Our Client: Small Business Owner, Insurance Agent & Financial Advisor
Our client owned her own business, a Farm Bureau Insurance Agency. She was also a licensed financial advisor. In these roles, she was responsible for maintaining relationships with her growing list of clients, creating business plans and budgets, branding and promoting products, traveling to sales events, following financial regulations, and advising clients on choices for insurance protection and investment planning.
Our client loved her job and business was booming. But one day her life took a drastic turn. She began experiencing debilitating symptoms. It started with numbness in her leg, which caused a fall. But over time, she noticed numbness and shooting pain in other areas of her body. She grew concerned and sought medical care from specialists.
Severe Symptoms from Brain & Spine Conditions
Imaging revealed Arnold Chiari malformation in her cranium and basilar invagination in her cervical spine. Further testing confirmed other complex conditions, including cervical medullary syndrome, vertebral artery compression syndrome, and myelomalacia.
Our client underwent multiple surgeries, including a Chiari decompression, craniectomy, laminectomy and odontoidectomy. Unfortunately, she continued to suffer from symptoms including facial numbness, paresthesia, balance issues, and pain in her neck and extremities. She also had cognitive difficulties including confusion, problems with fine motor skills, and altered depth perception while driving. These symptoms made it challenging for her to perform even simple tasks.
Devastating Impact on Her Job & Life
Our client's medical condition severely impacted her job and personal life. She could no longer manage her duties as a Farm Bureau agent due to the physical and cognitive limitations brought on by her condition. Simple tasks like ordering coffee or driving short distances became difficult and sometimes impossible.
Her pain, fatigue, and cognitive impairments rendered her unable to continue in her professional role. She lost clients and ultimately had to close her business. She was devastated, but as an insurance agent, she had planned for this unlikely event. She had bought coverage through a long-term disability insurance policy.
Why the Insurance Company Denied the Obvious
Our client filed for LTD benefits with her insurance provider, Sun Life. She thought it would be an “open and shut” case, but unfortunately, she was wrong. Sun Life denied her LTD claim.
Sun Life claimed, in part, that our client was not disabled and still capable of performing the essential duties of her job. The denial decision relied on medical reviewers who never met our client in person. Aspects of her claim were cherry-picked to support the decision. It was also asserted that our client did not have “earnings” under the policy because she was paid through her pass-through business entity.
The Sun Life denial letter mentioned her right to file an appeal. Our client knew at that moment she needed help.
How We Fought Back and Won Her Appeal
Fortunately, our client found our law firm. We were hired and immediately got to work. Our firm requested the complete claim file and reviewed records provided by our client and the insurance company. We developed a strategy to provide a comprehensive appeal package that included additional medical evidence. This evidence highlighted both the severity of our client’s pain and fatigue and the impact it had on her ability to perform the complex cognitive tasks necessary for her position.
We also researched court decisions nationwide and found strong legal precedent to support the assertion that our client was entitled to benefits regardless of whether she was paid directly or through her business.
Reversing a Denial of LTD Benefits
As a result of our firm’s efforts, Sun Life agreed to reverse its decision to deny benefits and put our client on claim. This resolution resulted in our client being paid $277,000 in back benefits and receiving ongoing monthly benefit checks.
If our client remains disabled under the Plan, she will be entitled to a total disability benefit award of approximately $2,700,000.
Our client was relieved with this outcome, and these benefits will provide her with the financial stability needed to focus on her health and well-being moving forward.
Contact Our Long-Term Disability Attorney
If you or a loved one were denied long-term disability due to a medical condition, please know you are not alone. Our long-term disability attorney helps claimants receive the benefits they deserve.
We're here to help, and on your side. Call us today at 816-203-0143. We'll review your denial letter for free and provide a strategy on how to fight back. You can also download our free long-term disability book, Denied Long-Term Disability? Learn How to Fight Back and Win Your Appeal.
