Dell & Schaefer Successfully Appeals Denial Of Benefits To Former Trial Attorney

Gastrointestinal issues are very common and often conditions that people don’t like to discuss in detail. They are also often downplayed by disability carriers as conditions that are not disabling as long as the claimant can take bathroom breaks. Insurance companies will regularly ignore the secondary issues that come along with having even minor gastrointestinal problems.

One of our clients recently contacted us after receiving a denial letter from her disability carrier, Prudential Insurance Company of America. Prudential had concluded – based on a paper file review by a doctor Board Certified in Gastroenterology – that Ms. E had the ability to work as long as she could take bathroom breaks.

Unfortunately, Prudential and its reviewing doctor had grossly underestimated the debilitating nature of Ms. E’s condition.

Ms. E, a senior trial attorney for a large company, was forced to stop working due to Stage III Rectal Cancer for which she underwent a partial resection and chemotherapy and radiation. The treatment, while successful, left her suffering from chronic Radiation Enteritis as well as cognitive limitations resulting from the chemotherapy – a common condition known as chemo brain.

As a very successful attorney with a lot of experience handling complex cases Ms. E took on the task of handling her own administrative appeal with Prudential. After several months she realized that handling the appeal on her own was an overwhelming task when at the same time she was suffering from chronic debilitating medical conditions. She was having a hard time sifting through the over 2,000 page claim file provided by Prudential and could not understand how Prudential could have denied her claim.

As the deadline drew closer she realized she could not handle the appeal on her own so she contacted our firm. During the first call it became clear to us that Prudential had improperly denied Ms. E’s claim. However, there were only three weeks remaining before the appeal was due.

Despite the limited time frame, we agreed to take on the case and immediately began working on the case.

Prudential had relied primarily on a paper file review by a gastroenterologist who downplayed the very severe symptoms suffered by Ms. E as a result of her Radiation Enteritis. It was clear that Prudential had to be made aware of their gross underestimation of the effects from this debilitating condition. What’s more, Prudential had completely ignored the well documented cognitive limitations suffered by Ms. E that prevented her from returning to work in her occupation or any occupation for which she was reasonably qualified.

We quickly gathered the medical records that could be assembled in the limited time frame and reviewed the deficiencies in Prudential’s review. The team was able to elicit several responses from treating physicians in time to submit the appeal to Prudential.

Within two weeks of submitting the appeal, a faxed letter was received from Prudential overturning the denial – one of the fastest decisions seen from Prudential on Appeal. Apparently, Prudential had another gastroenterologist review the same file – along with the evidence generated during the appeal including the responses elicited from the treating physicians. This gastroenterologist recognized the severity of our client’s condition and provided a report attesting to that.

Based on the appeal and the new doctor’s opinion report, Prudential has reinstated our client’s claim and will continue to pay benefits.

This claim is a perfect example of how easy it is for an insurance company to downplay the disabling nature of a condition related to gastrointestinal issues. Chronic Radiation Enteritis can be a severely debilitating condition that would affect anyone’s ability to work, regardless of the occupation.

If you have a similar claim with Prudential or any other disability insurance company please feel free to contact our office for a free consultation.

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FAQ

Do you help Prudential claimants nationwide?

We represent Prudential clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Prudential disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Prudential. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Prudential.

How do you help Prudential claimants?

Our lawyers help individuals that have either purchased a Prudential long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Prudential:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews   *****

Thomas D.

Alex Palamara with Dell & Schaefer, is an OUTSTANDING disability lawyer that you can TRUST without question. My entire experience with Alex Palamara of Dell & Schaefer was professional consulting at its best. With Dell & Schaefer you do NOT need to leave your home (I am in a wheel chair, travel is difficult) and you can have the best-of-the-best, on your side which is crucial while engaged with gorillas of industry like Cigna.

My experience with Alex was all-digital; we communicated through email and telephone from start-to-finish. Prior to securing representation from Alex, I was a mental “wreck” with anxiety constantly pondering “what-to-do…”. A never ending quandary. After receiving FREE initial consultation, I quickly understood it was a “no-brainer” to have Alex represent me, I secured Dell & Schaefer. My stress levels were reduced immediately and significantly. Alex became my single-point of contact, Dell & Schaefer managed everything for me. I am still amazed at how smooth the entire process was handled WITHOUT ever leaving the comfort of my home.

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