Buffalo, NY — Jeffrey Freedman Attorneys at Law, PLLC, and the law firm of Dell & Schaefer recently won a long term disability ERISA (Employee Retirement Income Security Act) appeal on behalf of a Brockport, NY, client for the maximum insured benefits, which, over the client’s lifetime, will reach approximately $347,000. The insurer, Jefferson-Pilot Corp., acquired by Lincoln National Corp., a leader in group disability insurance, had denied the client’s claim on initial application for long term disability benefits 18 months previously, stating he was able to work at his former employment.
“This client came to us after having seven back surgeries. He had stenosis, degenerative disc disease and neurological problems,” said Jeffrey Freedman, managing attorney, Jeffrey Freedman Attorneys, PLLC. “He had been employed as an engineer, and is a highly educated, bright individual. However, the job required him to sit for long periods of time. It was obvious to our attorneys he could no longer do that.”
The Freedman firm collaborated with the Dell and Schaeffer Law Firm, combining the two firms’ expertise in Long Term Disability (LTD) and Social Security Disability (SSD) claims. An administrative ERISA appeal was filed April 2012, challenging the denial the client received in October of 2011. When this was denied, a second appeal was filed in July of 2012.
“The Federal ERISA statutes require that when an insured is denied long term disability benefits, the insured must appeal the disability denial to a different employee at the same company that initially denied the claim,” said Alex Palamara, attorney. “If our second appeal had been denied, we would have had to take this case to federal court — but the medical documentation of this case was clear — this man could not work, and Lincoln National finally saw that.”
In addition to the residual effects of his surgeries, the client is in constant pain and on pain medication which interferes with his ability to focus clearly to meet the demands of his job. The client was also awarded Social Security Disability benefits, which, Freedman said, was confirmation that he could no longer work.
“As experts in disability law, we know what is needed to establish the right to collect benefits, we confer with the claimants’ medical providers and obtain the proof needed to be successful,” Freedman said. “But the truth is, the client paid into both of these programs over his work career under the assumption that if he really needed the benefits they would be there for him.
“It is very satisfying for us to be able to ensure someone who can’t work will have an income that is sufficient to sustain them for their remaining years.”
After an initial LTD lump sum award of $80,000 dated back to August, 2011, when benefits should have been awarded, the client will receive approximately $5,000 a month in LTD benefits (with some adjustment for Social Security Disability benefits) until age 67.