A Sales Representative for a cable provider became totally disabled due to chronic back pain, caused by bulging and herniated discs in his lumbar and cervical spines. After 24 months of paying benefits, his insurance company terminated his benefits because the policy’s definition of disability changed from whether one was disabled from performing his Own Occupation to disabled from performing the material duties of Any Occupation, claiming that he could perform sedentary work and specifically alleged he had transferable skills to perform the occupations of Dispatcher and Service Clerk. Confused by this logic, he approached Fields Law for help with less than 30 days remaining to submit an appeal. Our attorneys immediately reached out to New York Life to request a 45-day extension to submit his appeal, which was granted.
Based on our experience, we knew that New York Life had not performed a significant vocational analysis and had failed to appreciate how our client’s chronic pain and limited range of motion impaired him performing even sedentary work on a competitive basis. We sent our client’s file to a vocational expert who conducted a national and regional job outlook study and determined that the positions of Dispatcher and Service Clerk were not appropriate occupations for our client based on his age, education, work history, and experience. The Fields Law team quickly gathered the necessary evidence and drafted a strong appeal for our client. New York Life reversed its denial decision, issued the back-pay benefits our client was owed and resumed paying his monthly benefits.
