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Long Term Disability Benefits Claim - Case Study

*Names have been fictionalized to protect the privacy of our clients.

Nelson Alvarez - Disability Claim Denied

Faced with stress at work and numerous personal problems, Nelson was having trouble coping. Initially his employer had been understanding and under the Group Disability benefits he had at work, he applied for short-term disability on the recommendations of his family doctor and psychiatrist, who felt some time away from his daily stress would help him find a way to cope again.

The whirlwind of difficulties in Nelson's life did not disappear while he was away from work, and in fact, matters became worse. Nelson's anxiety and depression deepened. With this came more frequent visits to his doctors and higher levels of medication. At the conclusion of his short term disability coverage, he applied for long-term disability benefits, and after several months, without payments coming in, his claim was denied. The insurer said they would review his case if further and new medical evidence could be provided, but they were not satisfied that his condition was sufficient reason for him to be absent from his job as a social worker in a large government institution.

Submission of further medical evidence was met with similar denials and requests for additional information. Nelson was at the end of his rope when he decided to contact Share Lawyers.

After gathering medical records, policy information and other relevant data, a lawsuit was commenced on Nelson's behalf. It was explained to Nelson that pursuing the matter would take time and would be difficult. Within a year of retaining Share Lawyers, a private mediation had been arranged, and during an all-day session a settlement of $125,000.00 was negotiated. This enabled Nelson to pay off his debts and provided him with some security while he sorted out his personal and work-related problems. He now had some hope that he could put the pieces of his life back together.