United Airlines Ramp Serviceman With Primary Progressive Multiple Sclerosis Wins Illinois Prudential Long-Term Disability Insurance Appeal After Denial at the 24-Month Mark
Prudential paid our client’s long-term disability benefits for two full years — then cut them off the moment the policy’s definition of disability was about to get harder to meet. He is a United Airlines ramp serviceman from Illinois who stopped working because of primary progressive multiple sclerosis and the cascade of neurological problems that came with it.
This is a play we have watched insurers run over and over again: pay through the “own occupation” period, then terminate the instant the standard shifts to “any occupation.” We have seen it many times, and we have beaten it many times. After we filed his administrative appeal, Prudential reversed course and reinstated his benefits in full.
What makes this win worth studying is not just the outcome — it is how a termination built on stale paperwork came apart once the full medical picture was put in front of Prudential. If Prudential or any other disability insurance company has terminated your claim, you can speak with one of our long-term disability insurance attorneys anywhere in the country, at no charge, and we charge no fee unless we recover your benefits.
Table Of Contents
- 1. Why this case matters for every Prudential claimant
- 2. What the 24-month switch to “any occupation” really means
- 3. Prudential’s denial: a termination decided before the standard changed
- 4. The evidence Prudential refused to wait for
- 5. Why seated cashier, repair order clerk, and ticket taker were never realistic
- 6. Prudential reinstates the claim in full
- 7. Talk to a long-term disability insurance attorney
Why This Case Matters for Every Prudential Claimant
Before the detailed story, here are the lessons a denied claimant can actually use. They come from a real win: a United Airlines ramp serviceman whose Prudential benefits were terminated at the 24-month mark, restored in full after we proved he remained disabled from any occupation.
- A termination decided before the standard even changes is vulnerable. Prudential announced it would stop paying under the “any occupation” standard nearly four months before that standard took effect — and it did so without gathering a single piece of current medical evidence. That kind of head start is not diligence. It is a shortcut, and a shortcut is something you can attack on appeal.
- The insurer’s own file is often your best witness. A year before it pulled the plug, Prudential’s own reviewer had already written that our client was at maximum medical improvement, that his prognosis was poor, and that he would likely keep declining. You cannot credibly call a progressive disease “improved” when your own notes say the opposite.
- Objective functional testing dismantles a paper “you can do sedentary work” conclusion. A Functional Capacity Evaluation showing that our client could not sit, stand, lift, or use his hands at the level any desk job demands left Prudential’s vocational theory with nothing to stand on.
- A treating doctor who revises an old opinion is powerful. The very physician whose outdated questionnaire Prudential leaned on later concluded, after a documented decline, that our client could no longer sustain full-time work at any level. That reversal turned Prudential’s strongest exhibit against it.
- A strong appeal can force the review the insurer skipped. Faced with the full record, Prudential ran the peer review and the in-person examination it should have done in the first place — and that examination confirmed exactly what we had argued. We see this pattern across long-term disability claimants with multiple sclerosis, where progression is the rule, not the exception.
What the 24-Month Switch to “Any Occupation” Really Means
Almost every group long-term disability policy contains a hidden trapdoor, and most claimants never see it coming. For the first 24 months, you are disabled if you cannot perform your own occupation — the job you were actually doing. After 24 months, the policy quietly raises the bar: now you must be unable to perform any gainful occupation for which your education, training, and experience qualify you.
That single change is the most common trigger for a termination, because it lets an insurer argue that even if you cannot do your old job, there is some other, lighter job out there you could theoretically perform. This is why a vocational review tied to the change in the definition of disability is one of the most dangerous moments in the life of a claim.
Our client’s Prudential policy followed that exact structure. He had been approved and paid under the own-occupation standard for two years. The 24-month mark was the cliff. And Prudential decided to push him off it before he even reached the edge.
Prudential’s Denial: A Termination Decided Before the Standard Changed
Here is the part that should trouble anyone with a progressive illness. Prudential issued its termination letter — signed by claims examiner Ryan G. — roughly four months before the any-occupation standard was scheduled to take effect. The letter told our client that his benefits would end at the 24-month mark and declared:
“We determined you should have the ability to perform the tasks of a sedentary occupation while including your restrictions and limitations.”
And then, more bluntly:
“Your Multiple Sclerosis would not prevent you from performing any gainful occupation…”
On what did Prudential base this? Not on a current examination. Not on updated records. It relied on a single capacities questionnaire a treating physician had completed roughly eight months earlier, before the change in definition, with no contemporaneous evaluation to back it up. Prudential gathered no new medical evidence at all in the months leading up to the termination.
This is what a paper review looks like in practice — a decision made from the file, with no doctor laying eyes on the claimant. And it produced a conclusion that Prudential’s own records had already contradicted. A year earlier, the claim manager who reviewed our client’s capacity, Joel Leclerc, had written that the condition was:
“…likely permanent. His prognosis for improvement is poor; he will likely continue to decline in function as his disease progresses. He is at MMI.”
“MMI” means maximum medical improvement — the point at which doctors expect no further recovery. A later internal note — entered by claim manager Andrew Grimes — confirmed that his capacity “has not changed” since that assessment. So Prudential’s file said, in its own words, that this was a permanent, worsening condition. Then Prudential turned around and decided he could go back to work. That is not a medical judgment. That is a conclusion in search of a justification.
The Evidence Prudential Refused to Wait For
An administrative appeal under ERISA is the formal, deadline-driven challenge a claimant must file before a federal lawsuit is even possible, and it is governed by ERISA’s claims-procedure rules. It is also the one chance to load the record with everything the insurer ignored. Attorney Alexander Palamara built that record. The picture it painted was the opposite of a man ready to return to work.
The Functional Capacity Evaluation: Below Even Sedentary
A Functional Capacity Evaluation (FCE) is a standardized, hands-on test of what a person can physically do across a full workday — how long they can sit, stand, and walk, and how much they can lift, carry, push, and pull. Our client underwent one performed by a licensed doctor of physical therapy, and the results put him below the threshold for even sedentary work — meaning he could not sustain the demands of a basic desk job. The U.S. Department of Labor’s definition of sedentary work assumes a person can sit for roughly six hours in an eight-hour day. He could not come close:
- Sitting: about 15 minutes at a time, for a total of just under three hours in an eight-hour day.
- Standing: about 15 minutes at a time, for a total of 56 minutes.
- Lifting and carrying: only three pounds occasionally, with a one-pound bilateral carry.
- Pushing and pulling: limited to ten pounds of horizontal force.
- Hands and reaching: only occasional fine coordination, grasping, pinching, and forward reaching.
- To be avoided entirely: walking, stair climbing, balancing, bending, kneeling, squatting, and overhead reaching.
Crucially, the evaluation also measured the validity of his effort — and found 100% consistency of effort and 100% reliability of pain reporting. That matters, because it forecloses the insurer’s favorite fallback argument: that the claimant was exaggerating. He was not. The numbers were real, and they were devastating to Prudential’s position. If you have been asked to attend one of these exams, it is worth understanding whether a Functional Capacity Evaluation helps or hurts a disability claim before you go.
Two Treating Specialists — Including One Who Reversed Himself
His treating neurologist submitted a letter of support and a physician statement leaving no room for ambiguity. He confirmed that the neurological deficits were “chronic, permanent and are not expected to improve in the future. More likely, they are expected to worsen.” He documented MRI plaques characteristic of MS in both the brain and cervical spine, weakness, spasticity (muscle stiffness and involuntary tightening), gait dysfunction (an unsteady, impaired walking pattern), and substantial, reproducible fatigue — and he agreed with the FCE findings. That trajectory is consistent with the documented natural history of primary progressive MS, which is one of accumulating disability, not recovery.
The full diagnostic picture across his treating records went well beyond the multiple sclerosis (ICD-10 G35) itself. His physicians documented the constellation of conditions the disease had produced:
- Paraparesis — partial weakness of both legs, worse on the right.
- Spasticity — involuntary muscle tightening and stiffness in the lower limbs.
- Gait dysfunction with foot drop — an unstable, scissoring walking pattern and an inability to lift the front of the right foot.
- Neurogenic bladder (ICD-10 N31.9) — nerve-related loss of normal bladder control.
- Neuropathic pain — chronic nerve pain.
- Lumbar radiculopathy (ICD-10 M54.16) — pinched-nerve symptoms in the lower spine.
- MS-related fatigue — exhaustion severe enough to require naps during the day.
But the most damaging evidence for Prudential came from the very physician whose old questionnaire it had used. His treating physiatrist — a doctor in physical medicine and rehabilitation — had once believed our client retained some work capacity. After a documented flare and decline, he changed his mind in writing, concluding that our client was “now unable to sustain full-time work at any level” and that “the patient cannot return to work.” The exhibit Prudential leaned on had been overtaken by the facts.
The In-Person Examination That Confirmed Everything
Rather than accept the appeal record, Prudential had the file reviewed by physicians board-certified in neurology and in physical medicine and rehabilitation, and then sent our client for an Independent Medical Examination (IME) — an in-person exam by a physician of the insurer’s choosing, here a doctor board-certified in physical medicine and rehabilitation. It backfired. The examiner documented severe difficulty with gait and balance, extreme spasticity in both legs, clonus (involuntary rhythmic muscle jerks signaling nerve damage), and marked weakness in the right hip and lower leg. The examiner concluded that our client could not sustain full-time competitive work on a reliable basis, would need frequent unscheduled breaks, and faced an elevated risk of workplace injury — and that these limitations were long-term and likely permanent. The insurer’s own examination had confirmed our client’s case for him.
Why Seated Cashier, Repair Order Clerk, and Ticket Taker Were Never Realistic
Prudential’s vocational reviewers had identified three “gainful” jobs they said our client could perform: seated cashier, repair order clerk, and ticket taker. On paper, they sound undemanding. Against the actual evidence, they collapsed.
Every one of those jobs requires sustained sitting, repetitive hand use, and reliable attention across a full shift. Our client could sit only about 15 minutes at a stretch, had lost fine motor control in his dominant right hand, relied on a cane and an ankle-foot orthosis (a brace that supports a foot too weak to lift on its own), and needed naps during the day because of MS-related fatigue. A seated cashier handling cash and customers, a clerk keying in repair orders, a ticket taker on his feet greeting the public — each one demanded exactly the capacities the FCE and his treating doctors said he did not have. Identifying jobs a claimant cannot actually perform is not a vocational analysis. It is a paperwork exercise dressed up as one.
This was not the first time we have seen Prudential reach this kind of conclusion and then have to walk it back:
- We represented an MRI technologist with multiple sclerosis and degenerative disc disease whose terminated Prudential benefits we forced the company to reinstate.
- We represented another Prudential claimant denied under the “any gainful occupation” standard, a denial we overturned on appeal.
- And we represented a bank manager with multiple sclerosis, whose denial we reversed through an ERISA appeal against a different carrier.
Prudential Reinstates the Claim in Full
After completing the file reviews and the IME and reconsidering the full record, Prudential reversed itself. In a reinstatement letter signed by Complex Senior Appeals Specialist Angelica C., the company concluded that the file “does support impairment which would prevent him from performing the duties of any gainful occupation.” Prudential reinstated our client’s long-term disability benefits effective the very date it had terminated them, with no gap, and the back benefits were set to issue.
The reversal did not happen because Prudential had a change of heart. It happened because the record left it no defensible alternative. The evidence it had refused to gather, once placed in front of it, pointed in only one direction.
Talk to a Long-Term Disability Insurance Attorney
As attorney Alexander Palamara put it in the appeal, Prudential’s decision “lacks support in fact, in medicine, and in logic.” The same can be said of most terminations timed to the 24-month definition change — they are built on convenience, not current evidence, and they fall apart when someone forces a full and fair review.
If your benefits were cut off at the 24-month mark, or you have received a letter warning that the “any occupation” standard is coming, do not wait. ERISA imposes strict deadlines on your administrative appeal, and the appeal is the record a court will later be limited to if you ever need to file a lawsuit under ERISA. What you submit now can decide the case.
Established in 1979, our long-term disability insurance attorneys have represented tens of thousands of claimants nationwide and recovered more than $2 billion in disability benefits. Whether you are dealing with Prudential or any other disability insurance company, you can speak with one of our lawyers anywhere in the country for a free consultation, and we charge no fee unless we recover your benefits.
