Prudential Overturns Denial of Long Term Disability Benefits to College Professor
Author: Attorney Stephen Jessup
Prior to filing for disability our client was a Professor of Psychology at a large University. Unbeknownst to many around her she was battling a long history of Bipolar Disorder, Depression and Anxiety, which began to affect her ability to properly perform the duties required of her as a collegiate level professor. The daily battle she faced with depression and anxiety left her overwhelmed and emotionally exhausted. When she felt she could no longer properly fulfill her responsibilities to her undergraduate students or serve as a mentor to her graduate level students she made the very difficult decision of filing for disability.
Long Term Disability Benefits Are Awarded
Like many full time college professors, her university provided short and long term disability insurance benefits as part of her benefits package. Our client initially applied for short term disability benefits through Prudential and was approved. She did not experience any problems throughout the short term disability period and when it came for her claim to transition from short to long term disability benefits it appeared as if there would not be any problems from Prudential. She received noticed that her claim has been approved; however, the initial award of benefits came with the caveat that she was only to receive 15 days’ worth of benefits.
Although Prudential had only issued benefits for 15 days, it took approximately one month from the date she received notice her claim was approved before Prudential advised her in writing that additional benefits were not going to be paid due to what Prudential indicated was a failure to provide Proof of Loss under the policy. In response to this assertion our client provided Prudential with additional requested information in hopes of receiving continued disability benefits. Unfortunately, such was not the case. Approximately two months after initially approving her claim for long term disability benefits, Prudential formally advised our client that it had determined that there was no documented evidence in her treatment records sufficient to support her inability to perform the duties of her occupation. It should be noted that Prudential made this determination without having our client submit to an examination, consulting with her treatment providers, or as would be discovered reviewing all of her medical records.
Shortly after her claim was denied our client consulted with Attorney Stephen Jessup to discuss Prudential’s adverse determination and determine the best course of action in appealing same. Attorney Jessup secured a copy of our clients claim file and began gathering her medical records. It became readily apparent that Prudential was selectively reviewing our client’s records that were supportive of its decision to deny benefits, but ignoring those records that proved our client could not work in her profession. Furthermore, the records collected by Attorney Jessup far outweighed the amount collected by Prudential as contained in the claim file. Attorney Jessup consulted with our client’s treatment providers in order to obtain additional opinions as to our client’s functionality, to address any and all concerns in the medical records to be able to establish restrictions and limitations dating back to the date of denial, and to combat the opinions of Prudential’s peer review doctors. Armed with medical support sufficient to disprove Prudential’s opinion, Attorney Jessup attacked the vocational review conducted by Prudential as insufficient and not taking into consideration the mental demands of our client’s occupation as a College Professor, as well as the social interactions/demands required to properly perform the duties of same.
Attorney Jessup filed the appeal on our client’s behalf. Prudential attempted to stall in rendering a decision, exercising a 45 day extension on the 45th day following the submission of the appeal. Ever vigilant as to the deadline for Prudential’s decision, when Prudential failed to make a determination by the end of the 90th day, Attorney Jessup drafted a Complaint to be filed in Federal Court. Before the Complaint was filed, a letter was received indicating Prudential was overturning its decision to deny benefits and putting our client back on claim.
Has your claim been denied?
Like many people suffering from a Mental Health condition the added stress of fighting with Prudential took a toll on our client’s well-being and ability to focus on her treatment. If your claim is being challenged by your disability insurance carrier; your claim has been denied; or you do not want to deal with the stress of fighting with your insurance carrier monthly, please feel free to contact our office for a free consultation to discuss how we may be able to assist you.