The Proof is in the Records

It’s always gratifying when I can help my client get the benefits they deserve even if my theory of disability is different than originally thought. Sometimes while delving into a client’s medical records to prepare an appeal of a claim denied for one reason, we discover another more convincing reason for overturning a denial. Such was the case of our client Al Cohen (a fictious name but a very real client), who was employed as a Physician’s Assistant at a regional hospital working as a First Surgical Assistant, assisting with neurosurgical cases, making hospital rounds, and evaluating and treating patients.

Al suffered from Multiple Sclerosis. When the COVID pandemic hit, his physician recommended a period of Family Medical Leave Act (FMLA) noting that he was at a high risk for contracting COVID-19. Following that advice, Al went on FMLA and filed a claim for disability benefits under the employer’s disability plan with The Hartford. The Hartford denied the claim advising that leaving work based on potential exposure to COVID-19 was preventative/precautionary in nature and not evidence of disability, and that given his chronic diagnosis, in the absence of any change in treatment plan, the severity of symptoms and the support for any restriction was not evident.

When we took on Al’s case, we requested all of his medical records and prepared a medical chronology and summary of those reports. In doing so we were able to show progression of his symptoms prior to the date he last worked.

We discovered that in the six months before he stopped working, Al had treated with a podiatrist for Hallux Rigidus, bilateral foot pain and hammertoe. In fact, the month before stopping work, his physician documented bilateral foot pain rated “10” on scale of 1-10, and that treatment attempts with brace and injections did not give relief. Al’s physician also documented his weakness with walking, morning stiffness, swelling, redness and bruising. She prescribed bracing, strapping, orthotics, and RICE (rest, ice, compression, elevation).

Based on his medical records, we were able to prove that Al was unable to walk or stand for an extended period of time which his duties as a Physician’s Assistant required. While Al’s medical records could not prove a work disability due to contracting COVID-19, we did prove he was disabled as a result of his orthopedic condition and Al received his disability benefits. Case Closed!