Prudential pays computer system engineer’s ERISA disability benefits after 3 unsuccessful appeals by the insured and his previous attorney

This client, a computer systems engineer, hired our firm to dispute Prudential’s decision to terminate his long term disability benefits following his own two unsuccessful attempts to appeal this determination and an unsuccessful formal appeal filed by his prior attorney. Under the terms of his policy, he received long term disability benefits for two years under an “own occupation” definition (the inability to perform the substantial and material duties of his own occupation due to illness or injury) and then for another year under the “any occupation” definition (the inability to perform for wage or profit the substantial and material duties of any job for which you are reasonably fitted by education, training and experience), which became the standard for eligibility 24 months after his date of disability.

This engineer’s benefits were terminated after more than three years of being on claim as the result of a medical examination and records review by Prudential’s own doctors. After being hired, we spoke with our client’s doctors and a vocational rehabilitation expert to better understand his claim. As the result of our research and a better understanding of our client’s specific computer knowledge, limited experience and training in other occupations, and his disability related restrictions and limitations, we took the position that he could no longer work, for wage or profit, in any job. Our attorneys then prepared and filed a formal 413 page appeal, including exhibits and other supporting documents. More specifically, this Appeal plainly illustrated the extent of our client’s disability and provided Prudential with records, letters, expert reports and other documents which established his inability to work at any occupation.

Approximately 30 days after we filed the Appeal, the insured was placed back on claim and received all back benefits due and owing to date.