Physician Assistant Wins Disability Appeal Against Guardian

At the Law Office of Justin C. Frankel, P.C., we recently secured the reinstatement of long-term disability benefits for a client after Guardian wrongfully terminated her total disability claim. Our client worked as a Dermatological Physician Assistant, a highly demanding occupation that required continuous use of her dominant upper extremity, precise fine motor control, steady hand-eye coordination, repetitive procedural work, and the ability to safely perform biopsies, excisions, suturing, injectables, and other hands-on dermatologic procedures throughout the workday.

How Guardian Wrongfully Terminated the Disability Claim

When Guardian terminated the claim, it attempted to minimize the significance of the medical record and the real-world physical demands of the occupation. In our appeal, we demonstrated that the insurer’s decision was not based on a fair and balanced assessment of the evidence, but instead on selective review, insurer-favorable opinions, and a failure to properly evaluate the occupational duties at issue. We showed that the claimant’s treating physicians consistently supported disability, that the medical evidence documented ongoing right shoulder instability, weakness, loss of range of motion, sensory deficits, and chronic pain, and that these restrictions directly prevented her from performing the material and substantial duties of a hands-on Dermatological Physician Assistant.

The Link Between Shoulder Impairment and Occupational Function

Our appeal focused not only on the medical proof, but also on the critical connection between the client’s impairments and the requirements of her profession. A hands-on Dermatological Physician Assistant cannot safely function without reliable shoulder stability, arm endurance, dexterity, precision, and sustained procedural control. We emphasized that this was not a generic sedentary or light-duty job, but a specialized clinical role where even modest deficits in strength, sensation, coordination, and repetitive arm use can make patient care unsafe and occupational performance impossible. By tying the objective findings and treating-provider opinions directly to the claimant’s occupational duties, we were able to dismantle Guardian’s rationale and show why the termination could not be sustained.

Exposing Guardian’s Selective and One-Sided Review

We also challenged the insurer’s reliance on selective and biased review. Our appeal established that the totality of the record supported continued disability and that the claimant remained unable to perform her own occupation with safety, reliability, and reasonable continuity. We carefully outlined the insurer’s failure to properly consider the treating physicians’ restrictions, the functional consequences of the documented shoulder pathology, and the vocational significance of losing the ability to perform fine motor, hands-on dermatologic work. In doing so, we presented a clear, evidence-driven basis for reversal.

The Result: Guardian Reverses Its Wrongful Determination

As a result of our comprehensive appeal, Guardian reversed its wrongful determination and reinstated our client’s long-term disability benefits. This successful outcome reflects what our firm strives to do in every disability case: identify where the carrier got it wrong, develop the medical and occupational record with precision, and force the insurer to confront the full reality of the claimant’s inability to work.

At the Law Office of Justin C. Frankel, P.C., we are proud to fight for professionals whose benefits have been unfairly denied or terminated, and this result is another example of our commitment to holding disability insurers accountable and securing the protection our clients are owed.