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“Leslie” was a department store manager for a major national retailer. Her job required far more than sitting behind a desk. On a typical workday, she needed to stand and walk for long periods, supervise employees, assist customers, move throughout the store, bend, reach, and respond quickly to operational issues on the sales floor.
After suffering a serious back injury, Leslie underwent eight back surgeries. Despite extensive treatment, she continued to experience significant pain and physical limitations that prevented her from safely and reliably performing the duties of her occupation.
Leslie filed a long term disability claim, but her insurance company denied benefits. The denial relied heavily on a single phrase in one treatment note stating that Leslie was “feeling better.” The insurer treated that phrase as evidence that Leslie could return to work, even though her broader medical history showed ongoing functional limitations.
Riemer Hess challenged the denial by developing a stronger evidentiary record. We obtained additional reports from Leslie’s treating physicians, clarified that the improvement mentioned in the treatment note was temporary and did not mean she could return to work, and prepared a detailed statement explaining the physical demands of her department store manager position.
The appeal focused on the difference between feeling somewhat better after treatment and being able to perform a demanding occupation on a full-time, reliable basis. Leslie’s case required more than proof of a diagnosis. It required clear evidence showing how her back condition affected her ability to stand, walk, bend, remain on her feet, and sustain the pace and physical demands of her job.
After reviewing the additional evidence, the insurance company reversed its denial, paid Leslie the past benefits owed, and approved her long term disability benefits.
Riemer Hess continues to work with Leslie to help protect her benefits and respond to future insurer requests.
