Prudential Overturns Denial of Benefits on Appeal After Denying Claim On Basis That Insured Failed To Show Medically Supported Restrictions and Limitations
Mr. P was employed with Kemper Corporation (“Kemper”) when he was diagnosed with severe coronary artery disease and was forced to undergo a quintuple bypass surgery, leading to his total disability and complete inability from performing the material duties of his occupation as an insurance sales manager. Kemper insured all of its full-time employees, including Mr. P, under a group long-term disability insurance plan with Prudential Insurance Company of America (“Prudential”).
Although Mr. P had very much enjoyed working most of his life in the insurance industry, he had never expected that he would be filing a long-term disability insurance claim himself. He was very much surprised at the critical nature of his cardiac condition and under the advice of his cardiologist and other treating physicians he contacted Prudential and notified them that he was advised to stop working by his doctor and would be pursuing a claim for long-term disability benefits.
Once notified Prudential conducted a short interview with Mr. P and informed him that they would be forwarding claim forms to be completed that needed to be completed by him and his physicians. Not wanting to cause any delay, Mr. P, with the assistance of his treating physicians, promptly completed the Prudential claim application and attending physician statements and submitted them to Prudential.
Shortly following receipt of his claim, Prudential began conducting its medical review, which really included nothing more than a review of Mr. P’s medical records and the claim forms that he and his physicians had completed. A short time later Mr. P received a letter from Prudential informing him that his claim had been denied and stating, “based on the review of the medical records and [your doctor’s] inability to comment on your disabling condition, we find you do not have the restrictions and limitations that would prevent work capacity.”
Prudential claimed that they were not successful in receiving a response from one of Mr. P’s treating physicians, giving rise to their basis to deny the claim, despite the fact that Mr. P’s treating physicians had already completed attending physician forms and were fully supporting Mr. P’s claim.
Mr. P contacted Dell Disability Lawyers and retained Attorney Cesar Gavidia to represent him with his appeal of benefits. Attorney Gavidia and his team began the process of gathering all of Mr. P’s medical records. They also created customized medical questionnaires for Mr. P’s treating physicians, specific to Mr. P occupation as an insurance sales manager and his sickness. Attorney Gavidia wanted to leave no doubt in the Prudential Appeal Manager’s mind that Mr. P’s treating physicians supported him and that the medical evidence supported their conclusions and the restrictions and limitations that they had placed on Mr. P.
Shortly after receiving the administrative appeal and the evidentiary exhibits accompanying it, Prudential informed Mr. P’s legal team that it would be conducting a second medical review. After 3 months of reviewing Mr. P’s appeal and the additional evidence submitted by Attorney Gavidia and his team, Prudential finally communicated that it was overturning its previous decision to deny Mr. P’s claim. Prudential would be paying all past due benefits and approving Mr. P’s ongoing claim for monthly long-term disability benefits.
Mr. P is currently on claim and receiving long-term disability benefits from Prudential. Attorney Gavidia and his team at Dell Disability Lawyers continue to monitor Prudential’s actions, and ensure that all requests for medical documentation and claimant updates are addressed promptly and accurately.
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.