How Roberts Disability Law Secured Reinstatement of Long-Term Disability Benefits for Client with Multiple Lumbar Spine Conditions

The Client’s LTD Claim

Our client, “Jane,”  had been working as a Program Manager at Splunk, Inc. a software company that provides a search-engine platform for searching, monitoring, and analyzing machine-generated data, when she became disabled due to lumbar disc disease, lumbar spondylosis, lumbar radiculopathy status post four lumbar surgeries, sacroiliac joint dysfunction, trochanteric bursitis, and right shoulder impingement. After a 180-day Benefit Waiting Period, Splunk’s disability carrier, Standard Insurance Company, approved and began paying Jane long-term disability (“LTD”) benefits.

Five years later, Standard ordered updated medical records from our client’s physiatrist and orthopedic surgeon but did not request any updated physician statements of disability. The last statement from the physiatrist, which Standard had on file, dated back almost four years prior, and documented severe, persistent pain even with prescribed medications, significant limitation in Jane’s daily activities, limited range of motion, inability to drive, and inability for claim to sit/walk/stand for any extended periods at a time. Without seeking updated input from the physiatrist, Standard forwarded the medical records to a peer physician for paper review. Standard made no attempt to have our client evaluated in person, opting to rely on just a review of medical records.

Despite acknowledging the unchanged condition in her “chronic” conditions, Standard’s reviewing physician concluded that our client could return to a sedentary occupation with frequent sitting. Armed with these broader restrictions and limitations, Standard’s vocational assessment concluded that Jane could now return to her own occupation as a program manager and terminated benefits.

Our Strategy on Appeal

Our team, with Kristin Kyle at the helm, outlined an appeal plan that would focus various types of support for Jane’s ongoing disability and entitlement to LTD benefits. Striking to us was Standard’s sudden about-face about Jane’s ability to do her own occupation after agreeing that she was disabled for the past five years, and there were no significant improvements in her condition. On appeal, our team compiled the following (1) updated treatment records documenting ongoing pain and physical limitations; (2) objective testing and physician support for ongoing total disability; (3) the related Social Security Disability (SSDI) award and underlying basis therefor; and (4) detailed declarations of Jane, family members, and other third parties outlining the nature and extent of Jane’s ongoing functional impairment. Functional testing objectively confirmed what our client’s doctors had been certifying (and documenting in treatment notes) all along, that Jane remained unable to perform even a sedentary occupation.

Moreover, with regard to Jane’s SSDI award, we cautioned that while Standard encouraged and even offered assistance to our client in submitting her application, it did not give the approval any meaningful consideration of the facts. Courts reviewing ERISA-governed LTD matters have noted that insurance companies are not bound by SSA’s determination, but an insurance company must explain why their decision departs from the SSA’s decision.

Outcome

As a result of our detailed assemblage of both objective and subjective evidence to support Jane’s ongoing disability, Standard was forced to reinstate ongoing total disability benefits. We represent Jane in her ongoing claim with Standard to ensure that Standard pays her as long as she remains disabled.