Ellie H. was a 40 year old woman working in Human Resources. She was great at what she did.
Ellie was also born with spina-bifida, a condition arising during fetal/child development where the vertebrae don’t form properly around part of the spinal cord. These spinal issues have resulted in life-long chronic pain. But that never stopped her from working. She worked 20 years in the business and achieved the respect of her peers and employers.
Shortly after commencing a new dream job, she became ill with an infection. This infection led to a diagnosis of chronic fatigue. And it was incapacitating. She was forced to stop working only a few months into a job she loved.
She applied for short term disability benefits and her claim was accepted and paid. However, when it transitioned into long term disability, to her shock, the insurance company denied her claim.
The insurer denied the claim based on a pre-existing exclusion clause. The insurer said that her condition was related to her spina-bifida and therefore her LTD claim was denied based on a pre-existing exclusion clause.
Ellie’s doctors tried to explain to the insurer that the spina-bifida never stopped her before and the reason she couldn’t work was related to a different diagnosis – chronic fatigue. They didn’t listen to her or her doctors. A colleague referred her to McQuarrie Hunter. They took on her case and fought to get the benefits Ellie deserved. The disability lawyer at McQuarrie studied the exclusion clause and argued that the chronic fatigue was a new diagnosis and had nothing to do with her spin-bifida.
Pre-existing exclusion clauses and other policy terms, are often worded in a confusing manner making it very difficult for claimants and their doctors to know what needs to be proven to the insurance company. This is a very good reason to have an experienced disability lawyer review your claim when it is denied — for whatever reason. Ellie is sure glad she called McQuarrie.
McQuarrie has won many cases similar to Ellie’s.
Please note that that the client’s name was changed to protect her confidentiality.