Prudential overturned previous denial of long term disability benefits for Mississippi Nuclear Medicine Tech
Our client, Mr. T, formerly worked as a Nuclear Medicine Tech for a large hospital. In May 2011 a number of medical issues, chronic pain syndrome, cervical spine degenerative disc disease, cervical radiculopathy and neuropathy forced Mr. T to stop working and submit his claim for disability benefits first under his employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. Both benefits were funded and administered by Prudential Insurance Company of America (Prudential). Under his employer’s disability policies Mr. T would be considered totally disabled after 24-months if he was unable to perform the material and substantial duties of any gainful occupation, which was defined as any occupation he was qualified to perform by education, training and experience and considering any/all documented functional restrictions and limitations.
After paying Mr. T for more than 3½ years under the LTD Policy, Prudential denied further LTD benefits on the basis that he allegedly no longer met the policy definition of disability. Specifically, Prudential determined that “the medical information received did not support impairment that would prevent [him] from performing the material and substantial duties of any gainful occupation.” After receiving the denial, Mr. T contacted Dell Disability Lawyers and discussed his case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in Prudential’s denial letter and in the evidence it relied on and agreed to prepare and submit Mr. T’s ERISA appeal with the assistance of his appeal team.
The LTD appeal addressed all of Prudential’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of Prudential’s denial and significant inconsistencies with its medical reviewer’s findings. The appeal next addressed the fact that Prudential’s denial letter grossly misstates and mischaracterizes the record evidence regarding communications between its 3rd party medical consultant (Consultant) and Mr. T’s primary treatment provider. In particular, Prudential claimed that Mr. T’s physician offered a signed agreement with its Consultant’s opinion that Mr. T had light work functional abilities yet the undisputed medical evidence confirms the exact opposite. The appeal also addresses the fact that despite acknowledging Mr. T suffered from twenty-five (25) chronic medical conditions and despite having never examined or observed Mr. T, Prudential’s Consultant assigns to him functional capabilities far in excess of any of his treatment providers or Prudential’s own prior medical reviewer, who concluded that “the claimant had multiple medical conditions when taken individually and in total render him functionally impaired from sustaining even a part time sedentary capacity.” Finally, the appeal addressed the fact that Prudential did not comply with its obligations under 5th Circuit and Supreme Court precedent by failing to meaningfully address Mr. T’s award of Social Security Disability benefits.
Approximately nine weeks later, and after reviewing the appeal and hundreds of pages of exhibits and medical records, Prudential overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Ms. T’s LTD benefits. Attorney Symonds continues to represent our client to best ensure that Prudential will not terminate his benefits again. Feel free to call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.
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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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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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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.
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