Disability Attorney Represents Client After Metlife Denies Extension Of Long Term Disability Benefit

Disability Attorney Signifies Client After Metlife Declines Extension Of Long-term Disability Benefit

History behind have to employ a lengthy-term disability attorney

When John Lanier finished college, he grew to become a supervisor and software engineer. This eventually brought to some position with KPMG Talking to, Corporation. which grew to become Bearing Point, Corporation. in 2002.

The organization offered an worker benefits package, which incorporated both short-term and lengthy-term disability benefits. The program was given by Metropolitan Life Insurance Coverage Company (MetLife). Its core components incorporated an elimination period, then qualifications for 3 many years of benefits if the worker was not able to do the fabric and substantial responsibilities of (his) Own Occupation. The program stipulated that whenever the 3 years, an worker would simply be considered disabled if he/she couldnt perform any project for that theyOrshe was qualified for or turn into qualified when ever training, education and experience were taken into consideration.

Like a manager at KPMG/Bearing Point, Lanier was needed to visit extensively. This meant he spent hrs of every day walking and sitting. He regularly transported a pc with him, in addition to luggage. If your destination was within driving distance, he spent lengthy hrs driving. It had been a normal dependence on his position to lift 10 20 pounds., carry 10 pounds., and push or pull 30 40 pounds. every single day.

Lanier have been an energetic guy throughout college. He didnt drink or smoke and maintained the kitchen connoisseur. Regardless of this, back discomfort started to bother him within many years of departing college. He finally turned to surgery to find out if it might help relieve his signs and symptoms. The very first surgery in 1999 incorporated a lumbar diskectomy along with a laminectomy. It was then another laminectomy in 2001. The surgical procedures unsuccessful to work, so Lanier used in October 2002 for brief-term disability benefits underneath the Bearing Point worker benefits package given by MetLife.

Evidence showing disability

As proof of his disability, he provided detecting his dealing with physician. The signs and symptoms listed incorporated:

- chronic cervical and lumbar discomfort

- left lumbosacral radiculopathy

- hereditary thinning from the spine canal within the lower back

- fibromyalgia syndrome-like features expressed through chronic migratory discomfort

- objective physiological irregularities with multiple problems within the cervical and lumbar spine

- advanced degenerative joint disease within the lumbar spine at multiple levels, disc protrusion and spondylosis from C3 completely through T2

- bilateral ulnar neuropathy in the elbows

- dysfunctional sleep-wake cycles

It ought to be noted that his dealing with physician noted he seemed to be battling by having an panic attacks and depression during the time of his application.

Short-term disability approved

MetLife approved Laniers application for brief-term disability. Coverage under short-term disability fell from October 9, 2002 through April 6, 2003. Lanier then requested lengthy-term disability benefits. He pointed to his severe fibromyalgia syndrome and osteo arthritis within the lumbar spine, and the degenerative disc disease because the grounds for his claim. MetLife approved his claim on June 4, 2003, saying yes to pay for benefits for 36 several weeks underneath the own occupation clause from the plan. Coverage ended up being to begin on April 7, 2003.

MetLife informed Lanier six several weeks before their own occupation benefits would expire, the insurance provider had determined they wouldn't approve him for ongoing benefits underneath the any occupation the policy.

The disability insurance provider pointed to four bits of evidence it had accustomed to achieve the final outcome he would have the ability to operate in another occupation:

1.Appointment notes from his attending physician, Dr. Geoffrey Seidel, dated April 25, 2005, This summer 26, 2005 and August 25, 2005

2.Prescription demands dated June 11, 2005 and This summer 1, 2005

3.Attending physician statement dated August 25, 2005

4.Physical capacity evaluation dated August 25, 2005

Requirement for disability attorney arises when MetLife declines ongoing lengthy-term disability benefits.

MetLife leaned most on Dr. Seidels physical capacity evaluation (PCE) to achieve its conclusion that Lanier perform in another position. This evaluation recommended that Lanier was now in a position to take six hrs each day, are a symbol of 1 hour each day, and walk to have an hour each day. This was a improvement on the The month of january 9, 2003 PCE that reported he was just in a position to take four hrs occasionally, are a symbol of 1 hour occasionally, and walk for just one hour occasionally. MetLife stated that Laniers training, education and experience meant he perform inside a sedentary job.

They provided good examples of three positions they felt he could fill:

1) chief bank examiner,

2) controller using the Dot, or 3) a credit and collection manager.

Lanier hired a disability attorney and become a huge hit MetLifes decision in March 2006. In the appeal, Lanier incorporated a December 5, 2005 PCE by which Dr. Seidel remedied the misconceptions produced incidentally he'd completed the PCE on August 25, 2005. Dr. Seidel described he had incorrectly transported a solution from page one from the PCE to the second page. The physician informed MetLife this had produced a substantial error, that they had remedied within the December 5, 2005 PCE.

This PCE instead of showing a noticable difference in Laniers condition reflected degeneration from The month of january 9, 2003. Now, 2 yrs later, Lanier was restricted to one or two hrs each day your sitting position. Dr. Seidel reported that any more than this and Lanier experienced from head aches, intolerable back discomfort and radicular signs and symptoms. Also, he reported that chiropractic care changes had unsuccessful to create consistent relief.

Additionally to his doctors up-to-date PCE, Lanier also provided proof he had requested Social Security disability benefits as MetLife needed and been approved. Incorporated using the benefits decision was testimony from vocational expert Elaine M. Tripi, PhD of Social Security. This expert, after looking at Laniers symptomatology and functional restrictions, came to the conclusion he was not able to do his past or other work that is available locally.

Also, he incorporated four objective tests that confirmed his disability:

1.A September 22, 2005 electrodiagnostic test that confirmed his chronic left radiculopathy and demonstrated that no changes have happened since a 2003 test.

2.September 28, 2005 electrodiagnostic tests carried out on his right and left elbows that revealed bilateral ulnar neuropathy. Dr. Seidel pointed for this test as proof that Lanier wouldn't have the ability to perform typical sedentary work.

3.A September 23, 2005 MRI from the lumbroscal spine that confirmed the hereditary and chronic disc disease diagnosis and provided additional proof of spine nerve root compression.

4.A September 26, 2005 MRI from the cervical spine carried out that confirmed the worsening condition of his multi-level degenerative disc disease and stenosis as in comparison towards the 2003 MRI.

Turnaround of decision to deny lengthy-term disability benefits causes it to be seem like claimant no more needs disability attorney.

These details compelled MetLife to reconsider its decision to deny Lanier lengthy-term disability benefits. The disability insurance provider corrected its denial of advantages on June 14, 2006. Laniers lengthy-term disability benefits were reinstated, retroactive to April 7, 2006.

Simultaneously, Social Security had granted Lanier $60,440 in retroactive advantages to April 2003. MetLife stated that underneath the policy, Lanier owed MetLife $55,148 of the settlement. They introduced they could be reducing his monthly benefits through the $1990 he caused by Social Security. Additionally, starting in The month of january 2006, the disability insurance provider would stop having to pay him benefits until he paid back the overpaid benefits. Lanier settled the problem on The month of january 12, 2006.

Disability benefits attorney steps into picture again annually later.

MetLife sent Laniers medical records to 2 new medical professionals for review. A MetLife clinical specialist examined the file and stated the evidence unsuccessful to aid Laniers disability. Also, Mary L. Hale, vocational rehab consultant, examined the August 25, 2005 PCE and a more modern May 3, 2006 functional capacity review.

Disregarding the up-to-date December 5, 2005 PCE, she informed MetLife that there is no evidence to aid the declare that Laniers capabilities were under sedentary. MetLife taken care of immediately these details by notifying Lanier on Feb 6, 2007 the disability insurance provider was terminating his lengthy-term disability benefits once more.

Laniers disability attorney aided him with appealing the cancelation of advantages on August 2, 2007. The letter to MetLife contended the disability insurance benefits provider was neglecting to think about the information provided from his Social Security hearing in the first appeal.

The disability lawyers letter also pointed that MetLife erred by depending around the August 25, 2005 PCE. Incorporated using the appeal would be a Feb 19, 2006 note from Dr. Seidel proclaiming that he'd not seen a noticable difference in Laniers health since December 2005. He incorporated a obvious introduction to Laniers physical capabilities.

In a position to take 15-20 minutes before needing to wake up, reposition, lie lower or walk for any couple of minutes.

Not able to work on his computer in your own home in excess of twenty minutes because of the spasms that occur at the back of his neck.

Discomfort in leg increases to the stage where patient has lay lower if patient sits for too lengthy.

Difficulty coping from a psychological perspective.

MetLifes doctors claim medical apparent does not support disability.

MetLife sent Laniers attract two medical consultants. Both doctors made a decision to limit those reviews towards the medical records delivered to them by MetLife. Neither spoken with Lanier.

Dr. Reginald Gibbons, a mental health specialist, belittled Dr. Seidels diagnosis while he hadn't purchased cognitive tests to judge whether Laniers anxiety and depression produced functional restrictions. Dr. Sandar Pemmaraju, an actual medicine specialist, stated that medical evidence unsuccessful to aid Laniers lack of ability to do sedentary work and belittled the possible lack of a proper capacity examination in the file. Both doctors filed their reviews with MetLife on August 21, 2007.

Both of these reviews were delivered to Dr. Seidel for his response on August 24. He accomplished it on August 28. He noted he had only received Dr. Pemmarajus review, so could only discuss it. He noted that Dr. Pemmarajus review overlooked most of the clinical findings, recommending he hadn't checked out an entire permanent medical record. Also, he noted that the full functional capacity evaluation was not purchased, because there is nobody who had been prepared to pay for this.

Once more Dr. Seidel confirmed the problems that the recent examination had confirmed:

1.chronic cervical discomfort

2.chronic lumbar discomfort

3.left lumbrosacral radiculopathy

4.right cervical radiculopathy

5.fibromyalgia syndrome

6.dysfunctional sleep-wake cycle

7.objective reduced flexibility from the cervical spine, mild decrease in flexibility from the right shoulder, objective decrease in flexibility from the lumbar spine, and objective atrophy noted within the right upper extremity and left lower extremity

8.Radiographic proof of advanced severe degenerative osteo-arthritis from the cervical spine and lumbar spine more than what can be anticipated for his age.

If MetLife considered this response, there is no evidence within the administrative record it accomplished it. On September 6, 2007, the disability insurance provider sent Lanier a denial letter.

The disability insurance provider gave the next causes of maintaining the choice to reverse the choice to pay disability benefits:

[W]ith the medical records readily available for review, we came to the conclusion the file didn't contain any harshness of impairment that led to functional restrictions and limitations stopping you against carrying out sedentary degree of employment beyond Feb 6, 2007.

In finishing our review, we've determined that even though you have health conditions that give you support getting limitations and restrictions, you'd have the ability to perform sedentary level work. Your signs and symptoms and diagnoses wouldn't stop you from carrying out the alternate jobs recognized with alternate companies. Therefore, our original decision to terminate your lengthy-term disability benefits beyond Feb 6, 2007 was appropriate.

Further medical evidence showing disability is overlooked.

Lanier been told by MetLife again on September 20. This letter says MetLife had overlooked Dr. Seidels letter of August 28 since it didnt include any extra objective clinical proof supporting Laniers disability. Dr. Seidel order two more MRIs and electrodiagnostic testing of Laniers lower and upper limbs to rectify this.

The nerve passing tests confirmed the existence of cubital tunnel neuropathy both in elbows and irregularities in nerve function in the legs. The MRIs demonstrated irregularities. A little central protrusion in the C4-C5 level slightly flattened the vental cord, slightly effacing the exiting right and abutting the exiting left C5 nerves. The MRI also found mixed biforaminal humps, with the proper humps being more than the left. The MRI observed a flattening from the right side from the ventral cord in the C5-C6 level.

Mild retrolisthesis and mixed broad-based displacement having a slight flattening from the ventral cord at C6-C7 level that abutted the bilateral exiting C7 nerves seemed to be noted. Many of these irregularities were reasonable explanations for the amount of discomfort Lanier reported.

Disability attorney takes clients lengthy-term disability termination towards the Courts.

MetLife stated that none of the new information had any effect on their decision to terminate Laniers disability benefits by Feb 7, 2007. The disability insurance provider stated that new test results dated September 2007, even though they shown Laniers lack of ability to do sedentary operate in September, unsuccessful to demonstrate the outcomes unsuccessful to show his lack of ability to operate inside a sedentary job in Feb of the identical year.

Lanier and the disability attorney required action. They filed a suit against MetLife. Inside a separate article, we'll consider how Laniers disability insurance attorney presented the situation prior to the U.S. District Court. The main purpose here is to demonstrate how disability insurance providers work. Employing a skilled disability insurance attorney having a strong history is among the best opportunities you may make should you ever face creating a disability claim.