Pharmaceutical Sales Representative Suffering From Cervical and Lumbar Degeneration Won Appeal After Being Wrongfully Denied Long Term Disability

Janice came to Riemer Hess suffering from cervical and lumbar degeneration status post multiple fusions.  She was hardly functional and in desperate need of assistance.  Janice had been receiving benefits for nearly 2 years. However, upon transition to the “any occupation” phase of her claim, she was found to no longer be eligible for disability benefits and her benefits were cut off.  Realizing she was in need of an appeal for both her LTD benefits and Life Insurance (as her waiver of premium benefits were also denied simultaneously), Janice confidently retained Riemer Hess.

Team Riemer Hess quickly got to work.  As Janice had previously submitted a letter of appeal to the insurer, Team Riemer Hess’s first step was to make clear to the insurer that her letter was not a final appeal and that a formal appeal would be submitted within the 180 day deadline.  This was accomplished immediately. Next, Janice obtained the necessary testing to refute the insurer’s determination and overturn their decision.  She immediately underwent both a vocational assessment and a functional capacity evaluation which objectively demonstrated her inability to perform her job duties.  Narrative reports and disability questionnaires were obtained from her treating providers to support the functional testing obtained and further substantiate the finding that Janice was totally disabled from “any occupation.”

Following the submission of the appeal, the insurer attempted to have Janice undergo additional testing to refute the firm’s evidence.  Scott Riemer advised that Janice would not undergo any additional testing as the first round of testing was unbearable for Janice and any testing from the insurer’s physicians would likely be unsupportive.  Instead, Team Riemer Hess advised that the insurer could conduct a non-examining physician review of the record.  Given his experience in the field, Scott Riemer knew this review was the most appropriate given the circumstances and would be easily refutable should litigation become necessary.

Team Riemer Hess’s strategy proved to be successful and the appeal was approved – Janice’s LTD benefits were reinstated immediately.   Regarding the waiver of premium appeal, the insurer required additional information which Team Riemer Hess readily prepared.

In addition to having her LTD benefits reinstated, the insurer offered Janice a lump sum offer which totaled the entire value of Janice’s claim.  Team Riemer Hess reviewed the calculations and advised Janice that the offer was acceptable and should be taken.  The lump sum offer was finalized and Janice has received the payment.

Depression Disables Relationship Manager at National Insurance Company

Dwight was a successful relationship manager at a national insurance company. He lived and worked in NYC.  Dwight suffered from depression, which included symptoms of decreased energy, difficulty thinking, emotional isolation, sadness, hopelessness, irritability, and poor sleep, which resulted in him being unable to continue working.

Dwight made the difficult decision to  to stop working so that he could focus on his health.  The short term disability he applied for on his own  short term disability “STD” were initially approved.  His victory was short-lived because his benefits were quickly terminated. Dwight was devastated – and was at a loss what to do.  Dwight knew he was unable to return to work and he  knew he needed to appeal his denial, he contacted Riemer Hess for guidance.

Upon consultation with Scott Riemer,  Dwight knew he was in the right hands and retained the Firm to help him win his appeal for STD benefits and application for long term disability “LTD” benefits. During his consultation, Scott reviewed the denial letter and Dwight’s medical records and came up with an action plan on how to overcome the denial and get the approval for ongoing benefits.  The action plan included a referral for neuropsychiatric testing and a vocational analysis, which served as objective evidence as to how Dwight’s depression and its symptoms despite medical interventions, prevented him from being able to perform the critical and essential job duties of his occupation. Team Riemer Hess got to  work on obtaining the necessary medical evidence that was needed.  They were with Dwight each step of the way giving him confidence that he would win his claim. Team Riemer Hess also obtained the necessary medical records and reports from Dwight’s treating physicians.

The insurance company, overwhelmed by the totality of evidence submitted with the appeal, quickly realized the error of their ways and reinstated STD benefits.  Dwight was relieved and overjoyed at the positive outcome. His benefits were critical to his financial well-being. Dwight is now able to focus on the care that he needs.  Team Riemer Hess continues to assist Dwight with getting his LTD application approved and stands at the ready to assist on whatever may be needed to achieve victory once again. Team Riemer Hess and Dwight are confident they will prevail.

A Technical Support Analyst Suffering From Severe Sleep Apnea Wins His  Appeal

“Mark “was a technical support analyst for a leading financial institution when he was diagnosed with severe obstructive sleep apnea.  Mark began to experience cognitive difficulties associated with his sleep apnea as well as deficits in concentration and memory, and extreme fatigue.  Mark had previously received coverage under the family medical leave act (FMLA) and upon its termination attempted to return to work.  However, Mark’s return to work was unsuccessful as he remained unable to tolerate the high executive level functions required to meet the demands of his occupation.  Mark met with Mr. Riemer and a strategic plan was implemented geared toward transitioning Mark from short term disability benefits to long term disability benefits.

Team Riemer Hess submitted substantial medical documentation from Mark’s treating providers and despite the preponderance of evidence, the insurer denied Mark long term disability benefits contending he did not meet the definition of disability.  Team Riemer Hess knew immediately that an appeal was necessary as the medical evidence supported total disability in accordance with policy provisions and quickly got to work.

Team Riemer Hess had Mark undergo a neuropsychological evaluation to further document his cognitive dysfunction related to his sleep apnea; a functional capacity evaluation to document his fatigue and corresponding deficits in functioning; and a vocational evaluation to substantiate the fact that his impairments and resulting limitations precluded him from performing the demands of his occupation.  Additionally, statements of disability were obtained from Mark’s treating doctors, which further supported his inability to perform his occupation as well as updated medical records to show continued disability.   A comprehensive appeal was submitted with this new medical documentation and the Appeals Review Unit overturned the decision to deny Mark long term disability benefits.

Mark continues to receive long term disability benefits and Riemer Hess remains of counsel to monitor his claim to ensure benefits remain payable.

Cancer Complications Devastate Pharmacist

Laurel worked for a large national mail-delivery pharmacy conglomerate as a pharmacist.  Laurel worked at home filling and reviewing hundreds of thousands of prescription orders.  Two decades earlier, Laurel was diagnosed with muscular cancer of the shoulder and had to have the muscle removed in order to continue arm function.  Unfortunately, complications included chronic pain, frozen shoulder, and neuropathy.  One day, Laurel lost complete use of her shoulder which forced Laurel to stop working all together.

Laurel came to Riemer Hess after her benefits with her group insurance carrier were abruptly terminated.  Laurel, who lived out of town, had a telephone consultation with Scott Riemer, who developed an appeal strategy and recommended that Laurel meet with a vocational counselor to better document how her condition severely impacted her ability to work in her occupation.  Mr. Riemer also recommended functional capacity testing to capture Laurel’s functional abilities and neuropsychological testing to capture the impact her disability has had on her livelihood.  The team at Riemer Hess also: gathered extensive medical reports from Laurel’s physicians; analyzed the extensive surveillance footage the insurance company took of Laurel which grossly mischaracterized Laurel’s day-to-day abilities; and worked with Laurel’s family to gather statements which testified to Laurel’s diminished functional abilities.

Based on Riemer Hess’s comprehensive appeal submission, the insurer overturned its prior determination on Laurel’s LTD claim and reinstated her benefits.  Laurel has retained Riemer Hess to monitor her continued receipt of LTD benefits.

Post-Operative Cancer Treatment Disables an Investment Consultant

“Rita” was a successful investment consultant at a major consulting firm in Manhattan suffering from Carcinoid Tumors and debilitating gastrointestinal issues resulting from post-operative cancer treatment.  Her debilitatingg symptoms rendered her unable to continue working in any capacity.

Unfortunately, Rita’s insurance company denied her claim for disability benefits despite strong evidence establishing her inability work.  Rita met with Scott Riemer, who devised an appeal strategy and recommended that Rita meet with a vocational expert to better document how her ability to work was severely impacted by her disability.  Mr. Riemer and his team also gathered additional medical reports and records from Rita’s doctor detailing the devastating affects her illness has had on her livelihood.

Team Riemer Hess drafted a comprehensive appeal letter that explained in detail why Rita was unable to perform the substantial duties of her occupation and which refuted all of the reasons raised by the insurance company in support of its denial of benefits.  Based on the overwhelming evidence in the appeal, the insurer overturned its prior determination on Rita’s LTD claim.  Rita has retained Riemer Hess to monitor her continued receipt of LTD benefits.

Chemotherapy Treatment Disables Training Consultant

Jason was the Head Training Consultant for a number of high-end banks and insurance companies in New York City. Jason was diagnosed with throat cancer and HIV. The chemotherapy treatment, in addition to HIV, resulted in severe and debilitating fatigue, neuropathy of the hands and feet, stiffness in his hands and feet and dry mouth making it difficult to talk. Jason was receiving LTD benefits under his group disability policy he purchased years before through his employer. Unfortunately, his insurer without warning discontinued his benefits, claiming that Jason was not totally disabled and that he could return to work. Jason came to Riemer Hess seeking assistance with his appeal. Jason met with Scott Riemer who devised an appeal strategy which included recommendations for a functional capacity evaluation to document his actual restrictions and limitations as well as a vocational assessment to explain why he was unable to work in his own prior occupation as a Consultant or in any similar occupation. Team Riemer Hess also obtained detailed medical reports and records from Jason’s treating providers and statements of support from his former co-workers, family, and friends, who witnessed the devastating effects the chemotherapy side effects and HIV had on his livelihood. Upon receipt of Riemer Hess’s comprehensive appeal, the insurance company accepted liability and reinstated Jason’s benefits. Jason continued to receive benefits for three years when, once again, the insurance company terminated his claim asserting that he no longer satisfied the definition of disability under the any occupation standard. Jason once again met with Scott who devised another appeal strategy. This second appeal strategy included a follow-up functional capacity evaluation to show how much Jason’s functional abilities declined since his initial testing. It also included another vocational assessment to show how Jason would not be capable of returning to work in any occupation, but to also critique the improper vocational assessment proffered by the insurance company. The second appeal also focused on how the insurance company’s own physician did not review Jason’s complete medical records. The insurance company once again accepted liability on Jason’s claim and reinstated benefits. Riemer Hess continues to represent Jason to date and Jason can now focus his energy on managing his health.

Post-Operative Cancer Treatment Disables an Investment Consultant

“Rita” was a successful investment consultant at a major consulting firm in Manhattan suffering from Carcinoid Tumors and debilitating gastrointestinal issues resulting from post-operative cancer treatment. Her debilitating symptoms rendered her unable to continue working in any capacity. Unfortunately, Rita’s insurance company denied her claim for disability benefits despite strong evidence establishing her inability work. Rita met with Scott Riemer, who devised an appeal strategy and recommended that Rita meet with a vocational expert to better document how her ability to work was severely impacted by her disability. Mr. Riemer and his team also gathered additional medical reports and records from Rita’s doctor detailing the devastating effects her illness has had on her livelihood. Team Riemer Hess drafted a comprehensive appeal letter that explained in detail why Rita was unable to perform the substantial duties of her occupation and which refuted all of the reasons raised by the insurance company in support of its denial of benefits. Based on the overwhelming evidence in the appeal, the insurer overturned its prior determination on Rita’s LTD claim. Rita has retained Riemer Hess to monitor her continued receipt of LTD benefits.

Arthritis Disables An Investment Banker

“Jason” was a successful investment banker in New York City suffering from Seronegative Arthritis, Spondyloarthritis, Psoriatic Arthritis, Chronic Low Back Pain, Irritable Bowel Syndrome, Anemia, Obstructive Sleep Apnea, Tachycardia and Adenoma.  These illnesses caused myalgias and pain throughout Jason’s body, along with tenderness/swelling, fatigue and stiffness of the lower back, shoulder, knees, hands and hips.  Jason came to Riemer Hess seeking guidance with his exit strategy and assistance with his applications for Short Term Disability and Long Term Disability benefits.  Jason also needed assistance with his claim for Life Insurance Waiver of Premium benefits. Jason met with Scott Riemer, who devised a plan for his transition out of work and for his applications for STD, LTD and waiver of premium for his life insurance coverage.  After the meeting, Team Riemer Hess got to work.  The assigned paralegal assisted Jason in completing the application forms and compiling the necessary medical support.  Without any delay, the insurance company approved Jason’s STD claim through the maximum benefit period, and then approved his LTD and waiver of premium claims. While Jason’s LTD claim remained in good standing, the insurance company unfortunately denied Jason’s waiver of premium claim after approximately a year of benefits.  Following the denial, Jason once again discussed this matter with Mr. Riemer and his paralegal, who devised an appeal strategy and recommended additional objective testing to help support the appeal, including a functional capacity evaluation and a vocational analysis.  Team Riemer Hess also obtained a “rebuttal” report from Jason’s treating physician.  After Riemer Hess prepared and submitted a detailed appeal on Jason’s behalf, the insurance company reversed its termination and reinstated his waiver of life insurance premium.  To date, Riemer Hess continues to help Jason with the periodic updates requested for both his LTD and waiver of premium claims.

Back Injury debilitates a Department Store Manager

“Leslie” was a manager at a major department store who suffered a crippling back injury, which required her to endure eight painful back operations. Leslie’s insurance company denied her claim in spite of the fact that her job required her to be on her feet most of the day as well as continually bend. This denial was based solely on language in one of her doctor’s treatment notes stating that she was “feeling better.” In order to challenge this denial, Riemer Hess obtained additional reports from Leslie’s treating physicians, clarified that the improvement described in the treatment notes as only temporary, and prepared a detailed statement for Leslie describing the exertion requirements of her occupation. The insurance company reversed itself, paid Leslie all past benefits owed, and placed Leslie on disability benefits. Riemer Hess continues to work with Leslie to ensure that her benefits are not interrupted.

Lyme Disease Impairs A Sales Trader

“Todd” was a sales trader at a major investment bank. Todd suffered severe cognitive deficits as a result of Lyme Disease. Todd continued to work as long as he could despite the deficits, but was forced to go out on disability when he made several incorrect trades that cost his employer thousands of dollars. The insurance company denied Todd’s claim, asserting that he submitted insufficient objective evidence of disability. Todd was referred to Riemer Hess by a prominent employment attorney. The Firm prepared a comprehensive appeal, including neuropsychological testing and an abnormal brain SPECT scan. The Firm also included a compelling video statement from Todd which clearly showed how Lyme Disease has dramatically affected his cognitive abilities and speech patterns. The insurance company reversed itself, paid Todd all past benefits owed, and placed Todd on long term disability benefits. Riemer Hess continues to work with Todd to ensure that his benefits are not interrupted.

Chronic Fatigue Syndrome debilitates a Mergers & Acquisitions Attorney

“Bill” was a successful mergers and acquisitions attorney with a major law firm. Bill suffered from debilitating fatigue and cognitive deficits as a result of chronic fatigue syndrome. The insurance company denied his claim on the sole ground that Bill stated in his application form that he was “exercising lightly three or four times a week.” The insurer claimed that this was inconsistent with his claim of disability. When Bill received the insurance company’s frivolous denial, he knew he needed expert help and could no longer represent himself. Bill hired Riemer Hess to submit a comprehensive appeal. The appeal included neuropsychological testing, and abnormal findings on a tilt table test, sleep study, brain SPECT scan, spinal tap, and blood work. Upon receiving the Firm’s detailed and thorough appeal, the insurance company reversed itself, paid Bill all past benefits owed, and placed Bill on benefit. Riemer Hess continues to work with Bill to ensure that his benefits are not interrupted.

HIV Ravages a Senior Chemist

“David” was a senior chemist at a chemical company. David suffered from HIV and the side effects of his medications including diarrhea, fatigue and cognitive problems. Despite the support of his treating physician, the insurance company denied his claim on the ground that there was no “objective” proof that he was disabled from his “sedentary” occupation. The insurance company also asserted that David “only” had HIV and not AIDS. David was referred to Riemer Hess by his financial advisor. In preparation for his appeal, the Firm sent David for neuropsychological testing in order to quantify his cognitive deficits. We also gathered substantial medical literature documenting the disabling symptoms of HIV and its required medications. Lastly, we gathered proof from David’s colleagues establishing that David’s position was not at all sedentary. David worked at a chemical plant and constantly had to climb ladders and use heavy equipment. Moreover, his occupation required significant cognitive abilities. Upon receiving Riemer Hess's detailed and thorough appeal, the insurance company reversed itself, paid David all past benefits owed, and placed David on full long term disability benefits. David continues to receive benefits without interruption.

Multiple Sclerosis Incapacitates A District Sales Manager

“Alison” was the District Sales Manager for a major insurance company. After working for almost 30 years for this company and achieving significant professional success, she was denied long term disability benefits under both a group policy and an individual policy issued by her employer. In addition to the heartbreaking effects of her own illness, Alison had to deal with the cruel fact that the very company to which she had devoted almost three decades of her life did not feel that she ‘deserved’ long term disability benefits. Indeed, the insurance company denied Alison’s claim solely on the basis of a hired doctor’s opinion that Alison was capable of “sedentary” work. How could Alison’s own employer forget that her job was in no sense of the word “sedentary?” Alison hired Riemer Hess to appeal her denial. The Firm gathered all of Alison’s available medical evidence, obtained detailed reports from Alison’s treating physicians supporting her disability, and prepared a comprehensive appeal letter attacking each reason raised by the insurance company in its denial, including its erroneous conclusion that Alison’s job was “sedentary.” The insurance company reversed itself, paid Alison all past benefits owed, and placed Alison on long term disability with full benefits. Riemer Hess continues to work with Alison to ensure that her benefits are not interrupted.[/vc_column_text][/vc_column][/vc_row]

Consult with our Disability Attorneys in New York

If you have any further questions regarding appeals success, we can help. Our knowledgeable disability attorneys in New York will dedicate the time and energy you deserve. Call Riemer Hess, LLC, Attorneys at Law, today at 212-297-0700.