Settlement for Long Term Disability Client Suffering from Schizophrenia
Our client, a former occupational therapist who suffered from a severe mental impairment was denied Long Term Disability benefits by a large disability insurance company. After pursuing an appeal for her, we filed an ERISA disability lawsuit in federal court to get a judge to reverse the LTD insurance company.
Disability benefits were denied by the disability insurance company on the basis of a hired gun paper review doctor. The insurance doctor did not examine our client, or even speak to her over the phone. Instead, their supposed “independent medical reviewer” simply looked at her records. Incredibly, the insurance company’s doctor came up with a different diagnosis than the treating doctors! Her treating doctors diagnosed schizophrenia, but the insurance company doctor literally wrote that she was suffering from a different type of mental condition, schizo-affective disorder. Despite her doctors diagnosing her after actually seeing her and treating her for a series of examinations over months, the insurance company doctor thought he could simply change their diagnosis!
This new diagnosis was crucial, because the insurance company peer review doctor picked a medical condition that would have placed our firm’s client into a limited pay period. The condition her own doctors concluded she suffered from did not have a limited time pay period.
After filing motions and seeking discovery into the insurance company’s practices, Disability Attorneys John V. Tucker and Amy Ray negotiated a substantial confidential settlement for our client.