Long-term disability claims can be denied for various reasons but when it actually happens is can be shocking. Sonny was diagnosed with Type 1 Diabetes when he was just 14 years old. He spent his whole life being careful, a necessity given concerns around the long-term ramifications of the disease. Despite his best efforts, by the age of 42, he started to develop diabetic nephropathy, also known as kidney disease.
A mechanic, Sonny had to start making some concessions at work. Due to the kidney disease, he was having difficulty keeping up with the day-to-day activities that used to be a breeze. At first, the symptoms were manageable but as things progressed, he started to feel nauseous, suffered from shortness of breath, weakness, and started to become easily confused. He was retaining a lot of fluid which made moving around uncomfortable and sometimes painful. Sonny tried doing desk work, but eventually, he just had to stay at home.
As the kidney failure progressed, Sonny applied for long-term disability in order to go on dialysis and get on the transplant list for a new kidney. His claim was approved, and he was able to stay at home and conserve his energy while he went through treatment. Fortunately, his wife, Denise, was a match, and able to give him a kidney. They went ahead with the transplant, which gave Sonny a new lease on life, but he wasn’t out of the woods yet with a long recovery process. Unfortunately, his insurance company didn’t see it this way.
Six months after Sonny had the transplant, he was now deemed ineligible for his long-term disability benefits. They were to stop immediately. Because he’d had the transplant and no longer needed to be on dialysis or live with the symptoms of kidney failure, they believed he should be good to return to work. This was not the case.
“It can take a long time for transplant patients to return to work,” says Wendy Share, Executive Director at Share Lawyers. “Between the potentially drastic changes in lifestyle and the recovery process after receiving a transplant, it’s important to ease back into the workforce. Since Sonny’s job was so physically demanding, and the risk of infection was high, this was especially important.”
Cases like these are often dependent on having strong medical evidence to prove that the condition merits continuing time off work. There are also strict time limits to fight the insurance company’s decision. We were able to assist Sonny in gathering more medical information to support that he cannot return to work as a mechanic and were able to get his benefits back, including retroactive payments.