JP Morgan Chase Financial Advisor With Cancer Wins Prudential Long Term Disability Appeal
Our client was a 58 year old private client advisor for JP Morgan Chase Bank. He was forced to stop working due to squamos cell carcinoma of the mandibular jaw. He underwent numerous operations on his jaw including reconstruction, tracheostomy and postoperative radiation therapy. Apart from chronic pain suffers dysphagia and is limited in terms of how much he can open his mouth. His ability to eat and chew is restricted which requires him to use a feeding tube for much of his nutrition. In addition his ability to communicate which is hugely important activity and requirement of his job as a client advisor is greatly restricted.
Prudential, the long-term disability insurer for JP Morgan Chase, initially approved his claim and paid for 24 months, which was the own occupation period under his policy. Shortly before the 24-month own occupation period was due to end, Prudential began a review to determine whether our client would be eligible for benefits after 24 months, which required him to remain disabled from any gainful occupation for which he would qualify based on education, training, and experience. Following a medical review where Prudential’s doctor contacted his oncologist, who allegedly said that our client had had a good response to chemotherapy and misinformed there was no speech impairment or physical limitations related to his tumor or surgery, Prudential terminated the disability claim. They also stated that while they understood that he was missing many teeth and required a feeding tube for most of his meals they did not see that he was restricted or limited from returning to work. They also acknowledged that he was receiving social security disability but stated that although one type of disability benefit may be approved it does not mean another type would be approved.
We appealed the termination of benefits challenging the decision by Prudential and the opinions of its physician. We submitted additional evidence showing that our client’s speech was indeed greatly affected and slow. We also provided certified opinions from his oncologist regarding his limitations in speech and other areas. Upon submission of the appeal, Prudential overturned its decision and recommenced payment of his disability benefits. He continues to receive LTD benefits from Prudential as well as social security disability benefits which to this day remain unchallenged.
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