An ERISA Long Term Disability Tale

Posted on behalf of Rizk Law on Sep 08, 2010 in Insurance Issues

Once upon a time there was a long term disability claims examiner, “Charlie”. Charlie loved his job. Unlike many long term disability employers, “The Chevron” insurance enjoyed a good reputation sponsoring charitable events in the community.  For years Charlie worked staring at a computer, studying disability claim files—denying some claims, accepting others. Charlie bought a small house in tree and lived a happy middle class life. No one at The Chevron really noticed Charlie.   

Then one day while walking through the woods, Charlie slipped and fell on a slippery rock. In pain, Charlie yelled. Luckily, a friendly Hobbit happened to be walking by and heard the screams. The Hobbit helped Charlie up and rushed Charlie to the Friendly Wizard of Orthopedic Surgery.

Over the next few years, The Wizard waved his wand into Charlie’s back and neck three times. The Wizard’s magic wand helped Charlie and Charlie thought he could return to work at The Chevron.

Charlie told the Wizard that he wanted to return to work and The Wizard documented Charlie’s desire to return to work in his magic chart notes. However, Charlie’s condition worsened. Eventually, Charlie experienced “severe” daily neck and arm pain.  The Wizard sent Charlie to the Knight of Physical Therapy for a “Physical Capacities Exam”. The Physical Capacities Exam revealed that Charlie could not perform the duties of a long term disability claims examiner. The Chevron did not want Charlie back at work anyway even though it had plenty of work for Charlie to do.

Charlie then called The Chevron—who was Charlie’s long term disability insurer and well as Charlie’s former employer.  “Sorry Charlie, your job was a light duty job and our secret medical experts, who have never examined you, say you can do your job. Also there is no objective evidence of your disability. Claim denied…but you can appeal.

Because of the denial, Charlie could not pay his bills, had to move from his home in a tree and became very poor. With the help of an ERISA disability attorney, who Charlie saw online, Charlie appealed The Chevron’s denial.

Months and months pass. Even though he wanted to work, Charlie realized he just could not work.  The Wizard agreed explaining that “objective evidence” would not be expected in Charlie’s case. The physical capacity’s test, the Wizard said, shows that Charlie cannot work.  But, because of the denial, Charlie could not pay his bills, had to move from his home in a tree and became very poor.

Charlie’s denial was mysteriously reversed based on more secret medical experts hired by The Chevron. Charlie now receives ERISA disability benefits from The Chevron, reduced by Social Security.

The Morale: Don’t accept “Sorry Charlie”. Even disability claims examiners need the assistance of an attorney.