Prudential Overturns Decision to Deny Long-term Disability Benefits to Former JP Morgan Chase Financial Advisor With Mandibular Cancer

In 2014, our client, Michael, received the terrible news that he had squamous cell carcinoma of the alveolar ridge (Mandibular Cancer), and as a result was forced to cut a successful career as a financial advisor with JP Morgan Chase short. While undergoing extensive surgery on his jaw with flap reconstruction, treacheostomy and post-operative radiation therapy, Michael submitted his claim with JP Morgan Chases’ long-term disability insurer, The Prudential Insurance Company of America (“Prudential”).

The Prudential policy qualified disability as:

You are disabled when Prudential determines that:

  • You are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and
  • You are under the regular care of a doctor; and
  • You have a 20% or more loss in your monthly earnings due to that sickness or injury.
  • After 24 months of payments, you are disabled when Prudential determines that due to the same sickness or injury;
  • You are unable to perform the duties of any gainful occupation for which you are reasonably fitted by educated, training or experience; and
  • You are under the regular care of a doctor.

After submitting his disability claim, Prudential reviewed Michael’s Claimant Statement, Attending Physician Statement and the medical records provided by Michael’s treating physicians. Within a few weeks of the claim being submitted, Prudential approved the disability claim and Michael began receiving disability benefits.

Unfortunately, Michael not only lost a rewarding career that he loved, but also the ability to fully open his jaw, restricting his ability to eat and chew, and required the use of a PEG feeding tube in order to receive much of his nutrition. He lost multiple teeth due to his condition, as well as his ability to communicate effectively, a critical aspect of his occupation as a financial advisor.

Prudential’s Terminates Long-term Disability Benefits Finding That Financial Advisor Can Work in a Gainful Occupation.

After paying 24 months of long-term disability benefits, Prudential notified Michael that he no longer met the definition of “disability” in the long-term disability policy and that it felt he could work in a sedentary occupation. In its denial letter, Prudential identified four occupations it believed he could perform.

Prudential alleged that Michael could purportedly perform the occupations of financial representative, sales account manager, financial planner and registered financial representative.

After receiving his letter denying his claim for any gainful occupation benefits, Michael retained Attorney Cesar Gavidia and his appeal team at Dell Disability Lawyers.

In the Appeal, it was argued that all of the occupations identified by Prudential in its denial letter required significant and effective verbal communication. In the Appeal, Evidence from the Department of Labor was submitted confirming that the occupations identified by Prudential all required the unencumbered ability to “speak clearly so that the listener would understand” and the ability to “communicate information and ideas in speaking so that others would understand.”

It was further argued that in baselessly denying Michael’s long-term disability claim, Prudential also failed to account for the psychosocial impact that his language limitations and significant facial disharmony would impose.

Within 4 weeks of the Appeal being submitted, Prudential notified Attorney Gavidia and Michael that the adverse decision it had previously made was being overturned and that he indeed qualified for disability from Any Gainful Occupation for which he was qualified based on education training and experience.

Michael continues to receive long-term disability benefits from Prudential, and unfortunately remains disabled. Attorney Gavidia and his team at Dell Disability Lawyers continues to represent Michael in his claim and monitor all of Prudential’s activity closely.


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Prudential Reviews
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Showing 8 of 27 Reviews
Prudential

California State Disabilty "OFFSET" never mentioned or outlined when enrolling for STD coverage.

Reviewed by MartyG on June 29th 2023   Verified Policyholder | May 2023 date of disability
All terms and conditions of receiving a claim benefit not made available when enrolling. Hidden elements of eligibility... not fully transparent with issues that might eff... read more >
Prudential

Prudential terminated my LTD, so now I have no income

Reviewed by Carlos M on June 10th 2022   Verified Policyholder
I was working at a shipyard at San Diego and hurt my back again while working. Hurt my back in the US Navy in 98 and had issues since then so I decided to get the surgery ... read more >
Reply
Sent on June 11th 2022 by Attorney Rachel Alters

Carlos, yes we may be able to help. Please email your denial letter to Rachel@diattorney.com and cc Amanda@diattorney.com. Thank you.

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Prudential cancelled my policy amid COVID crisis

Reviewed by Patricia M. on September 15th 2020   Verified Policyholder
In the mist of the covid crisis Prudential decided I needed to prove my disability, yet again. I have been physically disabled since 10/31/1989. I now know that I have bee... read more >
Reply
Sent on September 15th 2020 by Attorney Jay Symonds

Patricia: This is a terrible situation. You likely have a right to appeal the decision. I suggest you contact our office and speak with one of the attorneys to discuss ... read more >

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I was sold a policy that I cannot use and no one will show me the policy

Reviewed by Jacqueline G. on August 18th 2020   Verified Policyholder
I had Prudential STD and LTD through my employer. I received my STD with no problem. Started receiving LTD for a while, then Prudential said I owed them because I receive ... read more >
Reply
Sent on August 18th 2020 by Attorney Stephen Jessup

Jacqueline, in many cases a disability carrier cannot offset for SSDI benefits that were in place prior to the date of disability under the applicable policy. Your empl... read more >

Prudential

Prudential verbally approved my claim and then sent me a denial letter

Reviewed by Jacquieline C. on April 3rd 2020   Verified Policyholder
I have been denied twice from Prudential for my LTD case. Back injury 2009 – knee injury 2011. Back doctor took me out of work (July 2018) due to me working 35 hrs per w... read more >
Reply
Sent on April 3rd 2020 by Attorney Jay Symonds

Jacqueline: Sounds like you have a pretty complex medical situation. And the fact that they verbally approved your claim over the phone then sent a denial letter is unu... read more >

Prudential

It would cost me more to fight Prudential than to let them get away with their games

Reviewed by Tim W. on December 9th 2017   Verified Policyholder
I’ve been thru all the same things everyone complains about here. I’ve always been one step ahead of their game due to research. I just got notice they are stopping my... read more >
Prudential

Prudential told me I would have a decision today, and now the need another week. Guess what, I'm still broke

Reviewed by Cancer Patient on June 22nd 2017   Verified Policyholder
Just called them and now they need another week and a half so they can do an occupational review on my job description or something like that. Even though the case manager... read more >
Reply
Sent on June 22nd 2017 by Attorney Stephen Jessup

DL, many state insurance commissioners will not get involved in ERISA governed disability insurance policies as these polices are governed under federal law. Please fee... read more >

Prudential

Prudential is the most dishonest and immoral company ever!

Reviewed by Marie C. on April 5th 2017   Verified Policyholder
Prudential is the most dishonest and immoral company ever! My husband has been on LTD with them for a few years. In December they sent a letter asking for $11,000 back. He... read more >
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