Evaluating a case is more than dollars and cents. After all, how do you value chocolate covered strawberries? The law is generally fair and just. But, sometimes logic doesn't apply. Watch this week's client story to see the multiple lapses in logic in the journey for justice.
Carol was a Customer Service Representative and a Technical Support Representative for a big cable company. She was very smart and very good at her job. She knew how to handle irate customers' technical problems very quickly and calmly. (Have you ever had a cable company problem?) She just had a knack for dealing with frustrated customers, and she knew the technical side, so her bosses loved her. She was the “fixer”.
However, health problems begin to plague the fixer. She developed fibromyalgia, and then carpal tunnel syndrome. It became impossible for her to keyboard all day. The pain distracted her from thinking clearly and calmly. At night she wanted relief so bad, she went straight to bed often without eating. She developed chronic obstructive lung disease and back problems. It seemed she was literally falling apart. She lost her “fixer” skill set and knew she could not keep working. As a result, she was forced to file a claim for long-term disability benefits under her company plan.
The medical evidence was so strong the insurer paid the claim. She continued receiving those benefits until Social Security had paid its disability benefit. The insurance company urged her … no coerced her by threatening to reduce her benefit … to file for Social Security disability. It hired a representative to represent her in fact. So, the insurer knew just when Social Security paid, because that attorney informed the insurer right after the hearing. So right when the Social Security Administration says Carol is disabled from performing any gainful occupation, the insurer decided Carol could perform a gainful occupation and no longer met the definition of disability. This was inexplicable except for the insurance company's financial motive to save money.
Her condition had not improved, and in fact now she was taking oxycodone as her pain was worse! To say Carol was furious is an understatement. To make matters worse, this termination came before Carol actually received her Social Security disability check. So, until the government sent monies (which can take a while) she had nothing to live on! That was so wrong.
Carol was devastated as well. She had grown children, but she did not want to be a burden to them. She had always taught them to be self-sufficient, to work hard, and to plan for that rainy day. Now she was in a rock and a hard place. To make it all worse, even if she won her long term disability benefit back, the Social Security benefits offset her long term disability benefit making the claim of very low value.
Carol begged us to help her, and despite the low value of the claim I agreed. I requested the claim record and found out what was going on behind the scenes. To buttress its determination, the insurance company hired a private investigator, who took some secret videos showing Carol shopping at a thrift store. (One of the few places Carol could afford to buy clothes.) The video only showed her slowly walking into the thrift store and eventually leaving after 30 minutes or so. The investigator did not follow her into the thrift store, so it did not see that she sat down shortly after she went in. She had only walked a few minutes when she sat down. Then she stood up and shopped a few more minutes. Nothing reflected the ability to work a job. Not that the ability to walk a few minutes means anything anyway!
Based on this video (and no doubt the timing of the Social Security decision) the insurance company terminated the benefit. No doubt the insurance company thought that no one would help poor Carol, because now her long-term disability benefit would be reduced by the amount of social security benefits received. Her case would have a very low value for the work necessary to win the case.
I presented an appeal to the insurance company. I was able to demonstrate that just because somebody could walk a few steps does not mean that she is fully capable of performing a job, especially with the problem that she had with keyboarding and pain. I obtained opinions from her doctors and fully developed the medical records with a nurse. The insurer, apparently believing we would not file suit over a low value case, refused to change its mind. But we had made her case strong and ready to take into court.
We filed suit, and eventually this case was resolved. While I worked for very little, Carol was very happy and one of the more grateful clients I have ever represented. She sent me a big box of chocolate covered strawberries much to my delight! Carol was very grateful that I fought for her just as hard as I would have fought for my own mother. Sometimes you must work hard for what right. I am glad Carol saw some justice. I am glad I made a friend for life!