Approval in Ft. Pierce, FL
Another approval, this time out of Ft. Pierce, FL. Client came to us with a denial of benefits from MetLife, suffering from medical conditions including Right side immobility, impaired cognition and memory, sleep apnea, hypertension, diabetes II, and a cardiac condition requiring a heart monitor. The disability insurance company acknowledged in the denial that client suffers from “residual weakness, difficulty with driving, ongoing fatigue, poor sleep hygiene, stress relating to the loss of a family member, and feelings of slow cognition”, yet went on to deny her stating that she showed a lack of participation in her care by not going to a referral of a neuropsychologist. It went on to state that having no neuropsychology records available for review “created a lack of data supporting ongoing physical impairments”. That is, lack of records from a doctor specializing in psychological disorders, was deemed sufficient cause to deny a claimant for physical conditions.
The client did, however, attend and complete Occupational Therapy as well as Physical Therapy, in addition to continued treatment with her regular physicians treating her physical conditions.
Despite the insurance company cherry-picking one line in a single visit to deny her benefits, our office gathered medical evidence and support from her doctors and submitted a 271-page appeal, which resulted in the reversal of the denial of benefits and client being paid on approval.