Prudential overturned previous denial of long term disability benefits for Mississippi Nuclear Medicine Tech

Our client, Mr. T, formerly worked as a Nuclear Medicine Tech for a large hospital. In May 2011 a number of medical issues, chronic pain syndrome, cervical spine degenerative disc disease, cervical radiculopathy and neuropathy forced Mr. T to stop working and submit his claim for disability benefits first under his employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. Both benefits were funded and administered by Prudential Insurance Company of America (Prudential). Under his employer’s disability policies Mr. T would be considered totally disabled after 24-months if he was unable to perform the material and substantial duties of any gainful occupation, which was defined as any occupation he was qualified to perform by education, training and experience and considering any/all documented functional restrictions and limitations.

After paying Mr. T for more than 3½ years under the LTD Policy, Prudential denied further LTD benefits on the basis that he allegedly no longer met the policy definition of disability. Specifically, Prudential determined that “the medical information received did not support impairment that would prevent [him] from performing the material and substantial duties of any gainful occupation.” After receiving the denial, Mr. T contacted Dell & Schaefer and discussed his case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in Prudential’s denial letter and in the evidence it relied on and agreed to prepare and submit Mr. T’s ERISA appeal with the assistance of his appeal team.

The LTD appeal addressed all of Prudential’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of Prudential’s denial and significant inconsistencies with its medical reviewer’s findings. The appeal next addressed the fact that Prudential’s denial letter grossly misstates and mischaracterizes the record evidence regarding communications between its 3rd party medical consultant (Consultant) and Mr. T’s primary treatment provider. In particular, Prudential claimed that Mr. T’s physician offered a signed agreement with its Consultant’s opinion that Mr. T had light work functional abilities yet the undisputed medical evidence confirms the exact opposite. The appeal also addresses the fact that despite acknowledging Mr. T suffered from twenty-five (25) chronic medical conditions and despite having never examined or observed Mr. T, Prudential’s Consultant assigns to him functional capabilities far in excess of any of his treatment providers or Prudential’s own prior medical reviewer, who concluded that “the claimant had multiple medical conditions when taken individually and in total render him functionally impaired from sustaining even a part time sedentary capacity.” Finally, the appeal addressed the fact that Prudential did not comply with its obligations under 5th Circuit and Supreme Court precedent by failing to meaningfully address Mr. T’s award of Social Security Disability benefits.

Approximately nine weeks later, and after reviewing the appeal and hundreds of pages of exhibits and medical records, Prudential overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Ms. T’s LTD benefits. Attorney Symonds continues to represent our client to best ensure that Prudential will not terminate his benefits again. Feel free to call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.

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Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

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