Prudential denied continued long term disability benefits for a former Stroke Coordinator for HCA Healthcare beyond March 31, 2014 by way of a denial letter dated April 24, 2014. According to the aforementioned denial letter, as of April 1, 2014, Prudential believed that the Stroke Coordinator, who eventually became our client, was able to perform the material duties of her regular occupation. This was in light of the fact that Long Term Disability (LTD) benefits had been previously approved and paid for 19 months after our eventual client went out of work on April 6, 2012. This was also in light of the fact that our eventual client suffered from and continued to suffer from Low Back Pain with Radiation to the Right Lower Extremity, Bilateral Lower Extremity Pain, Lumbar Radiculitis, Lumbar Spondylosis, Lumbar Spinal Stenosis, Arthralgias, Obstructive Sleep Apnea, Severe Hypersomnolence, Hypoxia, Apnea Hypopnea, Chronic Bronchitis, Chronic Obstructive Pulmonary Disease, Upper Respiratory Infection, Reactive Airways Disease, Hypoventilation Syndrome, Dizziness/Lightheadedness, Obesity, Diabetes Mellitus Type 2, Right Hand Paresthesias, Bilateral Carpal Tunnel Syndrome, Right Eye Corneal Transplant, Right Eye Cornea Replacement Rejection, Bilateral Glaucoma, Penetrating Keratoplasty (PKP), Right Eye Cataract, Headache, Gastroesophageal Reflux Disease, Nausea, Reflux Esophagitis, Chronic Gastritis, Hypercholesterolemia, Hyperlipidemia, Hypothyroidism, Hypertension, Tachycardia, Palpitation and Chest Pain, Depression and Anxiety.
In support of its position, Prudential solely relied upon internal reviews by its own employees to conclude that our eventual client should no longer continue to receive LTD benefits.
Long Term Disability Appeal Filed
Fortunately for the former Stroke Coordinator, she was able to find Attorney Alexander Palamara at Dell & Schaefer to represent her with her claim. After having a chance to review the medical records and Prudential’s Claim File for our now client’s LTD claim, an administrative appeal challenging Prudential’s determination was timely and properly filed. The Administrative Appeal was able to focus on the strengths of the client’s medical records as well as the weaknesses of Prudential’s internal reviews. It pointed out that Prudential’s reviewers possessed an inherent conflict of interest and it noted that Prudential decided to terminate our client’s claim without having a physician examine her. Even further, it noted that Prudential did not even have an “independent” physician review our client’s medical records. Prudential solely relied upon internal reviews by its employees who, of course, possessed the aforementioned inherent conflict of interest in deciding claims for benefits. On top of all the mistakes made by Prudential, the biggest mistake was how Prudential overlooked the abundant medical documentation which objectively supported our client’s claim as well as the abundant support of her treating physicians.
LTD Denial Overturned by Prudential
In today’s mail, we received a check for our client’s full benefit for the period of April 1, 2014 through January 31, 2015. Our client will continue to receive her LTD benefit for the foreseeable future as Prudential has also found that she satisfies the new definition of disability that became active after 24 months of benefits were paid. This new definition of disability requires that our client be “unable to perform the duties of any gainful occupation for which (she is) reasonably fitted by education, training or experience…”.
Our client is relieved to be back on claim, but she recognizes that the fight continues. As a client of Dell & Schaefer, she feels assured that her attorneys will do whatever it takes to keep her on claim until she is able to return to work or until her policy expires.
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.
Read more about Prudential disability claims on this page.