LTD claim approved for a second time for an Insurance Sales Agent after Prudential denies claim based on self-reported physical capabilities
Despite Prudential’s numerous attempts to deny our client her long term disability benefits, Attorney Alexander Palamara was able to successfully identify the egregious mistakes in Prudential’s newest reviews and this resulted in Prudential’s second decision to overturn a denial on this claim. Our client once again has ongoing and current payments of long term disability benefits which she has received since 2012.
Our client suffers from numerous physical ailments, but was originally forced to stop work as an insurance sales agent in 2014 due to Sjogren’s syndrome and optic neuritis. Our client also suffers from Fibromyalgia, Arthralgias, Persistent Headaches, Fatigue, Vertigo, Cervical Degenerative Joint Disease, Neck Pain, Joint Pain, Lumbar Spine Scoliosis, Rheumatoid Arthritis, Profound Paresthesias, Bilateral Knee Pain, Bilateral Metatarsal Phalangeal Pain, Essential Hypertension, Cognitive Decline and Dysfunction, Moderate Mood Disorder and Mild Anxiety Disorder.
Despite all of these diagnoses and full support by multiple treating physicians, Prudential continuously attempted to deny our client’s claim and terminate long term disability benefits.
Denials By Lincoln, Appeals by Attorney Palamara
In its first denial letter of 2014, Prudential stated that after “a thorough evaluation of the information in your file, we have determined that you do not meet the definition of disability…”. Prudential stated that it had “determined that the information in (her) file does not support impairment that would prevent (her) from performing material and substantial duties of (her) own occupation.” As such, Prudential terminated her claim. Unable to grasp how her claim could be denied in light of her physical condition, our client found Dell Disability Lawyers to assist her with an appeal to challenge the wrongful denial. Attorney Alexander Palamara reviewed the claim and agreed that there was no question she should be receiving benefits as she had objective documentation to prove her claim.
In his first appeal, Attorney Alexander Palamara made several arguments which challenged Prudential’s denial and detailed the objective medical evidence supporting her claim, including the support of two of our client’s treating physicians, who opined our client did not have the capacity to perform any type of work on a full time basis.
Less than two months after Attorney Palamara filed his appeal on behalf of our client, Prudential agreed with Attorney Palamara and her long term disability benefits were reinstated and all back benefits that were owed to our client were paid in full.
Unfortunately, two years later in 2016, Prudential once again made the decision to deny our client her long term disability benefits. This time, Prudential stated that it had “determined that the medical information received did not support impairment that would prevent [her] from performing material and substantial duties of any gainful occupation.”
As is common in most group Long Term Disability Policies, what it means to be disabled changed after 24 months of benefits were received. In this case, in order to continue to receive benefits, instead of proving that she was unable to perform the duties of her own occupation, now our client had to prove that she was unable to perform the material duties of any gainful occupation. A review of Prudential’s denial letter and claim file revealed that Prudential’s decision was based on the opinion of an in-house clinical reviewer who found the opinions of two of our client’s treating physicians questionable because their restrictions appear “overly restrictive” given our client’s own claim reported abilities.
Attorney Palamara once again challenged Prudential’s decision, highlighting supportive objective medical evidence that was overlooked by Prudential in its review and emphasizing the highly questionable tactic of an insurance company finding fault in a claimant who reports a higher level of physical capabilities than her own doctors believe she is capable of.
Thankfully, our client’s claim was once again reapproved and all back benefits that were owed were paid in full. With the assistance and support of her treating providers and their medical records, Attorney Alexander Palamara was able to successfully argue to Prudential that our client is unable to perform the material and substantial duties of her own occupation and unable to perform the duties of any gainful occupation.
Our client is relieved to be back on claim on claim and was happy to receive the benefits that should have been paid. Based on Prudential’s conduct, our client knows that the fight will never end, but she also knows that Attorney Alexander Palamara will do whatever it takes to keep her on claim until she is able to return to work or until her policy expires.
If you have been denied disability benefits by Prudential or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell Disability Lawyers for a free consultation.
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Prudential told me I would have a decision today, and now the need another week. Guess what, I'm still broke
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Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
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Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.