Denied After 10 Years of LTD Benefits for Adhesive Arachnoiditis
Our client was a manager at an insurance brokerage and employee benefit consulting firm in the Kansas City metro area. Her job was to assist corporate customers with benefit plans they offered to their employees, including long-term disability (LTD) plans. She had no idea that one day she would desperately need long-term disability benefits.
In 2008, our client began experiencing pain, numbness, and muscle spasms in her back and lower extremity. After working through the pain and treating conservatively for many months, her condition eventually worsened such that it prevented her from being able to work. She applied for long-term disability benefits under her employer’s plan with Lincoln Financial Group in late 2010. Our client was approved and received LTD benefits for roughly ten (10) years.
In 2011, she underwent a sacral (S2/S3) laminectomy to remove a large cyst that had entangled itself in and around spinal nerves. This is called a Tarlov Cyst and caused nerve compression, severe pain and numbness and other complications. Unfortunately, despite the laminectomy, out client’s pain did not resolve, and she continued to treat with steroid injections, physical therapy, and other pain management without any significant change in her condition.
In 2014, our client went to the Mayo Clinic in Rochester, MN. At the Mayo Clinic, she had a lumbar MRI both with and without contrast. The Mayo Clinic MRI was read by a board-certified neuroradiologist who diagnosed our client with Adhesive Arachnoiditis with clumping of the intrathecal nerve roots; and a surgical defect at the L5 level from her prior laminectomy.
Negative MRI Does Not Mean You Can Work
Adhesive Arachnoiditis a serious and debilitating spinal condition that occurs when inflammation of the spine nerve roots turn into adhesions “that merge or ‘glue’” together the cauda equina and the arachnoid-dural meninges of the spinal canal.
This adhesion causes dysfunction or death to the nerve root cells and results in severe pain and neurological impairments. This is a serious spinal condition that causes permanent impairments.
Logically, you would assume that this client would continue to receive her LTD benefits without any interruption. Unfortunately, that would be wrong.
After receiving LTD benefits from Lincoln Financial Group (LFG) for nearly a decade, LFG denied her benefits. The reason? Our client had a repeat lumbar MRI without contrast in 2020 and this MRI did not show any signs of Arachnoiditis. This resulted in LFG concluding that her condition was cured and that she could work in “any occupation”, including a sedentary one.
This was, of course, totally preposterous. Our client could not sit up for more than a few minutes without feeling excruciating pain. She was on numerous high-dose pain medications with serious side effects.
Filing a Long-Term Disability Appeal Against Lincoln Financial
When our client got the denial letter, she told us she did not know what to do. Her benefits were needed to survive and pay her bills. Fortunately, our client found our experienced long-term disability law firm. As an attorney focused on ERISA disability, our long-term disability lawyer has expertise in deep diving into the legal and medical minutiae.
We waded through the medical records and peer-reviewed journals and uncovered the real issue. Our client was not magically cured. The MRI that LFG relied on in making its decision was flawed. It was of insufficient quality and lacked the contrast element that is needed to identify our client’s spine condition.
We prepared an extensive appeal package that resulted in LFG reversing its denial on appeal. LFG paid all back benefits and reinstated our client’s monthly long-term disability benefits.
The lifetime value of this award will be in excess of $400,000.00.
How Our Long-Term Disability Attorney Can Help
If you have questions about long-term disability denials or appeals, call the Law Office of Kevin J. McManus at 816-203-0143. If you have been denied benefits, we will review your denial letter for free.
You can also download our free long-term disability book, Danger: Proceed at Your Own Risk. This guide shares insights regarding long-term disability appeals and why you should hire our long-term disability lawyer to handle such an appeal.