How Roberts Disability Law Won an Appeal for a Client with Chronic Back Pain After a Failed Spinal Fusion Surgery

Our Client’s Long-Term Disability Claim

Our client, “Jim”, worked as a Director of Quality Control for a large commercial construction company. He was active, upbeat, and deeply dedicated to his job overseeing complex building projects. Unfortunately, after developing severe back pain, Jim underwent a spinal fusion surgery and later a hardware removal procedure. The surgeries, however, failed to relieve his pain — and over time, his symptoms worsened.

Determined to keep working, Jim returned to his position in a reduced capacity. His employer was exceptionally supportive, allowing him to work partially from home, skip meetings that required prolonged sitting or standing, and even providing a recliner so he could rest between tasks. Despite these accommodations, Jim’s chronic lower back pain with sciatica, muscle spasms, dystonia, and numbness in both legs continued to intensify.

Eventually, working became unsustainable. Jim underwent another procedure to implant a Biotronik dorsal column stimulator and pulse generator, hoping it would bring relief. Unfortunately, the results were limited, and his symptoms persisted. Reluctantly, Jim stopped working and filed for long-term disability benefits.

His insurer, New York Life (NYL), denied the claim, asserting that Jim was capable of performing the duties of his “regular occupation.”

Our Strategy on Appeal

Roberts Disability Law, led by attorney Monica Lienke, developed a comprehensive appeal strategy focused on demonstrating the credibility of Jim’s pain, the objective medical evidence of his limitations, and NYL’s flawed vocational analysis of his occupation under the policy terms.

Our team gathered updated treatment records, arranged for objective functional capacity testing, and provided custom-tailored questionnaires for Jim’s treating physicians to ensure detailed, consistent documentation of his limitations.

Jim’s employer provided a letter describing how physically demanding his role truly was, and friends, family, and former colleagues submitted supportive witness statements highlighting his strong work ethic and the toll his condition had taken.

Hiring a vocational expert can be a worthwhile investment in some cases, but in this case Monica was able to save the client from expending this additional cost by formulating a plan to submit the necessary vocational evidence through other means, which included guiding Jim in preparing a detailed declaration describing his specific job duties, collecting photographic evidence, and gathering relevant references from the Dictionary of Occupational Titles. This approach clarified the true requirements of his position and addressed NYL’s misclassification of his occupation.

The Outcome

Through a thorough, evidence-based appeal, our firm addressed every issue raised in NYL’s denial letter — and even anticipated additional arguments the insurer might raise. As a result, NYL reversed its denial, determining that Jim was in fact entitled to long-term disability benefits. His benefits were fully reinstated.

This case underscores the importance of a strategic, detailed approach to LTD appeals — combining strong medical evidence, clear vocational documentation, and advocacy that tells the client’s full story.

Need Help With a Denied Long-Term Disability Claim?

If your long-term disability claim has been denied or terminated, Roberts Disability Law can help. Our experienced ERISA disability attorneys have successfully represented professionals across California and nationwide in appeals involving conditions such as chronic pain, failed back surgery syndrome, and other complex medical impairments.