matrix absence management better business bureau

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) Tuckpointers Local 52 Health & Welfare Trust, 281 F. 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). The outcome: payment of benefits to the client.įerrin v. We attended with the client to document what occurred, keeping the process credible, and resulting in the IME doctor agreeing our client was disabled.

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.

Combining these elements made the client’s case more credible, and resulted in Matrix overturning the denial. 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. 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 helped a client suffering from scoliosis get a denied long-term disability claim paid by Matrix Absence Management. Bartolic Law helps clients with claims reviewed by Matrix Absence Management at all stages.

Matrix absence management better business bureau