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Prudential denies and settles long-term disability claim with CPA after CPA becomes totally disabled from chronic cervical neck pain and radiculopathy

Attorney Cesar GavidiaAuthor: Attorney Cesar Gavidia

Our client, Richard, was employed as a senior accountant with a communications company. While performing work at his home one day, he fell from a ladder and severely injured his neck. His fall resulted in herniated disks in his cervical spine. His pain became chronic and he began experiencing numbness and tingling through his arms and hands. His doctors diagnosed him with herniated discs at C4-C5 and C5-C6, cervical disc degeneration, radiculopathy and vertigo. Richard underwent a two level anterior cervical discectomy with decompression and fusion, however, his pain persisted.

Soon after his surgery, Richard found himself in so much pain and discomfort that he was unable to focus on his work. Attention to detail, focus and precision were critical skills required to perform his occupation and those skills were now compromised. Even his colleagues and manager soon took notice when Richard failed to meet project deadlines and he was making obvious mistakes.

Richard soon made the difficult decision of filing a disability claim under his employer’s Prudential Short-term and Long-term Disability Plan. Following receipt of his claim, Prudential approved his short-term claim. However, soon after receiving all of his short-term disability benefits Prudential notified Richard that it did not find that he was unable to perform his occupational duties as a senior accountant. Prudential noted that since Richard had advised them that he was able to drive, take on-line classes and do some walking to remain as active as possible, that it did not find that the restrictions and limitations in regards to his upper extremity pain and weakness were supported.

Richard contacted and hired Dell & Schaefer and Cesar Gavidia to submit his administrative appeal. The appeal attacked several significant flaws in Prudential’s denial, including disputing that Richard had indeed undergone an extensive treatment work-up for his symptoms and impeaching the credibility of the medical team, which determined, despite the volume of medical evidence to the contrary, that medically reasonable restrictions would be the ability to change neck positions every thirty minutes to avoid increased muscle pain and stiffness…. Despite the volume of evidence contained in the administrative appeal, Prudential decided to uphold its decision and continue denying Richard his long-term disability benefits.

Following Prudential’s denial of Richard’s appeal, Dell & Schaefer filed suit against Prudential in federal court asserting causes of action associated with Prudential’s violation of ERISA and Richard’s denial of long-term disability benefits. Richards case was aggressively litigated and ultimately settled for a lump sum amount mutually agreeable to both parties.

Find a lot more info about Prudential claims on our main Prudential disability claims page.



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