In this video, disability attorneys Gregory Dell and Victor Peña talk about a case won by Mr. Peña in a second appeal for a man who suffered with back and knee injuries as well as carpel tunnel syndrome. The man claimed he was unable to work in his own occupation which was classified by a vocational assessment as a light-duty occupation.
His initial claim was denied on the grounds that his medical record did not support his disability claim. On appeal from that denial, MetLife acknowledged the medical records supported functional impairment, but that his injuries were not job-related. They were related to his time in the military, so they were excluded under the war injury exclusion of the policy. Since the denial on appeal was for a different reason than the initial denial, MetLife allowed a second appeal. His attorney then left the case and the injured man then hired Victor Peña at Dell & Schaefer.
For the second appeal, we had him take a functional capacity exam (FCE), which confirmed he was unable to work in his own occupation. His treating physician was able to tie the results back to the time of the initial denial of benefits, and show how he suffered from those same limitations at the time of the first denial. This was a major reason for our success on appeal.
We were also able to show that most of his medical conditions did not occur during war time, so should not be excluded. For example, his knee injury occurred during a training exercise, not during war.
If your disability insurance claim has been denied or if you need assistance on a similar matter, please to contact Attorneys Dell & Schaefer for a Free Consultation.