Our client for this long term disability appeal was a telephone sales consultant who developed interstitial cystitis, a bladder condition that causes urgent and frequent urinary pain. In 2012, she applied for long-term disability benefits through her employer’s ERISA disability plan.

Her initial claim made without counsel was denied. After retaining counsel an extensive administrative appeal, identifying the ways in which her condition was hindering her ability to perform her occupational duties, was prepared. As a result Reliance, the carrier, reversed its initial decision and reinstated benefits for our client. 

However, in 2014, the definition of disability changed from “unable to perform your own occupation” to “unable to perform any occupation.” This led Reliance to once again terminate the claim, after reviewing additional medical records. While no improvement in her condition was cited, Reliance felt that while maybe not her job, there was some type of job that our client could do instead. 

Our long term disability appeal argument:

  • Given the fact that our client could not perform her own occupation (which was already sedentary in nature), there was no substantial change in the disability definition that would warrant termination of benefits.

Reliance reinstated benefits, with a future lifetime value of $488,965.