People who suffer an injury which prevents them from working often wind up depressed. In our client story this week, our client tried to lead a normal life in order to prevent that depression. But that created problems.
After a very serious brachial plexus injury, several cervical fractures, rib fractures and a clavicle fracture, our client was hospitalized and then admitted into rehabilitation for an extended period of time. He filed a claim for long-term disability benefits and the claim was paid. His policy did what it should – it provided him with income when he could not work.
But he was determined to get back to his job. The adjuster for the insurance company warned him that if he returned to work, it would be very difficult or impossible for him to receive disability benefits again. His hard work paid off. He was able to return to work. As a result, his long-term disability benefit was terminated. He understood but was happy to be back at work.
His job required him to travel across the entire southeast. Aside from excellent interpersonal skills, this sales job also involved climbing on roofs and carrying lengthy ladders. He was able to do this for several years. His condition deteriorated over the years. He was hurting. The pain was interfering with his thinking. He fatigued easily. He did not have good balance. His pain medication affected his mental sharpness and made him dizzy. It was dangerous for him to continue working.
He filed another claim for long-term disability benefits. The insurance company sent him to its doctor. The doctor found that he was disabled.
People who suffer an injury that prevents them from working often wind up depressed. But our client was not going to let that happen to him. He did what he could to maintain some semblance of a normal life, even though it was one fraught with limitations and the inability to work. He went shopping with his wife. He played golf. He drove his car short distances.
Undaunted by their own doctor's finding that our client was disabled, the insurance company hired a private investigator to follow and videotape our client. The reality was that our client could only play a few holes on the golf course and he didn't play well at all. He could only drive short distances. He could not walk long while shopping. Nonetheless, the insurance company used the video to refuse to pay the claim even though none of these leisure activities demonstrated an ability to carry around a long ladder, nor safely climb on roofs while on pain medication. They did not show how he could do anything meaningful on a full-time basis for which he had education, training or experience.
So, our client's attempts to lead a somewhat normal life even with a disability rather than to stay at home in bed depressed resulted in the denial of his benefits! That is not fair.
We were able to strengthen our client's case and present an effective appeal. The insurance company held firm. We filed suit in federal court. We were able to resolve the case to our client's satisfaction. Do the facts of this case sound familiar? We might be able to help.