Prudential Overturns Decision to Deny Long-term Disability Benefits to Former JP Morgan Chase Financial Advisor With Mandibular Cancer

In 2014, our client, Michael, received the terrible news that he had squamous cell carcinoma of the alveolar ridge (Mandibular Cancer), and as a result was forced to cut a successful career as a financial advisor with JP Morgan Chase short. While undergoing extensive surgery on his jaw with flap reconstruction, treacheostomy and post-operative radiation therapy, Michael submitted his claim with JP Morgan Chases’ long-term disability insurer, The Prudential Insurance Company of America (“Prudential”).

The Prudential policy qualified disability as:

You are disabled when Prudential determines that:

After submitting his disability claim, Prudential reviewed Michael’s Claimant Statement, Attending Physician Statement and the medical records provided by Michael’s treating physicians. Within a few weeks of the claim being submitted, Prudential approved the disability claim and Michael began receiving disability benefits.

Unfortunately, Michael not only lost a rewarding career that he loved, but also the ability to fully open his jaw, restricting his ability to eat and chew, and required the use of a PEG feeding tube in order to receive much of his nutrition. He lost multiple teeth due to his condition, as well as his ability to communicate effectively, a critical aspect of his occupation as a financial advisor.

Prudential’s Terminates Long-term Disability Benefits Finding That Financial Advisor Can Work in a Gainful Occupation.

After paying 24 months of long-term disability benefits, Prudential notified Michael that he no longer met the definition of “disability” in the long-term disability policy and that it felt he could work in a sedentary occupation. In its denial letter, Prudential identified four occupations it believed he could perform.

Prudential alleged that Michael could purportedly perform the occupations of financial representative, sales account manager, financial planner and registered financial representative.

After receiving his letter denying his claim for any gainful occupation benefits, Michael retained Attorney Cesar Gavidia and his appeal team at Attorneys Dell & Schaefer.

In the Appeal, it was argued that all of the occupations identified by Prudential in its denial letter required significant and effective verbal communication. In the Appeal, Evidence from the Department of Labor was submitted confirming that the occupations identified by Prudential all required the unencumbered ability to “speak clearly so that the listener would understand” and the ability to “communicate information and ideas in speaking so that others would understand.”

It was further argued that in baselessly denying Michael’s long-term disability claim, Prudential also failed to account for the psychosocial impact that his language limitations and significant facial disharmony would impose.

Within 4 weeks of the Appeal being submitted, Prudential notified Attorney Gavidia and Michael that the adverse decision it had previously made was being overturned and that he indeed qualified for disability from Any Gainful Occupation for which he was qualified based on education training and experience.

Michael continues to receive long-term disability benefits from Prudential, and unfortunately remains disabled. Attorney Gavidia and his team at Dell & Schaefer continues to represent Michael in his claim and monitor all of Prudential’s activity closely.

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FAQ

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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