Prudential Insurance Company of America overturned previous denial of long term disability benefits for Oregon Software Engineer

Our client, Mr. B, formerly worked as a Software Engineer for an International Software Corporation. In November 2014 a number of issues including chronic bipolar disorder, schizoaffective disorder, short term memory loss, and obstructive sleep apnea forced Mr. B to stop working and submit his claim for disability benefits first under his employer’s self-funded short term disability (“STD”) plan administered by Prudential then continuing under his employer’s Long-Term Disability (“LTD”) Policy administered and funded by Prudential. Under both of his employer’s disability policies Mr. B would be considered totally disabled if he was unable to perform the material and substantial duties of his regular occupation, which was defined as the occupation he was routinely performing when his disability began.

After paying Mr. B for more than 7 months 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 Mr. B “had not provided sufficient proof to establish that he was unable to perform his regular occupation.” After receiving the denial, Mr. B 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. B’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. The appeal next addressed the fact at the time Prudential discontinued benefits effective January 2016 there was more than sufficient medical evidence contained in the claim file and submitted by Mr. B’s physicians to support his ongoing claim for benefits due to his diagnosed condition(s) of chronic obstructive sleep apnea/narcolepsy. The medical records submitted clearly establish that Mr. B was under the regular care and treatment of a Board Certified Neurologist for chronic sleep apnea/narcolepsy since 2009. And those records clearly establish that Mr. B suffered a myriad of symptoms associated with his conditions. What’s more, although required for a full, fair and thorough review of Mr. B’s claim, neither the claims examiner nor the medical consultant conducted or provided a detailed assessment of the available medical records, especially those around the time Prudential denied Mr. B’s claim. The claim file also confirmed that no attempt was made by Prudential to contact Mr. B’s treatment providers to determine the nature and extent of his restrictions and limitations. And finally, the claim file confirms that Prudential failed to consider a fully supportive and comprehensive Neuropsychological Evaluation conducted on Mr. B just months before the denial.

Nearly four months later, and after reviewing the appeal and hundreds of pages of exhibits and medical records as well as the expert reports, Prudential overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Ms. B’s LTD claim. 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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FAQ

Do you help Prudential claimants nationwide?

We represent Prudential clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Prudential disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Prudential. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Prudential.

How do you help Prudential claimants?

Our lawyers help individuals that have either purchased a Prudential long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Prudential:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

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.

Dell & Schaefer Client Reviews   *****

Dr. Robert F.

A year ago in August I had the unfortunate situation where I injured my left hand playing in a recreational adult ice hockey game. My first reaction was fear, panic, and my work career is in danger. Having a job as a physician my hands are critical in day to day life but more important to do my job. I remembered at that point a local radio discussion about disability and knew that I had bought a policy 20 years ago and never thought I’d need it but always paid the policy just in case of a potential need.

I contacted Dell and Schaefer and I must say it was one of the best decisions of my life. Now my attorney, Cesar all I can say is THANK YOU! Michal THANK YOU! It at times going through the process was nerve racking scary but they walked me through it and always were there for my questions and concerns. When your life changes in one second you don’t know how to react. The group at Dell & Schaefer do. They understand not only what your going through but realise its individual for each client but always take a personal interest in your concerns. All I can say is my life has changed but choosing Dell & Schaefer to assist me in my claims process was one of the best decisions I ever made in my life

Thank you Cesar, Michal, and the whole firm. I’m with you for life.

Regards, Dr. Rob F.

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