Case Number: 2019-001878-pending placement

In Consumer Fraud

Route 91 shooting survivor is seeking a consultation regarding her discontinuation of long-term disability benefits provided by employer insurance. The client had a pre-existing ankle condition which significantly affected her mobility prior to 1 October, and she consequently worsened this condition when she ran for two miles to escape the violence. Towards the end of 2018, client switched orthopedic providers and the disability insurance was not timely provided with certification of client’s continued disability. The client’s case was closed and appealed, providing the client with the opportunity to submit the needed medical documentation. However, the appeal decision still remained unfavorable: despite certification from the client’s orthopedic doctor, a validating and concurrent review from the disability insurance’s third-party physician, and an ankle procedure that would occur less than one month following the final appeal decision, the client’s benefits were not reinstated. Disability provider instead concluded that the client can return to her previous employment and, per the insurer’s own occupational analysis, seemingly misclassified the level of physical demand which the client would be expected to perform in the specific course of her employment.

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