Bartolic Law helps clients with claims reviewed by Matrix Absence Management at all stages. We helped a client suffering from scoliosis get a denied long-term disability claim paid by Matrix Absence Management. Matrix conducted a background check and surveillance of the client, using photos posted on social media to accuse the client of engaging in activities beyond the client’s reported limitations. We were able to pick apart Matrix’s analysis by digging into the investigators’ process, comparing it to the photos, providing a detailed explanation of any image, and combining the presentation with an objective and valid functional capacity evaluation demonstrating what the client could and could not do. Combining these elements made the client’s case more credible, and resulted in Matrix overturning the denial. In another case Matrix denied, it sent our client to an Independent Medical Examination to evaluate the client’s sciatic nerve pain, impairing the client’s ability to stand and walk, or even sit for meaningful enough amounts of time to hold full-time employment. We attended with the client to document what occurred, keeping the process credible, and resulting in the IME doctor agreeing our client was disabled. The outcome: payment of benefits to the client.
Matrix Absence Management often requires you to initiate your disability claim in its online portal. It is quick and convenient, but often causes people to open claims without guidance. The system will not even allow you to submit the claim unless you tell Matrix the date you are going back to work. If the date you choose is too soon, Matrix may use this against you, asserting you are no longer disabled. If you choose a date too long in the future, it may deny your claim.
Matrix Absence Management will often offer you free Social Security Disability assistance by one of its preferred vendors. These vendors handle a high volume of Social Security cases for Matrix, simultaneously trying to get your SSDI claim approved, and acting as a collection agent for Matrix. If the vendor asserts the wrong basis for your disability, such as mental health, Matrix may then limit your long-term disability benefits.
Ferrin v. Aetna Life Ins. Co., 336 F. Supp. 3d 910 (N.D. Ill. Sept. 28, 2018) (holding insurance policy’s grant of discretionary authority is void under Texas law due to certificate being issued after effective date of regulation, and policy renewing after effective date, and holding Plaintiff was disabled from Any Reasonable Occupation where treating doctors certify she can sit at the occasional level, and insurer’s consultants opine Plaintiff can sit frequently, as weighing all evidence together would make capacity likely at low end of frequent range at best).
Sadowski v. Tuckpointers Local 52 Health & Welfare Trust, 281 F. Supp. 3d 710 (N.D. Ill. Dec. 20, 2017) (holding plan was arbitrary and capricious in denying medical benefits for removal of spinal cord stimulator following a fall down the stairs and infection where plan argued the expenses were caused by the same injury as the car accident necessitating implantation of the stimulator years earlier)
Tassone v. United of Omaha Life Ins. Co., 264 F. Supp. 3d 867 (N.D. Ill. Aug. 30, 2017) (awarding client long term disability benefits denied by United of Omaha despite insurer’s doctor opining there was no objective evidence of functional impairment)
Suson v. PNC Fin. Servs. Grp., Inc., No. 15-CV-10817, 2017 WL 3234809 (N.D. Ill. July 31, 2017) (holding Liberty Mutual’s denial of client’s long term disability benefits was arbitrary and capricious where Liberty Mutual disregarded client’s carpal tunnel syndrome and relied on a vocational opinion to which client never had an opportunity to address before litigation)