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.
Resources to Help You Win Disability Benefits
Get Your Prudential Disability Application Approved
Prevent a Prudential Disability Benefit Denial
Negotiate a Prudential Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Prudential told me I would have a decision today, and now the need another week. Guess what, I'm still broke
Q: My mother paid many years for a long-term care policy. When she had to be put in an assisted care facility, Prudential won't pay. Do you accept cases like this?
Q: Can I sue my PRUDENTIAL LTD for the cost of hiring a disability attorney to get my benefits reinstated?
Q: Is it best to hire an attorney first and then file a complaint with Indiana Insurance License Board or do both? How long does it usually take to resolve a case like this?
If I File A Short Term Disability Claim With My Carrier And My Claim Is Denied, Do I Also Need To File A Separate Long Term Disability Claim?
Can the disability company limit my disability benefits to 24 months if I have been diagnosed with depression as a result of my physical disability?
Federal ERISA Lawsuit Filed Against Prudential After It Denies Long-term Disability Benefits to Insured With Parkinson's Disease
Reviews from Our Clients
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.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
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.