Prudential Denial Overturned on Appeal After Attorneys Dell & Schaefer Established that Medical Device Representative Could Not Perform Duties of Any Gainful Occupation

Our client, Luis, worked as a Medical Device Sales Representative and Territory Manager for Olympus Corporation. In 2015 at 48 years old he was forced to stop working due to chronic pain and severe functional limitations due to cervical spondylosis, radiculopathy, lumbar disc disease and post laminectomy syndrome. In 2012 he underwent a C5-C6 fusion surgery, and a later that year underwent a revision of that surgery. In late 2015 he underwent an anterior cervical discectomy, decompression and fusion at C6-7. Despite surgery, multiple rounds of therapy, injections, and pain management he continued to suffer debilitating pain. His job required him to lift and carry up to 25 pounds, as well as sit, stand and walk up to eight hours a day. Furthermore, he was expected to operate a motor vehicle and drove nearly 70,000 miles per year for his sales occupation.

Despite his best efforts to work through his pain and discomfort, Luis was eventually forced to file for disability with Olympus’ long-term disability insurer, Prudential Insurance Company of America (“Prudential”). After collecting his medical records, reviewing his claim forms and forms completed by his treating physicians, and conducting 3 different reviews of the medical file by an internal nurse, Prudential approved Luis’ claim for benefits.

Approximately 12 months later Prudential subjected the claim to a paper review by Board Certified Physical Medicine and Rehabilitation physician, Dr. Philip Marion. Dr. Marion’s reputation as a bias, impartial, insurance company hired gun precedes him. Despite never examining Luis, and only conducting a review of the medical records, Dr. Marion concluded that Luis was capable of performing work within the light to sedentary exertional demand category. However, he did find physical restrictions relating to neck hyperextension activities and that the restrictions, at least in term of that, were permanent. Soon after receiving Dr. Marion’s report Prudential brought the axe down on Luis’s claim and terminated his benefits.

Luis sought the representation of Attorney Cesar Gavidia and his Appeal Team of Andrenette Morris (Appeals Specialist) and Michal Mizrahi (Legal Assistant). Attorney Gavidia and his team formulated and applied a strategy of both supplementing Luis’s long-term disability claim with a Functional Capacity Examination Report that concluded Luis had less than sedentary work capacity, and attacking the sham report produced by Dr. Marion.

After seeking a 45 day extension of time Prudential overturned its decision, paid all benefits owed through the date of the decision, and reinstated the claim. Luis’s claim has been successfully managed by Attorney Gavidia and his team, who work to ensure that Prudential will not again wrongfully terminate Luis’ claim for benefits. Feel free to call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.”

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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.

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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.

Dell & Schaefer Client Reviews   *****

Randy K.

This was the second time my LTD provider (Prudential) terminated my coverage. Steve got my coverage back the first time the provider terminated it. I contacted Steve and Danielle immediately when I was notified of the second termination.

Even though the LTD provider was to use Dell & Schaefer as a conduit of communication to me, they superseded this agreement and communicated this fact directly to me. Steve and Danielle began gathering the supposed facts behind the termination and saw they were bogus. My case file was sent to an independent physician in a different state who simply read documents to determine that my symptoms were falsified and upheld the termination. Steve contacted the provider and drew exception to that entire process.

Since I am not an attorney I can’t begin to imagine the legal wrangling that took place to contradict that opinion. An actual “hands on” IME was scheduled by the LTD provider to see if it would concur with the other physicians findings. The findings of the “hands on” physical examination disagreed in nearly every way with the report delivered by the physician that simply read a report and didn’t lay a hand on me.

As a result of the dedication of Steve and Danielle my LTD was reinstated this month, along with all the back benefits dating back to the date of termination in June of 2015. Steve and Danielle went, in my opinion, above and beyond the call of duty to see that I got back what was rightfully mine. They have my eternal admiration and respect!

***** 5 stars based on 202 reviews

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