After appeal filed by Attorney Jay Symonds, Prudential overturned its previous denial of long term disability benefits for New York Financial Control Officer

Our client, Ms. L, formerly worked as a Control Officer for a large financial services institution. In May 2016 a number of medical issues, including Lyme Disease, babesiosis, Fibromyalgia, CFS, vertigo, vestibular dysfunction migraine headaches forced Ms. L to stop working and submit her claim for disability benefits, first under her employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. Both benefits were funded and administered by Prudential. Under her employer’s LTD policy, she would be considered totally disabled if she was unable to perform the main duties of her “own occupation” as a Control Officer.

After paying Ms. L for the maximum benefit period under the STD policy, which relied on a definition of total disability nearly identical to that in the LTD policy, Prudential denied LTD benefits on the basis that she allegedly no longer met the policy definition of disability. Specifically, Prudential stated that her “claimed conditions… are not supported by the medical evidence available…[and] no restrictions and/or limitations are supported by the physical/neurological examinations performed, on the imaging studies, on physiological studies or on the laboratory testing provided.” After receiving the denial, Ms. L contacted Dell Disability Lawyers and discussed her case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in Prudential’s denial letter and in the evidence it relied on and agreed to prepare and submit Ms. L’s ERISA appeal with the assistance of his appeal team.

The LTD appeal addressed all of Sun Life’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of Prudential’s denial and significant inconsistencies with Prudential’s medical reviewer’s findings. In particular, the appeal addressed Prudential’s unilateral dismissal of the opinions of Ms. L’s highly respected neurologist and infectious disease specialist and its incorrect suggestions that Ms. L’s clinical course was “atypical” and that her constellation of symptoms were “inconsistent” with her documented diagnosis. The appeal also focused on Prudential’s overly restrictive assessment and failure to address whether, regardless of cause, the medical records and treating physician’s medical records support the fact that Ms. L does suffer from debilitating symptoms that prevented her from working, which they clearly did.

Less than one month after filing the appeal, and after reviewing the appeal and hundreds of pages of exhibits and medical records, Prudential overturned its decision to terminate benefits reinstated Ms. L’s long-term disability benefits.


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Prudential Reviews
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Showing 8 of 27 Reviews
Prudential

California State Disabilty "OFFSET" never mentioned or outlined when enrolling for STD coverage.

Reviewed by MartyG on June 29th 2023   Verified Policyholder | May 2023 date of disability
All terms and conditions of receiving a claim benefit not made available when enrolling. Hidden elements of eligibility... not fully transparent with issues that might eff... read more >
Prudential

Prudential terminated my LTD, so now I have no income

Reviewed by Carlos M on June 10th 2022   Verified Policyholder
I was working at a shipyard at San Diego and hurt my back again while working. Hurt my back in the US Navy in 98 and had issues since then so I decided to get the surgery ... read more >
Reply
Sent on June 11th 2022 by Attorney Rachel Alters

Carlos, yes we may be able to help. Please email your denial letter to Rachel@diattorney.com and cc Amanda@diattorney.com. Thank you.

Prudential

Prudential cancelled my policy amid COVID crisis

Reviewed by Patricia M. on September 15th 2020   Verified Policyholder
In the mist of the covid crisis Prudential decided I needed to prove my disability, yet again. I have been physically disabled since 10/31/1989. I now know that I have bee... read more >
Reply
Sent on September 15th 2020 by Attorney Jay Symonds

Patricia: This is a terrible situation. You likely have a right to appeal the decision. I suggest you contact our office and speak with one of the attorneys to discuss ... read more >

Prudential

I was sold a policy that I cannot use and no one will show me the policy

Reviewed by Jacqueline G. on August 18th 2020   Verified Policyholder
I had Prudential STD and LTD through my employer. I received my STD with no problem. Started receiving LTD for a while, then Prudential said I owed them because I receive ... read more >
Reply
Sent on August 18th 2020 by Attorney Stephen Jessup

Jacqueline, in many cases a disability carrier cannot offset for SSDI benefits that were in place prior to the date of disability under the applicable policy. Your empl... read more >

Prudential

Prudential verbally approved my claim and then sent me a denial letter

Reviewed by Jacquieline C. on April 3rd 2020   Verified Policyholder
I have been denied twice from Prudential for my LTD case. Back injury 2009 – knee injury 2011. Back doctor took me out of work (July 2018) due to me working 35 hrs per w... read more >
Reply
Sent on April 3rd 2020 by Attorney Jay Symonds

Jacqueline: Sounds like you have a pretty complex medical situation. And the fact that they verbally approved your claim over the phone then sent a denial letter is unu... read more >

Prudential

It would cost me more to fight Prudential than to let them get away with their games

Reviewed by Tim W. on December 9th 2017   Verified Policyholder
I’ve been thru all the same things everyone complains about here. I’ve always been one step ahead of their game due to research. I just got notice they are stopping my... read more >
Prudential

Prudential told me I would have a decision today, and now the need another week. Guess what, I'm still broke

Reviewed by Cancer Patient on June 22nd 2017   Verified Policyholder
Just called them and now they need another week and a half so they can do an occupational review on my job description or something like that. Even though the case manager... read more >
Reply
Sent on June 22nd 2017 by Attorney Stephen Jessup

DL, many state insurance commissioners will not get involved in ERISA governed disability insurance policies as these polices are governed under federal law. Please fee... read more >

Prudential

Prudential is the most dishonest and immoral company ever!

Reviewed by Marie C. on April 5th 2017   Verified Policyholder
Prudential is the most dishonest and immoral company ever! My husband has been on LTD with them for a few years. In December they sent a letter asking for $11,000 back. He... read more >
Answered Questions by Our Lawyers
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Showing 8 of 38 Answered Questions

Q: What can I do about my long term benefits that’s ending after 2 years?

Answered on June 6th 2023 by Attorney Gregory Dell
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Q: My mother paid many years for a long-term care policy. When she had to be put in an assisted care facility, Prudential won't pay. Do you accept cases like this?

Answered on March 23rd 2023 by Attorney Gregory Dell
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Q: Can I sue my PRUDENTIAL LTD for the cost of hiring a disability attorney to get my benefits reinstated?

Answered on June 1st 2020 by Attorney Jay Symonds
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Answered on February 16th 2020 by Attorney Cesar Gavidia
A: Kathy, it depends on the terms of your disability insurance policy. Refer to your disability insurance policy ... Read More >

Q: Is it best to hire an attorney first and then file a complaint with Indiana Insurance License Board or do both? How long does it usually take to resolve a case like this?

Answered on September 5th 2014 by Attorney Stephen Jessup
A: Jenny, if your claim is denied a lawsuit is to be filed in Federal Court. The Indiana insurance board does not... Read More >

Q: Can I fire Allsup and owe them nothing?

Answered on August 27th 2019 by Attorney Jay Symonds
A: ItisMe, the terms of your relationship and obligations with Allsup would be spelled out in the contract/agreem... Read More >
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