Prudential Denial Overturned on Appeal After Attorneys Dell & Schaefer Established that Medical Device Representative Could Not Perform Duties of Any Gainful Occupation
Author: Attorney Cesar Gavidia
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.”