Prudential Agrees to Reinstate Long Term Disability Benefits for an Employee of DRS Technologies who suffers from very severe back issues

Due to his previous employment at DRS Technologies where he worked as an Environmental & Health Safety Specialist, our eventual client was covered under a Long Term Disability (LTD) Insurance Policy with The Prudential Insurance Company of America. This LTD Policy was in place for DRS Technologies’ employees should they be unable to perform the material and substantial duties of their regular occupation or any gainful occupation due to sicknesses or injuries. The policy would pay 60% of the employees’ previously monthly earnings should they satisfy the terms and conditions of this policy.

It was a good thing our eventual client was covered under such a policy because as of May 10, 2012, he was no longer able to “perform the material and substantial duties of his regular occupation.” Forced to stop working due to the physical limitations resulting from spinal stenosis lumbar region, sciatica, lumbago, myalgia and myositis, lumbar radiculitis, postlaminectomy syndrome of lumbar region, postlaminectomy syndrome of cervical region, cervical spondylosis without myelopathy, headache, cervicalgia, status post bilateral L5-S1 foraminotomy and right L5-S1 microdiscectomy, status post anterior cervical discectomy and fusion, our client applied for and was initially approved for LTD benefits by Prudential. LTD benefits began on November 6, 2012, after he satisfied the 180 day elimination period.

Prudential’s First Denial of LTD Benefits

After being paid LTD benefits for the period November 6, 2012 through September 30, 2013, our eventual client was informed by Prudential by way of a letter dated October 14, 2013 that his benefits would terminate as of September 30, 2013. In the aforementioned denial letter, Prudential relied upon a review of its in-house clinical team, the results of a Functional Capacity Evaluation (FCE) it commissioned and Covert Surveillance. Although the results of the FCE provided that our client performed with full effort and had no physical demand/work capacity, Prudential instead decided to rely upon the covert surveillance it had conducted over a three day period two months prior to the FCE.

Apparently because the covert surveillance showed our client “get in and out of two different vehicles”, shopping at a supermarket and a home improvement store, and entering a pizza parlor to pick up a pizza, Prudential felt that the results of the FCE were invalid and that the limited results of the covert surveillance were more compelling. As such, Prudential denied our eventual client’s continued claim for LTD benefits based on the covert surveillance.

Finding Dell Disability Lawyers

Within a week of being denied continued benefits, our now client contacted and hired Dell Disability Lawyers to assist him with his administrative appeals to challenge Prudential’s determination. After accumulating updated medical records, the administrative record from Prudential and the covert surveillance, a timely appeal was filed that challenged Prudential’s incorrect decision. Our appeal first focused on how the surveillance was not an accurate measure of our client’s ability to perform his own or any occupation on a full time basis. Furthermore, our appeal noted that Prudential failed to consider compelling medical evidence for the time before, during and after the covert surveillance was performed. Lastly, our appeal challenged Prudential’s decision to completely disregard the Functional Capacity Evaluation it had commissioned with a medical professional of its choosing.

Prudential’s Second Denial of LTD Benefits

Unfortunately for our client, our first attempt at convincing Prudential that its decision to deny was incorrect was unsuccessful. By way of a letter dated June 4, 2014, Prudential informed Dell Disability Lawyers that it was upholding its previous decision to deny continued benefits. This time Prudential relied upon the paper review of an “independent” physician consultant who specializes in Occupational Medicine. While this physician reviewer found that our client had restrictions and limitations, this physician ultimately sided with the insurance company who hired him. Utilizing this review of a doctor who never treated, evaluated or even laid eyes upon our client, Prudential once again denied our client’s claim.

Dell Disability Lawyers’ Second Appeal

With the option of filling a second/final appeal or filing a lawsuit, our client, confident in his medical records and file, chose to file an appeal with the hope of avoiding time consuming litigation. Armed with updated medical records and the claim file of the Social Security Administration, who also found our client disabled, a second appeal was timely filed.

Utilizing arguments to challenge Prudential’s “independent” physician consultant’s review, and again challenging Prudential’s reliance upon surveillance, the appeal left Prudential with no choice but to reinstate our client’s claim for LTD benefits.

Within 45 days of the second appeal being filed, Prudential finally came around and agreed that our client deserved to remain on claim. Furthermore, Prudential even agreed that our client was unable to perform the duties of any gainful occupation which meant that our client would continue to receive LTD benefits beyond the first 24 months of his claim.

Although our client was ready to file an ERISA LTD lawsuit against Prudential, he is happy to be reinstated and that Prudential agreed to find him disabled from any gainful occupation. Our client continues to remain on claim to this day and he knows that Attorney Alexander Palamara will continue to do whatever it takes to keep him on claim until he is either able to return to work or until his policy expires.

If you have been denied disability benefits by Prudential or any other disability insurance provider, please do not hesitate to contact the Attorneys at Dell Disability Lawyers for a free consultation.

Read more about Prudential disability claims.


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Prudential Reviews
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Showing 8 of 642 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.

Prudential

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 >

Prudential

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 >
Answered Questions by Our Lawyers
(39)
Showing 8 of 39 Answered Questions

Q: Prudential is sending me to an IME but refuses to allow recording. Should I refuse to go to the IME?

Answered on May 7th 2024 by Attorney Gregory Dell
A: Mike:This is always a tough situation. You cannot refuse to go. I would show up with a witness and a recor... Read More >

Q: What can I do about my long term benefits that’s ending after 2 years?

Answered on June 6th 2023 by Attorney Gregory Dell
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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?

Answered on March 23rd 2023 by Attorney Gregory Dell
A: Allan, I am sorry to hear about Prudential’s long term care denial for your Mom’s care. We have handled ma... Read More >

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Answered on December 28th 2020 by Attorney Steven Dell
A: Lauraine, unfortunately you can be denied even if SSDI approved you. If you need assistance managing your LTD ... Read More >

Q: How does Prudential calculate attorney fees?

Answered on July 31st 2010 by Attorney Stephen Jessup
A: Lomy, calculate attorney fees for what exactly? Under ERISA, the federal law that governs employer provided po... Read More >

Q: Can I sue my PRUDENTIAL LTD for the cost of hiring a disability attorney to get my benefits reinstated?

Answered on June 1st 2020 by Attorney Jay Symonds
A: Loretta: Assuming the attorney was successful and got the denial overturned, the short answer is no you cannot... Read More >

Q: Do I have to pay back my STD and LTD after being approved for Widows SSD?

Answered on February 16th 2020 by Attorney Cesar Gavidia
A: Kathy, it depends on the terms of your disability insurance policy. Refer to your disability insurance policy ... Read More >

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?

Answered on September 5th 2014 by Attorney Stephen Jessup
A: Jenny, if your claim is denied a lawsuit is to be filed in Federal Court. The Indiana insurance board does not... Read More >
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Engineer With Depression Wins Prudential LTD Appeal

The claimant is a former Senior Technology Services Engineer for Accolade, Inc. who was force... Read More >

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In James Ampe v. The Prudential Insurance Company of America, et al., Plaintiff Ampe worked for several years for the Massachusetts ... Read More >

Prudential Wrongfully Relies on Neuropsychological Report to Deny LTD Benefits After 12 Years

Initial denialMr. Paquin became disabled in 2003 after contracting encephalitis from a mosquito infected with the West Nile virus. The inf... Read More >

California Court Overturns Prudential Denial of LTD Benefits

In reviewing long term disability denial letters we find that there are a handful of industry wide arguments made by insurance companies to mi... Read More >

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In the case of Gallegos v. Prudential, a California Federal District in the Northern District of California entered an order instructing Prude... Read More >

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Our office was recently contacted by an insured whose claim for long term disability benefits had been recently and abruptly denied by Prudent... Read More >

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The case of Kidd v. The Prudential Insurance Company of America demonstrates the importance of disclosing all potential assets on a bankruptcy... Read More >

Prudential Denial of Disability Benefits to Employee that Was Disabled While Working is Reversed

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Federal ERISA Lawsuit Filed Against Prudential After It Denies Long-term Disability Benefits to Insured With Parkinson's Disease

Mr. G had previously worked as a foreman for a large fertilizer company. One day at work Mr. G suffered a fall into a bin of fertilizer. Altho... Read More >

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