Prudential Reinstates Long Term Disability Benefits on Appeal to Sales Manager Who Suffered Multiple Strokes
Our client was a Regional Director of Sales for one the largest data processing groups in the world. To say that he was at the pinnacle of his career is an understatement. After knowing a life of work and success in the work place it was a devastating blow when it all came to an end following two Left Capsular Infarctions (Stroke) within several weeks of each other. Despite his best efforts and desire to recover and return to work it soon became apparent that the lingering physical effects of the strokes as well as the effect they had on his memory and cognitive functioning that this would not happen. It was then that he turned to his employer’s short and long term disability policies.
Short Term Disability
Our client made application for short term disability benefits through the Reed Group, a third party administrator hired by his company to evaluate and make recommendations as to approving or denying short term disability benefits. His claim for short term disability benefits was approved and his experience with the Reed Group was relatively benign in comparison to what was to come with Prudential and his claim for long term disability benefits.
Long Term Disability Application
More often than not the same insurance company will review claims for both short and long term disability. This obviously helps keep the claim process between the two stages somewhat continuous. However, as was the case with our client, the fact that two different companies were involved essentially made the process of applying for benefits under the long term disability policy a completely new process. Armed with a plethora of medical records and reports from his doctors that indicated he would not be able to return to his former occupation and the fact his short term disability claim was approved relatively smoothly, it seemed that there would be little trouble in getting his claim for long term disability benefits approved. Unfortunately, Prudential would use every tactic in its arsenal to deny his claim.
The Denial of Benefits
Prudential’s denial letter contained all too familiar language to anyone whose claim has been denied: a lack of “objective evidence” that evidenced “restrictions and limitations” to our client’s ability to perform the duties of his “sedentary occupation.” In denying the claim, Prudential completely ignored the reports of our clients doctors and physical therapists that noted loss of physical and cognitive capabilities following the strokes, and minimized his incredibly demanding job to nothing more than requiring the ability to sit at a desk all day. Prudential completely fulfilled its purpose of adding insult to injury.
Attorney Stephen Jessup was assigned to file the Administrative Appeal on our client’s behalf. Upon receipt and review of the claim file, Attorney Jessup discovered that Prudential relied solely on the opinion of a nurse case manager in denying the claim and that no attempts to speak with our client’s doctors were ever made. In preparing the appeal Attorney Jessup arranged for our client to undergo Neuropsychological testing to document any and all cognitive impairments stemming from the strokes, as well as a full Functional Capacity Evaluation with a board certified Occupational Medicine doctor in order to accurately document the litany of physical impairments that would prevent him from returning to his former occupation. After receiving the reports and test results Attorney Jessup then contacted our client’s doctors to obtain additional letters of support that would completely undermine the review conducted by Prudential’s nurse. Confident in the sufficiency of evidence in support of disability obtained during the appeal process, Attorney Jessup filed our client’s appeal. Faces with an overwhelming amount of information and being attacked as to the subpar review conducted on our client’s claim, Prudential notified our Office prior to the expiration of the 45 day deadline that it was overturning the denial of our client’s claim for long term disability benefits.
Has your claim been denied?
Our client’s story is a reminder that an insurance carrier will attempt to minimize any medical condition in an attempt to deny a claim for benefits in hopes that the insured will not fight back. Depending on your policy you may only have one chance to prove your case before having to file a lawsuit. Do not take an appeal lightly, as failure to properly document your file could have adverse effects on your legal rights. If your claim for long term disability benefits has been denied please feel free to contact our Office to discuss how we may be able to assist you.
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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?
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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.