Prudential denies disability benefits despite FCE Exam stating former Data Distributor Inc. employee with heart condition cannot perform sedentary occupation

A disability attorney recently filed a long term disability lawsuit due to Prudential Insurance Company’s wrongful denial of disability benefits to a former project manager. This case shows that despite strong objective evidence and a positive FCE exam in support of multiple disabling conditions, Prudential can still hire physicians that can review a file and determine that a claimant has no restrictions and limitations.

The Facts of the Prudential Disability Denial

The plaintiff as part of his employment benefits with Data Distributors Inc as a project manager, was a participant in a life insurance plan as well as a long term disability plan that was insured and administered by Prudential. The plans are said to be governed by the Employee Retirement Income Security Act (ERISA).

The plaintiff stated in the lawsuit that he stopped working for Data Distributors on or around August 4, 2009 as he was suffering from multiple heart problems and shortness of breath. His medical diagnosis consists of ischemic cardiomyopathy, diabetes, hypertension, systolic heart failure, hypercholeserolemia, hypertriglyceridemia, status post ICD, low back problems, left knee problems and left elbow problem.

Termination of Disability Insurance Benefits

After filing for a claim for long term disability benefits, Prudential initially approved the plaintiff’s claims for long term disability benefits as well as a life insurance premium waiver. Prudential, however, terminated the plaintiff’s disability benefits and waiver of premiums on June 30th 2010.

Prudential denies two ERISA Appeals submitted by Claimant

On July 28th 2010, the plaintiff submitted his first administrative appeal to Prudential. As part of the administrative review process, Prudential requested MES, a medical review company, to review the plaintiff’s medical records. The plaintiff contended that MES requested an internist to review the records and render an opinion. The internist, however, concluded that the plaintiff could handle the duties of up to a light duty occupation, which consisted of lifting up to twenty (20) pounds of force occasionally and negligible force frequently for lifting, carrying, pushing and pulling.

On September 1, 2010, Prudential denied the plaintiff’s administrative appeal resulting in the plaintiff submitting another appeal on February 21st 2011. To support his appeal, the plaintiff included a functional capacity evaluation (FCE) which indicated that the plaintiff did not meet the lifting and sitting requirements required of a sedentary occupation. The plaintiff’s treating physician, a cardiologist, also opined that the plaintiff was unable to perform the material and substantial duties of his regular occupation.

In its review process, Prudential assigned MLS, another medical review company to review the plaintiff’s records. The review concluded that the plaintiff would be able to handle a sedentary workload capacity but indicated a VO2 max stress test (done for standing and walking) should be done to better assess the plaintiff’s cardiovascular issues. The review also opined that the plaintiff did not give a true effort on the functional capacity evaluation and determined that many of the activities performed in a sedentary office occupation would not require repetitive lifting from floor to waist and waist to the level of the scalp. The plaintiff stated in the lawsuit that none of the plaintiff’s treating physician and therapist were consulted during the Appeal review process. Hence, on May 27th 2011, Prudential denied the plaintiff’s second administrative appeal.

Legal Basis for Lawsuit against Prudential

The plaintiff alleged that Prudential’s decision to deny his claim for long term disability benefits was unreasonable, arbitrary and capricious due to the following reasons:

Relief Sought by the Plaintiff

As a result of Prudential’s actions, the plaintiff is seeking from the Court the following relief:

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Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

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