Prudential Overturns Denial for Dell & Schaefer Client Suffering With Serious Back Conditions
Author: Attorney Alex Palamara
Our client previously worked as a Vessel Pilot for the Ingram Barge Company. Besides being a Vessel Pilot, our client is a husband and a father of three children. Prior to this episode, our client was very active with his children, traveled, played sports, and enjoyed many outdoor hobbies such a fishing and hunting with his family. Unfortunately for our client, his life changed and will never be the same due to the condition of his back. He suffers from lumbar spondylosis without myelopathy, lumbar radiculopathy, as well as deep myofascial pain/severe tendonitis, and muscle spasms.
Due to his employment at Ingram Industries Inc., our client was covered under a Long Term Disability (LTD) Insurance Policy that was insured by The Prudential Insurance Company of America. This LTD policy was in place to provide financial protection for the employees of Ingram Industries Inc. in case they suffered a disabling condition that would leave them unable to perform the material and substantial duties of their occupation.
In March of 2013 our client was forced to apply for such benefits after he was unable to continue working at his occupation. Initially Prudential determined that our client was disabled and began paying him Long Term Disability benefits in August of 2013 after the elimination period expired. Our client received such benefits from Prudential until April 30, 2014. By way of a denial letter dated May 21, 2014, Prudential informed our client that his benefits would be terminated effective May 1, 2014. In support of its denial, Prudential relied upon an Independent Medical Examination (IME) and Covert Surveillance. The doctor who performed the IME apparently found no “objective findings to support any restrictions or limitations from any activities.” In the surveillance video, our client was observed “riding a sit-on lawn mower for 30 minutes, hand washing a full size pick-up truck for approximately 20 minutes utilizing a pressure hose, reaching overhead, standing on the bumper and bending at the waist several times and then following that, driving a vehicle for approximately another hour while (he) went to different fast food restaurants.”
Vessel Pilot Contacts Dell & Schaefer
After receiving the aforementioned May 21, 2014 denial letter from Prudential, the Vessel Pilot found Attorney Alexander Palamara of Dell & Schaefer. After having a chance to review Prudential’s denial letter and claim file, as well as the medical records from our now client’s treating physicians, a proper and timely administrative appealed was filed by Attorney Alexander Palamara at Dell & Schaefer challenging Prudential’s decision to deny further long term disability benefits.
LTD Denial Overturned by Prudential
Within 45 days of the filing of the administrative appeal, our client got word that Prudential had overturned its decision to deny benefits and determined that our client was “eligible for additional benefits.”
Although our client is currently relieved to be back on claim, he understands that the fight does not end. However, as a client of Dell & Schaefer, he feels assured that his attorneys will do whatever it takes to keep him on claim until he is able to return to work.
If you have been denied Long Term Disability Benefits by Prudential or any other insurance provider, please do not hesitate to contact the Attorneys at Dell & Schaefer for a free consultation.
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