Prudential overturned previous denial of long term disability benefits for Connecticut Audit Manager

Our client, Mr. D, formerly worked as an Audit Manager for a large, international heating and air conditioning manufacturer. In September 2013 a number of psychiatric issues, including PTSD, bipolar disorder and major depression forced Mr. D 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). Mr. D’s LTD Policy had a 24 month maximum benefit limitation on psychiatric disabilities. Consequently, after 24 months of LTD benefits, Mr. D would continue to be considered totally disabled if he was unable to perform the material and substantial duties of his own regular occupation solely as a result of a physical sickness or injury, separate and independent of any ongoing psychiatric conditions from which he may suffer.

In March 2016, after paying Mr. D for 24 months based on his psychiatric conditions, Prudential denied continued LTD benefits on the basis that Mr. D he allegedly no longer met the policy definition of disability. Specifically, Prudential stated that his physical “restrictions and limitations [were] within the physical demands of [his] regular occupation.” After receiving the denial, Mr. D 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. D’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. In support of the appeal, Attorney Symonds submitted an Attending Physician’s Statement (APS) from Mr. D’s Infectious Disease physician – with whom he had treated for more than 13 years – as well as his Cardiologist – with whom he had treated with for more than 15 years. Both physicians stated unequivocally that Mr. D’s physical illnesses and ailments prevented him from performing the material and substantial duties of his regular “light capacity” occupation or, for that matter, any sedentary occupation. The appeal also points to the fact that, despite Mr. D’s many complex conditions and treating specialists, Prudential’s denial rested on a records review conducted by an in-house medical consultant with little clinical experience and board certified in Occupational Medicine. Finally, the appeal addressed the fact that Prudential made no attempt to determine whether Mr. D could actually perform his “regular occupation.” Rather it relied on a generic job description from Mr. D’s employer which was less than a single page and attempted to encompass the full scope of Mr. D’s “essential duties and responsibilities” in just nine (9) single sentence bullet points. And nowhere did it discuss or mention the physical requirements of Mr. D’s job. The appeal established that when compared to Mr. D’s actual duties and responsibilities, which were clearly quite intellectually complex, detail oriented and more physically demanding than simply “light” work, Prudential’s purported investigation was incomplete and unreasonable.

Less than four (4) 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. D’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.

Questions About Hiring Us

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, 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.

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