It is undisputed that our client served honorably in the Vietnam War during the time period of 1968 to 1969. Most recently he had been an employee of US Foodservice for over 17 years without issue. He worked as a District Sales Manager. However in 2008, a change in management at his job brought drastic changes which lead to him experiencing increased stressed. This additional stress resulted in our client to suffer increased anxiety and depression.
Medications helped somewhat, but he found that he was not able to cope with the increased stress, depression and anxiety which lead to increased nightmares and disrupted sleep. As a result of this combination, our client began suffering with impaired memory and concentration while at work. In April 2013 his treating psychiatrist ordered him to take a leave from work. Luckily for the client, his employer provided him with disability insurance coverage with Prudential if such a situation arose.
Application for Benefits
Being covered under a long term disability insurance policy and being unable to perform the material and substantial duties of his own occupation, our client applied for long term disability benefits on his own. His policy, like many LTD policies, will “not cover a disability due to way, declared or undeclared, or any act of war.” After his application was filed, Prudential unfortunately found that his PTSD and depressive disorder were related to his service during the Vietnam War and as such held that “the War Exclusion applies to your claim.” This decision was expressed to him in a December 9, 2013 denial letter.
Appeal by Lawyers at Dell & Schaefer
Unsuccessful with his application for LTD benefits, the client found the lawyers at Dell & Schaefer to help him with the administrative appeal that needed to be filed to challenge Prudential’s initial decision that denied his claim for benefits. Now this appeal was unique in the sense that Prudential was not saying that the client was not disabled. In fact the December 9, 2013 denial letter listed all the issues that the client was going through that added up to the fact that he was unable to perform the material and substantial duties of his regular occupation.
However, because Prudential found that his disabling conditions were ultimately caused by his service in the Vietnam War, the lawyers at Dell & Schaefer had to prove that his history of such actually happened to be unrelated to his claim for benefits.
An appeal was filed on June 6, 2014. This appeal laid out the reasons why the client’s disability was not war-related but in fact due to the increased work stress which lead to depression, anxiety, panic attacks, insomnia and impaired memory/concentration. The appeal was able to show the specific changes at work that occurred due to the change in management. The appeal also demonstrated how the client was able to get married, raise 6 children, work several long term jobs, including starting and running his own business, and the fact that he worked for US Foodservice for 17 years without issue. This helped to show that his service in the Vietnam War had no relation whatsoever to his claim for disability benefits.
Appeal was Successful
By way of a June 25, 2014 letter, 19 days after the appeal was submitted, Prudential informed lawyer Alexander Palamara of Dell & Schaefer that his appeal was successful. Prudential overturned its initial decision to deny benefits and was now awarding our client monthly benefits. Our client will be receiving a big back benefit check for the time period when benefits should have been paid and he will also be receiving a monthly benefit until he is able to go back to work or until his eligibility for benefits ends.
Should you have a similar claim with Prudential or any other disability insurance provider such as Unum, MetLife, Cigna, etc., please feel free to contact the lawyers of Dell & Schaefer for a free consultation.