Small Mistakes Cost Big Time

The idiom ‘the devil is in the details’ means that mistakes are usually made in the small details…including mistakes or inaccuracies in your medical records, especially when your disability benefits are at stake. Here’s the rub: you – and not your medical providers – are responsible for all medical record inaccuracies.

For our client Dean Burden that lack of oversight resulted in a denied long-term disability (LTD) claim. Luckily for Dean, he came to our office for help.

As a National Account Manager for a major carton company, Dean makes telephone calls, in-person visits and presentations to existing and prospective customers. Dean’s job requires about 20-25 hours of computer time, 5 hours on the phone, 15-hours driving and 5-hours of direct customer care weekly.

“I was always a very active person, personally and professionally. Slowing down was not in my DNA. With retirement approaching, my wife and I were thinking about the ‘next chapter’ in our lives. We planned to buy a large RV, get away from the humid summer months in Florida, and travel out west, where we planned to work summers at National Parks,” said Dean.

However, Dean’s active work and home life activities began suffering as a result of his chronic cervical and lumbar spine disease requiring increasing medical interventions. As his medical condition worsened and his daily pain increased, Dean’s employer couldn’t accommodate his increasing restrictions, and urged him to file a claim for short term disability benefits, which was approved by SunLife.

However, his LTD claim was denied because of an error in his medical records, a mistake that Dean had overlooked, and medical records are the key to proving a disability claim.

Dean didn’t realize that his medical records sent to SunLife showed that he had mentioned to his doctor that he “wanted to get a recumbent bike and take up trail riding.” Dean never mentioned buying a recumbent bike or taking up trail riding, but because his doctor documented it in his notes, which was included in each future visit, it appeared as a fact that Dean was riding a recumbent bike and trail riding.

SunLife seized on this small doctor’s note as their reason to deny Dean’s LTD claim, arguing that these activities were inconsistent with someone suffering a severe spinal disability.

After receiving the denial from SunLife, Dean says he was ready to file an appeal and asked his pain management physician for a disability lawyer he could trust with his case. “Without hesitation, she recommended that I contact Claudeth Henry, as my doctor had nothing but praise for her hard work and knowledge of medical issues like mine.”

When Dean came to us, we reviewed his medical records, discovered the discrepancy, and worked with his doctor to correct the physician’s note. On appeal we were able to flip the script by showing that owning a recumbent bike was not inconsistent with being disabled.

Armed with our research and supporting corrected medical records from his doctor, SunLife approved Dean’s LTD claim.

“I found Claudeth to be compassionate and caring, reviewing my case often with an open door should I have questions and I’m sure pleased with the outcome,” says Dean. Case Closed.