From Denial to Reinstatement: Law Office of Justin C. Frankel, P.C. Secures Reinstatement of Wrongfully Terminated Short-Term Disability Benefits

At the Law Office of Justin C. Frankel, P.C., we routinely represent claimants whose disability benefits have been unfairly denied or terminated despite overwhelming medical support. In a recent matter, our firm successfully secured the reinstatement of a client’s short-term disability benefits after Sedgwick wrongfully terminated the claim based on an incomplete and unsupported review of the evidence. The case highlights the importance of a comprehensive appeal that focuses not only on medical records, but also on the real-world impact a disabling condition has on an individual’s ability to perform the duties of their occupation.

The Wrongful Termination

Our client had been receiving short-term disability benefits after becoming unable to work due to serious medically documented conditions. Despite continued treatment, ongoing symptoms, and supporting opinions from treating providers, Sedgwick terminated benefits before the client had recovered sufficiently to return to work. Like many disability claim terminations, the decision relied heavily on a paper review conducted by consultants who never personally examined the claimant and who discounted significant evidence from the treating medical providers.

The benefit termination failed to account for the totality of the medical evidence, disregarded documented functional limitations, and overlooked the actual requirements of the claimant’s occupation. Rather than conducting a balanced assessment, the claim administrator selectively relied on portions of the record that supported denial while minimizing evidence demonstrating continued disability.

Our Appeal Strategy

The Law Office of Justin C. Frankel, P.C. developed a detailed and evidence-driven appeal challenging every aspect of Sedgwick’s determination. Our team carefully reviewed the claim file and assembled a compelling record demonstrating that the claimant remained unable to perform the material duties of their occupation during the disputed period.

The appeal focused on several critical issues:

• Demonstrating that the treating providers consistently documented ongoing symptoms, restrictions, and limitations that prevented a return to work.
• Highlighting Sedgwick’s overreliance on non-examining reviewers whose opinions conflicted with those of providers who had personally evaluated and treated the claimant.
• Showing that the insurer failed to adequately consider how the claimant’s medical impairments translated into functional limitations in the workplace.
• Establishing that the denial was based on a selective and incomplete review of the record rather than a full and fair evaluation of all available evidence.
• Supporting the appeal with legal authority emphasizing the importance of considering treating provider opinions, subjective symptoms, and occupational demands when evaluating disability claims.

The Result

After reviewing our appeal submission and the extensive evidence supporting continued disability, Sedgwick reversed its prior determination and reinstated the claimant’s short-term disability benefits. The successful outcome ensured that our client received the benefits they were entitled to receive while continuing treatment and recovery.

Why We Were Successful

This victory reflects a principle that guides every disability appeal our firm handles, insurers and claim administrators must evaluate the entire claim record, not isolated pieces of evidence that support a denial. By presenting a complete medical narrative, documenting functional limitations, addressing vocational demands, and holding the claims administrator accountable to its obligations, we were able to demonstrate that the termination decision could not withstand scrutiny.

At the Law Office of Justin C. Frankel, P.C., we understand that disability claims are about more than paperwork. They are about protecting the financial security of individuals who are unable to work because of legitimate medical conditions. When benefits are wrongfully denied or terminated, our firm works aggressively to build a persuasive evidentiary and legal record that gives our clients the best possible opportunity to obtain the benefits they deserve.

Contact the Law Office of Justin C. Frankel, P.C. today for a free consultation (516) 222-1600 and learn how an experienced ERISA disability attorney can help protect your rights and maximize your chances of success.

Justin C. Frankel is the founder of the Law Office of Justin C. Frankel, PC, a Long Island, New York headquartered law firm representing clients nationwide in disability insurance claims. For more information please go to our website www.jfrankellaw.com.