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Success Story: Sophie Gartner

How Unclear Medical Records Can Lead To Denied Claims

Success Story - Sophie | Share LawyersSophie, 43, is a senior investigator at a research institute. She loves her job, as it challenges her on a daily basis to think critically. An avid reader, fan of word puzzles and math problems, her mind is her livelihood as well as her pride and joy. That’s why it was so heartbreaking when she hit her head.

It was a long weekend in the summer and Sophie slipped on her friend’s dock when she was getting out of their boat. She came down hard, hitting the back of her head against the wood, and blacking out for nearly a minute. When she came to, her friends quickly took her to the hospital to make sure everything was okay. The emergency doctor did some tests and found a minor contusion. 

They told Sophie to rest for a day or two and then she would be fine, able to return to life as normal. Sadly, this wasn’t the case.

Immediately after hitting her head, she felt dizzy, nauseated and confused. The confusion started to settle after a couple of days, but the photosensitivity, nausea, and dizziness made even getting to work feel impossible let alone actually doing her job. She couldn’t focus, was getting easily confused, and, for large periods of time during the day, couldn’t read or write.

She took another week off and went to visit her family doctor who gave her some more details than the emergency department physician had initially. The contusion was a visible sign of a concussion, and she should have been spending this entire time resting instead of returning to work. The doctor warned that, without adequate rest, the concussion could get worse and even lead to postconcussion syndrome (PCS) which can take several months to treat as opposed to several weeks.

Sophie was referred to a neurologist and decided to apply for short-term disability. Unfortunately, her claim was denied with the insurance company stating there was insufficient medical evidence, unclear medical records from the emergency department that only mentioned a contusion of the brain and that, by returning to work after the injury, she was not ill enough to merit the benefits.

Unfortunately, insurance companies take returning to work very seriously, seeing it as a clear indicator of physical ability and wellness despite clients often returning to work due to incorrect diagnoses, or a lack of awareness as to their new limitations. This was the case for Sophie, but the insurance company wasn’t having it. Her physician tried to help with providing additional medical evidence, but her appeal was also denied.

Finally, Sophie’s mother saw an ad for Share Lawyers and decided to take control of the situation. While they thought they could manage to fight this denied claim on their own, it was proving all too difficult. Together, we were able to help Sophie fight for the disability benefits she needed in order to take enough time to fully recover and get rid of her symptoms, and finally, return to the work she loves full time.

*All names and identifying details have been changed to protect the confidentiality of all involved.