Our client was originally denied long term disability benefits by Prudential after he was forced to make a claim due to persistent symptoms related to a concussion he had previously suffered. He had worked as a Senior Project Manager for SNC Lavalin Corporation. Due to his symptoms that included post-traumatic headaches, vision impairments, decreased focus, sleep dysregulation, cognitive deficits, fatigue, dizziness, anxiety, and mood changes, the client was forced to leave work on December 17, 2011. During the time period of December 17, 2011 through September 4, 2012, the client was unable to perform the material and substantial duties of his occupation. However, beginning on September 5, 2012, the client was able to return to work full-time.
Although his short term disability claim was approved for the full 3 months after he initially left work, and although his long term disability claim was limited to a period of just March 16, 2012 through September 4, 2012, Prudential refused to pay the client any long term disability benefits.
Claimant Contacts Dell & Schaefer
After being denied in letters from Prudential in May and December of 2012, the client came into contact with Attorney Alexander Palamara of Dell and Schaefer on May 30, 2013. As the deadline for filing the administrative appeal was quickly approaching, Dell and Schaefer had to act quickly in order to timely file the administrative appeal that was due on June 19, 2013. Luckily for the parties involved, a copy of the Claim File had already been produced to the client by Prudential. Armed with 20 days and a team of experienced disability specialists, Attorneys Dell and Schaefer were able to analyze and digest all aspects of the claim.
The Administrative Appeal
The Appeal filed by Dell and Schaefer was able to show the strengths of the client’s case as well as the weaknesses of Prudential’s earlier reviews. For instance, one of the client’s treating physicians opined that the client had no useful ability to function in regards to working in coordination with others due to psychological symptoms. Additionally, the doctor stated that the client would be unable to work at a consistent pace, nor would he be able to meet competitive standards. The doctor found that the client would have issues remembering work-like procedure; making simple work-related decisions; completing a normal workday and work week without interruptions from psychologically based symptoms; asking simple questions or requesting assistance; being aware of normal hazards and taking appropriate precautions; accepting instructions and responding appropriately to criticism from supervisors; getting along with co-workers or peers without unduly distracting them or exhibiting behavioral extremes; responding appropriately to changes in a routine work setting; and dealing with normal work stress.
In addition to arguing the strong support of the client’s treating physicians and their unrebutted objective opinions, the appeal also focused on the fact that Prudential’s internal appeals were guided by its inherent conflict of interest. As such, the appeal demanded that Prudential award the client full disability benefits for the period of March 16, 2012 through September 5, 2013, the date in which the client was able to return to work.
On August 9, 2013, Prudential informed Attorneys Dell and Schaefer that its administrative appeal was successful and that the client would be awarded full disability benefits for the period in question.
Today the client is able to work full time. Thankfully, the client was ultimately awarded the benefits he deserved for the time period he was unable to work.
Should your claim be denied or if you have a fear that Prudential or any long term disability insurer might be planning to deny your claim, please do not hesitate to call Attorneys Dell and Schaefer for a free consultation to discuss your case.