse in complex and high-stakes disability claims.
Call the Dabdoub Law Firm to get experienced disability lawyers on your side. We can help 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 (800) 969-0488 or contact us online to speak with an experienced disability attorney. Pay no fees or costs unless you get paid.