Ericsson Supply Chain Analyst With Hemorrhagic Stroke Wins Texas Prudential Long-Term Disability Insurance Appeal After Benefits Terminated
Prudential paid this claim for months — and then cut it off. Our client, a Supply Chain Analyst for Ericsson in Texas, had survived a hemorrhagic stroke that required emergency brain surgery and left her with lasting weakness in her dominant hand, neurological deficits, and serious psychiatric conditions. Prudential decided she could return to a high-pressure analytical job anyway.
This is a pattern we have confronted and dismantled many times: an insurer approves a claim, pays it, and then terminates it on the word of a file reviewer who never laid eyes on the claimant. We appealed, and Prudential reversed itself — reinstating her long-term disability benefits and carrying the claim forward even after the policy’s definition of disability tightened.
How we did it is worth understanding for anyone whose own claim has been denied on a paper review. If Prudential or any other disability insurance company has terminated your benefits, you can speak with one of our disability insurance lawyers anywhere in the country at no cost, and we charge no fee unless we recover benefits for you.
Table Of Contents
- 1. Why this case matters for every Prudential claimant
- 2. From a high-pressure supply chain role to the ICU
- 3. Prudential paid for months, then cut her off on a paper review
- 4. The FCE: below sedentary on every measure that counted
- 5. The neuropsychological evaluation that ended the argument
- 6. Why Prudential’s 24-month mental-illness limit did not apply
- 7. Prudential reinstates the claim — and carries it past the definition change
- 8. Were your Prudential disability benefits denied or terminated?
Why this case matters for every Prudential claimant
Before the detailed story, here are the lessons a claimant facing a similar fight can take away. Every one of them came directly from a decision we made on this case.
- An insurer cannot deny you for missing a test it never ordered. Prudential dismissed our client’s cognitive impairment because the file contained no “validated neuropsychological testing” — testing her own neurologist had recommended and that Prudential simply never arranged. That is not a basis for denial. It is a gap the insurer created, then blamed on the claimant. The answer was to go get the testing and put it in front of them.
- When your disability has both a physical and a psychiatric cause, the 24-month mental-illness cap may not limit you. Prudential’s policy caps benefits for disabilities caused by mental illness at 24 months, but that cap does not apply to conditions that result from a stroke. By anchoring the claim in the physical and neurological damage from the brain bleed — not only the depression, anxiety, and dissociative diagnoses — we kept the claim from being boxed into a short, mental-illness-limited payout.
- Objective functional testing beats a file reviewer’s opinion. A neurology reviewer who never examined our client called her deficits “mild” and compatible with desk work. A hands-on Functional Capacity Evaluation measured what she could actually do and proved she could not sit for an hour or type with her dominant hand. Real-world performance carries more evidentiary weight than a doctor reading a file.
- A first-appeal denial is not the end of the road. Prudential denied the first appeal. We filed a voluntary second appeal built around the single most decisive piece of evidence in the entire file — a comprehensive neuropsychological evaluation — and won, without ever filing a lawsuit.
From a high-pressure supply chain role to the ICU
Our client built her career as a Supply Chain Analyst for Ericsson, doing the kind of work that runs on relentless cognition: reading hundreds of emails a day, analyzing financial results, modeling forecasts, solving complex end-to-end supply chain problems, and making fast decisions under constant pressure. She routinely worked long days and was, by every account in the record, very good at it.
Then she suffered a hemorrhagic stroke caused by a basal ganglia artery rupture — a nontraumatic intracerebral hemorrhage, subcortical (ICD-10 I61.0). She arrived at the emergency room with altered mental status, the inability to speak, and right-sided paralysis. She was intubated, admitted to the ICU, and underwent an emergency craniotomy to evacuate the bleed. Months of inpatient and outpatient neurorehabilitation followed.
The stroke did not simply pass. It left her with persistent right-sided weakness in her dominant hand, balance and coordination problems, slowed processing, memory failures, and word-finding difficulty. In the months after, she also developed severe psychiatric conditions — major depressive disorder, generalized anxiety disorder, bipolar disorder, and dissociative identity disorder — that her providers tied to the trauma of the brain injury. The residual effects of a stroke are exactly what make it so difficult to return to work, a reality at the heart of nearly every long-term disability claim involving a stroke.
She tried to go back. Under a modified, part-time schedule with accommodations, she returned to her job — and lasted two days before her symptoms forced her to stop. Her employer later confirmed in writing that it could not use her at the few hours per week she could manage. That failed return-to-work attempt, far from undermining her claim, would become some of the strongest proof of disability in the file.
Prudential paid for months, then cut her off on a paper review
Prudential initially accepted the claim and paid long-term disability benefits for roughly ten months under the policy’s own-occupation standard. Under an own-occupation standard, a claimant is disabled if she cannot perform the material and substantial duties of her own job; after 24 months of payments, this policy — like most group plans — switches to an any-occupation standard, which asks whether the claimant can perform any job for which she is reasonably qualified. What happens when a disability policy changes from own occupation to any occupation is that the bar to keep benefits rises sharply — but our client never even reached that change before Prudential terminated her.
The termination, signed by Senior Disability Case Manager Ginger DeGroot, closed the claim and rested on a single clinical opinion. As Prudential’s denial put it, “Your medical condition would not prevent you from performing your usual occupation.” That conclusion came not from an examination, but from a paper review.
A diagnosis is not a denial — but a paper review is not a basis for one either
A paper review, also called a file review, is an opinion rendered by a doctor who never meets the claimant and instead reads the records. Prudential had its file reviewed by a neuropsychologist, Dr. Elana Mendelssohn-Gara, who concluded the records did not support restrictions and limitations. She never examined our client. She never spoke with the treating providers who did.
The denial leaned heavily on two isolated forms completed by a psychiatrist affiliated with our client’s hospital program — a provider who saw her only in that brief, structured setting and offered no ongoing care — while discounting the internist and inpatient psychiatrist who actually knew her. Elevating a non-treating provider’s checkbox forms over the doctors with genuine, longitudinal knowledge of a patient is a recurring tactic, and it is exactly the kind of imbalanced review the law does not permit.
The first appeal, and the test Prudential never ordered
Because this is a group plan governed by ERISA, the claim ran through a mandatory internal appeal. An ERISA administrative appeal is the internal review an insurer must complete before a claimant can file suit, and the statute requires a full and fair review of the claim under ERISA’s claims-procedure rules. Attorney Jason Macri assembled the first appeal around objective evidence Prudential had never bothered to gather, including a Functional Capacity Evaluation and updated treating records.
Prudential upheld the denial anyway, this time relying on two new file reviewers — a neuropsychologist, David Nowell, PhD, and a neurologist, Dr. Edward Chai. Dr. Nowell dismissed the cognitive impairment on the ground that there was no “validated neuropsychological testing” in the file. The problem with that reasoning is straightforward: our client’s own neurologist had recommended neuropsychological testing, and Prudential never arranged it. The insurer used the absence of a test it never ordered as the reason to deny. That is not a finding. It is a circular argument — and we set out to break it.
The FCE: below sedentary on every measure that counted
A Functional Capacity Evaluation (FCE) is a standardized, hands-on test that measures what a person can physically do — how long they can sit, stand, lift, grasp, and concentrate — across the course of a working day. Unlike a file review, it puts the claimant through the actual demands of work. We submitted an FCE performed by a licensed occupational therapist, and the results were unambiguous.
The therapist first confirmed the testing was valid: our client’s heart rate rose more than ten beats per minute with exertion, she grimaced and grew short of breath, and her pain climbed from a baseline of 2 out of 10 to as high as 6 out of 10 as the exam went on. This was not a claimant holding back. It was a body that could not sustain effort. Within those validated limits, the evaluation documented:
- Sitting: no more than one hour at a time, and no more than five hours total in a day
- Standing: roughly ten minutes at a time, about two hours total
- Walking: roughly twenty minutes at a time, about two hours total
- Right hand (her dominant hand): grasping, fingering, and reaching for only about two minutes continuously and thirty minutes total per day
- Computer work: tolerance of roughly fifteen minutes of screen time, or a single email; one handwritten sentence took three and a half minutes before she had to stop
- Mobility: an antalgic (pain-avoiding) gait and impaired standing balance, both tied to the stroke
The occupational therapist concluded that our client could not meet the demands of her own occupation or of any work at any exertion level, including sedentary work. In plain terms, she was less than sedentary — meaning she could not sustain even the lightest, mostly-seated category of work that the U.S. Department of Labor classifies as sedentary. Her job as a Supply Chain Analyst required constant sitting and frequent-to-constant keyboarding. The FCE showed she could do neither.
This is the same fault line we exposed for an MRI technologist Prudential cut off after citing multiple sclerosis and degenerative disc disease — a termination we also reversed by documenting both her neurological and physical conditions — and for a former vice president left disabled by multiple strokes, benefits we also got reinstated after the insurer tried to argue him back to work. A file reviewer’s resting-exam opinion does not survive contact with a properly performed functional test.
The neuropsychological evaluation that ended the argument
Prudential had built its case on the absence of formal cognitive testing. So on the voluntary second appeal, we gave the insurer the one thing it claimed was missing — and far more than it expected.
We submitted a comprehensive neuropsychological evaluation performed by a board-certified clinical neuropsychologist. It took roughly fifteen hours over three separate days and included a clinical interview, collateral interview with her spouse, behavioral observation, and an extensive battery of standardized tests. It was the opposite of a paper review, and it produced objective, measurable proof of impairment.
On the Wechsler Adult Intelligence Scale, the standard measure of adult cognitive ability, the numbers told the story plainly — they describe a person who can no longer keep pace with, learn, or reliably perform skilled work.
- Processing speed fell in the borderline range (index of 76, around the 5th percentile) — she could not keep up with routine work tasks, emails, and data the way her job demanded.
- Working memory was low average (index of 86) — she struggled to hold information in mind while using it.
- Full-scale IQ measured 89, low average — a substantial drop from the high-functioning baseline her education and career reflected.
- Verbal learning and delayed recall were severely impaired (below the 1st percentile) — she could not reliably acquire, store, or retrieve new information.
- Executive function showed severe impairment in response inhibition — the ability to multitask, adapt, and manage competing demands was gone.
- Fine motor speed was moderately impaired in both hands, directly corroborating the FCE’s findings on her stroke-damaged right side.
Beyond the cognitive testing, personality testing on the Minnesota Multiphasic Personality Inventory (MMPI-2) reflected significant psychological distress and compromised coping, and the evaluation documented severe depression and anxiety and directly observed dissociative episodes during the testing itself, consistent with her dissociative identity disorder under the DSM-5-TR. Most important, the neuropsychologist did not attribute her impairment to the stroke alone or to her psychiatric illness alone. He explained that the two together produced “a level of functional impairment greater than would be expected from either condition alone,” and concluded plainly that our client was “not capable of sustaining competitive employment at this time.” That synergy — physical brain injury compounding psychiatric illness — would prove decisive for reasons beyond the medicine.
Why Prudential’s 24-month mental-illness limit did not apply
There was a second battle inside this case that most claimants never see coming. Prudential’s policy contains a 24-month mental-illness limitation: disabilities caused in whole or part by mental illness are paid for a lifetime maximum of 24 months. This is a separate 24-month provision from the own-occupation-to-any-occupation change described earlier — a one-time, lifetime cap that exists only for mental illness. Prudential flagged that limitation against this claim from the start, treating her psychiatric diagnoses as a ceiling on how long it would ever have to pay.
Here is what the insurer did not want to confront. That cap does not apply when the disabling condition results from a stroke. The policy says so in its own terms, exempting conditions that are the result of stroke from the mental-illness limitation. This was never a pure psychiatric claim. It was a brain-injury claim with psychiatric consequences — and the difference was worth years of benefits.
So we anchored the claim in the physical and neurological damage the stroke left behind:
- Right-sided weakness in her dominant hand, confirmed on examination and measured in the FCE
- Ataxia and incoordination — an antalgic gait, impaired balance, and dysdiadochokinesia (the inability to perform rapid alternating movements) on the right
- Obstructive sleep apnea with poor CPAP tolerance, causing excessive daytime sleepiness and poor stamina
- Objective imaging — her brain MRI showed Wallerian degeneration extending from the area of the hemorrhage into the brainstem
That last finding mattered enormously. Wallerian degeneration is the breakdown of nerve fibers downstream of an injury, and in intracerebral hemorrhage its presence on imaging is a recognized marker that tracks with worse motor outcomes, as the peer-reviewed literature on corticospinal tract degeneration after brain bleeds documents. In plain terms, it is hard, physical proof that her loss of strength and balance was real and permanent — not something a claimant could imagine or exaggerate. When Prudential’s own neurology reviewer finally credited the evidence, he acknowledged that the imaging reflected “substantial loss of pyramidal fibers which translates functionally to loss of strength and balance,” providing physical, objective information that correlated with her real-world performance.
This is the same principle we used to help a Prudential claimant defeat the 24-month mental-nervous limitation, an outcome we also secured by proving the disability reached beyond a purely psychiatric diagnosis. A mental-illness cap only works for the insurer if the disability is only mental illness. This one was not.
Prudential reinstates the claim — and carries it past the definition change
Faced with an FCE it could not refute, a neuropsychological evaluation it had demanded and then received, and a physical-injury foundation its own mental-illness cap could not reach, Prudential reversed course. It reinstated our client’s long-term disability benefits, paid the back benefits owed from the date it had wrongly terminated her, and restored monthly payments of more than $4,000.
Just as significant, Prudential carried the claim through the 24-month point at which the policy’s definition of disability tightened from her own occupation to any occupation — and extended benefits beyond that change. A claim the insurer had tried to end was now positioned to continue. And it was won at the voluntary second appeal, before a single lawsuit was filed.
None of this happened by accident, and none of it happened because Prudential changed its mind on its own. It happened because the record was rebuilt, piece by objective piece, until the denial had nothing left to stand on.
Were your Prudential disability benefits denied or terminated?
As attorney Jason Macri wrote in the appeal, Prudential’s review process was “not evidence-driven but outcome-driven” — relying on non-examining file reviewers who refused to change their conclusions no matter what the evidence showed. If that sounds like what happened to you, you are not imagining it, and you do not have to fight it alone.
If your benefits were denied or terminated, your time to act is limited: an ERISA denial generally gives you 180 days to file an administrative appeal, and missing that deadline can cost you the right to sue altogether. Building the appeal correctly — with the objective evidence the insurer is counting on you not to gather — is what wins these cases. There are also steps you can take to protect your Prudential claim before a denial ever happens.
Our firm has represented disability insurance claimants since 1979, helping tens of thousands of people and recovering more than $2 billion in benefits from every major carrier. We represent claimants nationwide, and we charge no fee unless we recover benefits for you. Contact our office for a free, no-obligation review of your claim, and let one of our disability insurance lawyers tell you honestly where you stand.
