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Dell & Schaefer Disability Lawyers Discuss Importance of a Functional Capacity Exam and Proper Analysis of Injuries Under the War Exclusion

In this video, disability attorneys Gregory Dell and Victor Peña discuss a case Mr. Peña won against MetLife for a claimant who came to us after his first appeal to MetLife was denied and his then attorney refused to continue. The man worked in a job that was classified as “light duty,” even though it required him to stand for long periods of time, lift heavy items, and work with tools. He suffered from back conditions, carpal tunnel syndrome, knee injuries and had other symptoms that interfered with his ability to work in his own occupation.

His initial claim for benefits was denied. MetLife said his medical records did not support functional impairment from working in his own occupation. He appealed and he was again denied, but on different grounds than the original denial. This time, MetLife found his medical records did support a functional impairment, but it was due to a knee injury and other medical conditions that were excluded as service related war injuries. Since this was a different reason than the original denial, MetLife allowed a second appeal.

This is when we took over the case. We submitted medical evidence to document his claim that he was impaired. A functional capacity exam (FCE) confirmed he could not perform the duties of his own job. His treating physician was able to tie those test results back to the time of his original claim, and conclude that he had these same impairments at that time.

We also proved that his knee injury occurred during a training exercise, not in war, and that most of his medical problems were outside the wartime exclusion. This time, MetLife agreed and awarded him LTD benefits.

If your disability insurance carrier has denied your benefits, please contact attorneys Dell & Schaefer for a Free Consultation.

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