When Guardian Life abruptly terminated one of our client’s long-term disability (LTD) benefits, we knew we had a fight on our hands. Her case illustrates the importance of challenging insurers who unfairly deny claims based on benefit limitations for mental and nervous conditions—and why having experienced legal representation can make all the difference.
Our Client’s Story
For two years, our client received LTD benefits from Guardian due to her inability to work. However, Guardian decided to terminate her benefits, citing a 24-month limit (or maximum benefits payable under the policy) for mental health conditions. They claimed that her PTSD and ADHD were the sole basis for her disability, despite her extensive history of serious physical conditions, including:
- Chronic facet joint syndrome
- Cervical myelopathy
- Peripheral neuropathy
- Barrett’s esophagus
- Cervical stenosis
- Migraine headaches
Having conveniently ignored her significant physical impairments, it was clear to us that Guardian’s decision was unjustified.
Our Appeal Strategy
We used our years of experience to prepare an appeal strong enough to challenge Guardian’s denial. Here’s how we approached the process:
- Focusing on Physical Impairments: We demonstrated that our client’s physical conditions—not just her mental health diagnoses—were independently disabling. By submitting extensive medical records, we left no doubt that her physical limitations prevented her from performing even sedentary work.
- Exposed Flaws in Guardian’s Evaluation: We carefully analyzed Guardian’s decision and pointed out its errors, including its failure to consider the full extent of our client’s impairments and its reliance on outdated or incomplete medical opinions.
- Utilizing Expert Testimony: We worked with her treating physicians and other specialists to obtain compelling medical opinions and vocational evidence demonstrating her inability to return to work in any capacity.
Our Results
In light of the overwhelming evidence we presented, Guardian reversed its decision and reinstated our client’s long-term disability benefits. This victory ensured that she would continue to receive the financial support she needed to focus on her health and well-being. We recovered nearly five figures in past due benefits and the potential for over $100,000 in future benefits.
Don’t Let a Long-Term Disability Denial Take Away Your Financial Security
If your long-term disability benefits have been denied or terminated, you don’t have to accept the insurance company’s decision. At the Ortiz Law Firm, we have the experience and knowledge to take on even the largest insurers and will fight for the benefits you deserve.
Contact us online or call us today at (888) 321-8131 for a free case evaluation. Don’t wait—your financial stability and peace of mind are too important to leave in the hands of an insurance company. Let us help you fight back.