6 Trial Lawyer • Spring 2023 Megan Glor By Megan Glor OTLA Guardian Liz called me at the recommendation of her estate lawyer. She explained she had left her 15-year career as a software engineer nine months earlier because of unbearable neck and back pain. She said her pain had exhausted her and she had struggled to perform her work duties. She had started bringing work home with her in the hope of catching up at night, unsuccessfully. She had, for the first time in her career, received negative performance reviews and got a sense her manager might be eying her for termination in an upcoming round of layoffs. Based upon her declining performance, Liz knew she was seen as a weak link in her department. She was stunned how far she felt she had fallen. Not only was she struggling at work, but increasingly, she was so exhausted from pain and the stress of her workplace struggles that she was not able to care for her young children as she always had or fully participate in family life. After a weekend of despair over an exacerbation of pain and her difficulties at work, Liz’s manager’s stinging comment about a missed deadline was the final blow. Liz had made an urgent appointment with her primary care physician, who agreed it was appropriate for Liz to leave work and submit a benefit claim through her employer’s group disability plan. The disability plan, Liz explained, was managed by an administrator and the assigned claim manager initially told Liz cheerfully that her claim should be “no problem.” Liz, however, quickly had a feeling things might not go well. The claim manager seemed disorganized. She claimed that medical records Liz knew had been submitted were missing. She also told Liz that historical medical records that documented Liz’s long history of chronic back pain, many rounds of physical therapy, orthopedic evaluations, chiropractic treatment referrals and a car accident that had made everything worse were unnecessary, because “the issue is whether you are disabled now, not back then.” Increasingly, things had felt “not right” and, Liz explained, she had begun to wonder whether she should hire a lawyer. During a particularly frustrating call, Liz told the claim manager she realized she might need a lawyer. The manager dissuaded her, explaining that the claims process is “simple” and “almost done.” When Liz’s claim was denied, the manager explained she could appeal, explaining, “all we need is a letter from you saying you appeal and explaining why you think the decision was wrong,” and added, “the process is designed to be simple for the insured.” Liz’s appeal was quickly denied. Liz’s condition had not improved and she now had the additional burden of having no income or benefit stream. Liz told me that she wanted to fight the claim denial. She explained that her doctors were on board and that she realized we might need an expert witness. She said she thought her complete medical history would also be helpful and that she had many supportive colleagues who would attest to her devotion to her career and obvious struggles that led to her departure from work. I had to break it to Liz that it was too late for any of that, and that there would be no consideration of additional information or testimony, no expert witnesses and no jury trial. Limited rights and remedies This is because Liz’s claim — through her group disability plan provided through private employment — was Financially Viable Employee Benefit Claims
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