“Jason” was a successful investment banker in New York City. His work required high-level judgment, long hours, sustained focus, client responsiveness, and the ability to perform in a demanding financial environment.
Jason suffered from several serious medical conditions, including seronegative arthritis, spondyloarthritis, psoriatic arthritis, chronic low back pain, irritable bowel syndrome, anemia, obstructive sleep apnea, tachycardia, and adenoma. Together, these conditions caused chronic pain, muscle aches, tenderness, swelling, fatigue, and stiffness affecting his lower back, shoulders, knees, hands, and hips.
As his symptoms worsened, Jason became concerned about whether he could safely and reliably continue working. He came to Riemer Hess for guidance on his exit strategy and for help applying for short term disability, long term disability, and life insurance waiver of premium benefits.
Riemer Hess helped Jason plan his transition out of work and prepare his disability claim materials. The team assisted with the application forms, gathered medical support, and presented the claim in a way that connected Jason’s symptoms and restrictions to the demands of his occupation.
The insurance company approved Jason’s short term disability benefits through the maximum benefit period. It then approved his long term disability claim and his life insurance waiver of premium claim.
Although Jason’s LTD benefits remained in good standing, the insurance company later terminated his waiver of premium benefits after approximately one year of payment. This created a new issue: Jason needed to prove that he continued to satisfy the policy’s requirements for waiver of premium, even though his LTD claim was still being paid.
Riemer Hess developed an appeal strategy focused on objective functional evidence and treating physician support. The team recommended additional testing, including a functional capacity evaluation and vocational analysis, to document Jason’s physical limitations and explain how those limitations affected his ability to work. Riemer Hess also obtained a rebuttal report from Jason’s treating physician to address the insurer’s rationale for terminating the waiver benefit.
After Riemer Hess prepared and submitted a detailed appeal, the insurance company reversed its termination and reinstated Jason’s life insurance waiver of premium benefit.
Riemer Hess continues to help Jason respond to periodic update requests for both his long term disability benefits and his waiver of premium benefits.