Short & Long Term Disability Cases We’ve Won for Our Clients Against Guardian

An Industrial Die Grinder from Massachusetts tore his rotator cuff at work. He applied for Long Term Disability benefits, but there was a 365-day waiting period before benefits would be paid. After the waiting period expired, Guardian denied benefits, saying that the application was received two days after his disability had begun so he was not covered by the policy.

Upset at the insurer and his lost income, he called Fields Law for help. Our attorneys drafted a strong two-part appeal. The first part was entirely procedural: Guardian was reading its own policy wrong with regards to coverage. The second part was based on the strength of the medical record: our client was clearly disabled. Guardian reversed its denial decision. Our client received a lump-sum payment for back pay and ongoing monthly benefits.

An accountant from West Virginia seriously injured her shoulder in an accident at home. She had multiple surgeries, but ultimately regained only limited use of her right arm. She stopped working because she was in constant pain and had limited use of her dominant hand. Guardian, her insurance provider, approved her application for Long Term Disability benefits, and she received benefits for almost ten years until she received a letter saying that she was no longer disabled would no longer receive benefits.

Shocked that Guardian would stop benefits after almost ten years, she contacted Fields Law Firm to assist with an appeal. Our attorneys searched through our client’s medical records and found Guardian had ignored several comments from doctors. The Fields Law attorneys called our client’s doctors to write full reports so the insurance provider could not ignore them in the appeal. Ultimately, our client was awarded continuing Long Term benefits and a lump-sum payment for back pay.

Our team represented a worker who was unable to continue his job due to neurocardiogenic syncope. This syndrome an autonomic nervous system reflex disorder that causes the individual’s heart rate and blood pressure to drop, leading to fainting episodes. In discontinuing the worker’s benefits, the insurance company relied on the opinions of two doctors who had never even seen the man, but felt that he could perform sedentary work based on their review of his medical records. Additionally, the insurance company stated that restrictions, as provided by the treating doctor, were preventative in nature and not indicative of his ability/inability to perform gainful work.

The Fields Law team presented a strong appeal to the insurance company. We argued that our client’s restrictions were in place to prevent him from fainting and sustaining further injury and those restrictions did not preclude payment of benefits under his policy. The Fields Law team also gathered updated medical records for the client and illustrated that his condition had not improved since he was initially awarded benefits. Based on these efforts, the insurance company agreed to reinstate our client’s benefits.