Prudential Overturns Disability Denial for Third Time to Insured with Cluster Headaches

Our client, a former software programmer from Texas, has had a long and tumultuous history with Prudential as it relates to his claims for short and long term disability benefits. With any disability carrier you can never let your guard down, as an approval one day does not mean that benefits will continue forever. In this particular case we have won three different ERISA disability appeals for our client and we continue to represent him on a daily basis.

We Keep Fighting and Our Client Continues to Get Paid

He first contacted Attorneys Dell and Schaefer in 2009 to assist him in appealing the denial of his claim for short term disability benefits. At that time Prudential held that his Chronic Cluster Headaches would not prevent him from performing the duties of his occupation, as all of his symptoms were based on subjective complaints. In preparing the initial appeal for short term disability benefits it became apparent that Prudential was reviewing his medical history as if he had Migraine headaches. Anyone who suffers from Cluster Headaches knows that they are much different than Migraine headaches. Whereas there is a wealth of medical information and treatment options for Migraines, the same cannot be said for Cluster Headaches. Following an appeal submitted by Attorneys Stephen Jessup and Gregory Dell, our client’s claim for Short Term Disability benefits was approved. However, the fight was not over. In evaluating our client’s claim for Long Term Disability benefits, Prudential again issued a denial of benefits.

Prudential Tries To Limit Disability Benefits To Two Years And Claims “Self Report” Symptoms

Attorneys Jessup and Dell again began the process of filing an appeal of Prudential’s denial. Despite the medical evidence already submitted during the course of the short term disability claim, Prudential continued to argue that our client’s Cluster Headaches were based solely on self report and that they should have resolved to the point that he could return to work. It was apparent from the long term disability policy governing the claim that Prudential was arguing this position as the policy contained a two year limitation for conditions deemed to be of “self report.” The Self Reported Symptoms Conditions Limitation in the Policy specifically mentioned “headaches” as an enumerated condition under the limitation. In preparing the appeal it was clear that in fighting on our client’s behalf, we would have to not only prove the debilitating nature of our client’s Cluster Headaches to secure initial benefits but also prepare the claim to be in the best position to overcome the two year self reported symptoms limitation, which would also be further compounded by the two year “any occupation” review that would occur at the same time.

Overcoming the Two Year Limitation of Disability Benefits and a Third Appeal in Within 3 years

Attorneys Jessup and Dell coordinated with our client’s treating physicians and other medical professionals to have our client undergo testing in an effort to provide “objective evidence” of what Prudential deemed to be a subjective condition. Following the submission of the appeal, Prudential approved our client’s initial claim for long term disability. However, Prudential’s decision came with a caveat that benefits would be limited to two years under the self reported symptoms conditions limitation.

After the initial award of long term disability benefits, Attorneys Jessup and Dell began compiling additional medical documentation to submit to Prudential in advance of the two year limitation period. Despite the extensive information that was exchanged back and forth between Prudential and Attorneys Dell and Schaefer, Prudential again issued a denial in advance of the two year limitation period based on our client’s “subjective” condition. Following an in depth review of the voluminous claim file as it existed at the time of this last denial, Attorneys Jessup and Dell immediately began the process of gathering additional medical support and crafting the arguments that would form the basis of the appeal of Prudential’s latest denial.

Following a long appeal review, which included a request for an extension, Prudential again overturned its denial of our clients benefits and deemed him to be totally disabled under the any occupation provisions of the policy, and in doing so conceded that there was objective evidence of our client’s Chronic Cluster Headaches, which removed it from the twenty four month limitations for conditions of “self report.”

Many medical conditions, such as migraines, fibromyalgia, chronic fatigue, etc. are considered to be “subjective” in nature in the opinions of the insurance companies, and as such fall under additional scrutiny and are more susceptible to being challenged. The fact that many insurance companies write specific limitations for these types of conditions creates additional roadblocks to receiving benefits. Over the course of three years, our client had to fight on three separate occasions not only to receive the benefits he was entitled to, but to also prove the existence of his debilitating medical condition. If you are having difficulties with an insurance carrier due to the nature of your medical condition or need assistance in fighting for or keeping your benefits intact, please contact Attorneys Dell and Schaefer for a free consultation.

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.

Dell & Schaefer Client Reviews   *****

Michael F.

I hired Greg Dell to handle my LTD claim with the most horrendous insurance company in the world; The Hartford.

It is difficult, if not impossible, to find a firm/attorney that specializes in LTD claims. Greg has always been available for consultation, and brings an ease and no nonsense approach to the arena. He brings the experience and perspective to your case that one needs because it is difficult to remove yourself from the emotional knee jerk responses that are typical in these situations.

He is very fair with his time and efforts and is not an attorney that will bill you to death every time you look his way. I really appreciate that.

I highly recommend Greg, and feel more secure with my LTD claim knowing I can turn to him when I have questions, concerns, and when The Hartford behaves badly.

***** 5 stars based on 202 reviews

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