Insurance Company Denies Benefits for Client with Bipolar Disorder

Lester, 31 years old, grew up suffering from ADD and cluster migraines. His symptoms were manageable throughout childhood and even adolescence, however they got more difficult as he aged. Lester never imagined he would be diagnosed with bipolar disorder, let alone have his benefits denied.

Lester trained as a computer software salesman, found a job, and worked his way up the ladder at a company he respected. Sometimes, though not often, cluster migraines would affect his productivity; when this happened he had to go home from work and spend time away from a computer screen. In 2015, Lester was making a six-figure salary for the first time in his life, but with this compensation also came an intense pressure to excel in his job. He worked harder than usual to keep his ADD and migraine symptoms in check, as he didn’t want them to affect his work.

Panic Attacks Started

Soon after his latest promotion, Lester began to experience panic attacks before going to work in the morning. He immediately went to a medical specialist so he could understand what was happening to him. After being diagnosed with generalized anxiety, he tried several different medications to find the best fit. He also started attending his counselling sessions.

Despite all of this, Lester still felt like he wasn’t getting the care he needed, and his symptoms began to interfere at work. When he began to look for alternative treatments for his anxiety, he started smoking marijuana as a method to cope. His mother, whom he lived with, began to notice the Lester was becoming slow and lethargic, sleeping much of the time and not leaving the house unless he was going to work. He was also angering more easily than usual. Lester’s mother assumed that these changes in his son’s behaviour were due to his marijuana consumption.

Lester Was Arrested

One evening while driving home from work, Lester was pulled over for speeding. He was charged for driving under the influence and possession of marijuana, after the police searched his car. He was released on bail, but now he was facing criminal charges.

After his arrest, Lester’s symptoms seemed to worsen. He began acting erratically and spent much of his time out of the house. He was exercising a lot and posting a lot of confusing things on his Facebook and Instagram. His mother suggested that Lester go to another medical specialist in order to get a second opinion. A second doctor diagnosed Lester with Bipolar Disorder, claiming that he had likely developed the condition earlier in his adolescence and was only recently seeing an increase in symptoms.

After receiving this additional diagnosis, Lester made the decisions to take time off of work. The computer software’s group benefit insurance plan was quite good, and his claim for long-term disability benefits was quickly accepted. Lester was relieved that he could focus on managing his mental health and overall well-being.

Benefits Denied

Two years had passed, and Lester was on the right track. He had used this time to seek talk therapy treatment, and was recently trying meditation in the mornings and evenings. He got a rude awakening in April when his monthly disability cheque was replaced with a notice of benefits denied, so his benefits were stopping. The insurance company believed that Lester was no longer eligible for benefits, because it was beyond the two-year time period, and that he would be able to work another occupation.

Lester was crestfallen. He believed that he was finally getting somewhere with his methods of treatment. He knew there was no way that he could find a new job in his field of training that paid as well as his job with the computer software company. Benefits denied was not an option.

Free Consultation With Share Lawyers

Lester tried doing research online, but was getting nowhere. One day while in his doctor’s waiting room, he stumbled along a Share Lawyers brochure and was intrigued. He gave Share Lawyers a call, and scheduled a free consultation with the firm.

After assessing his medical documents and working closely with Lester’s medical professionals, Share Lawyers was successful negotiating a favourable settlement. Lester felt so grateful and relieved that he could return to his scheduled appointments and treatments.

*All names and identifying details have been changed to protect the confidentiality of all involved.

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