Verdicts and Settlements

At the time of the events in this case, our client was 60 years old and, due to a wide variety of medical problems, was feeling every one of those years. However, as a proud worker who loved her relatively new job, she was determined to continue working and perform her duties as a Regional Account Executive to the best of her abilities.

Her job was a quota-driven position that required constant travel. She spent Mondays in the office, but from Tuesday through Friday, she drove hundreds of miles to meet with large clients. When traveling throughout her territory, often staying overnight in impersonal hotels, she gave presentations and conducted performance reviews while also drafting reports, responding to emails, and keeping up with Salesforce logging. She typically met with four to six clients per day, starting around 9:00 a.m. and finishing as late as 10:00 p.m.

These visits and presentations required her to carry a laptop bag and heavy printed materials in boxes. She was expected to be on her “A game” at all times, looking presentable, appearing professional, and remaining upbeat, sharp, and fully engaged with upper management clients.

Unfortunately, over time, her arthritis and joint pain made it increasingly difficult to manage the demands of her job. She began to struggle with concentration and focus due to pain and fatigue. Eventually, she reported that “my whole body hurt,” and the physical and cognitive demands of the job continued to worsen her symptoms.

Our client attempted to manage her symptoms on her own by taking ibuprofen and applying topical creams to reduce soreness in her hands. When she returned to her hotel, she used ice packs and heating pads. She tried to find relief through rest, but her neck and back symptoms did not improve. The pain significantly impacted her ability to get a restful night’s sleep, which compounded her symptoms. Eventually, she had to acknowledge that she could no longer continue working. She explained her symptoms to her doctors, who placed her off work.

She then filed a claim for long-term disability benefits under the insurance policy offered by her employer. Initially, the insurance company approved her claim for disability benefits. However, when one of her doctors completed a form stating that she could return to work, the company quickly denied her claim.

After the denial, she contacted Donahue & Horrow for assistance with the appeal that was required before initiating a lawsuit. Michael Horrow and his team handled the appeal, gathering evidence to support her claim and submitting it to the insurance company for review.

For example, the doctor who initially stated that she could return to work later reversed his opinion and explained why. That reversal, however, was not enough to convince the insurer that she had been disabled during the entire period. The insurance company was also not persuaded by the other evidence submitted in support of her appeal, including, but not limited to: (1) the results of a functional capacity evaluation stating that she could not sit long enough to perform even a sedentary job, let alone one requiring travel; (2) MRI and X-ray findings showing that her back pain was caused by cervical disc degeneration, cervical radiculopathy, cervical degenerative disc disease, spinal stenosis, neural foraminal impingement, and osteoarthritis; and (3) the fact that she was scheduled for back surgery.

Instead, the insurance company relied on the opinions of its paper review physicians who, in violation of Ninth Circuit case law, concluded that because she could perform unrelated activities such as walking and going on vacation, she must also be able to return to full-time work.

When the insurance company refused to reverse its decision, an ERISA lawsuit was filed on her behalf. In a detailed complaint, Michael Horrow laid out the primary evidence establishing that she was disabled. Eventually, the parties agreed to participate in mediation with a neutral, third-party mediator. With the assistance of that mediator, the parties reached a settlement that resolved the litigation to the client’s satisfaction.

Insurance companies have hundreds of lawyers at their disposal. If you are going to challenge an insurance company, you need the help of a law firm like Donahue & Horrow LLP that has decades of experience fighting insurance companies. Donahue & Horrow are ready to fight for the benefits you deserve. Call (877) 664-5407 for a free consultation.