Prudential Reinstates Disability Benefits To School Teacher

Our client was a former public school teacher in South Florida who was forced to file for long term disability benefits under her school district’s disability policy with Prudential due to debilitating Chronic Pain stemming from multiple disc herniations in her neck and lower back and osteoarthritis of the knees. Like the vast majority of Prudential disability insurance policies our client’s policy contained a two year “regular occupation” definition of disability that would pay benefits in the event she was unable to perform the material and substantial duties of her occupation as a school teacher. Then after long term disability benefits had been paid for 24 months the definition of disability changes to the stricter, “any gainful occupation” definition of disability.

Following the submission of an application for benefits, Prudential approved our client’s claim under the regular occupation definition of disability with little difficulty. After 24 months of payments Prudential then conducted its review as to our client’s entitlement to benefits under the any occupation standard of disability and upon completion of same determined our client to continue to be totally disabled from performing the duties of any gainful occupation based on the overwhelming amount of supportive medical evidence.

The Denial of Benefits

For over two years Prudential continued to provide continued monthly disability benefits to our client under the “any gainful occupation” definition of disability. Needless to say our client was not concerned about Prudential denying her claim, based on the fact that Prudential had never denied her claim for benefits and she was receiving her Social Security Disability benefits. Then, after being on claim for four years, without warning she received a letter from Prudential which stated that based on a review of her records she would not be precluded from returning to her former occupation as a school teacher and that in addition to being able to return to her former occupation that she would be able to perform a multitude of other less physically demanding occupations.

Appealing Prudential’s Denial

Our client contacted Attorneys Dell & Schaefer and spoke with Attorney Stephen Jessup to discuss what could be done to get her benefits reinstated. Review of Prudential’s claim file indicated that the medical review conducted by Prudential was relegated to a limited review of medical records from only a few of our client’s treating physicians, and focused solely on her knee conditions while ignoring the abundance of medical information relating to our client’s back and neck conditions. In doing so Prudential had an easy job of arguing our client could perform full time sedentary work and in turn denying her claim. Attorney Jessup attacked Prudential for failing to conduct a full and fair review of our client’s file as required by ERISA. Knowing that pointing out Prudential’s flaws would not in and of itself make Prudential admit it’s error in denying benefits, Attorney Jessup arranged for our client to undergo an IME and Functional Capacity Evaluation to fully document her physical restrictions and limitations. Armed with objective testing to establish our client’s physical ability to work Attorney Jessup systematically proved that our client could not perform the duties of her prior occupation as well as the alternate occupations Prudential claimed she was capable of performing.

Within the 45 days allotted to render a decision following the filing of the appeal, Prudential notified our Office that it was overturning the denial of our client’s claim, reinstating her benefit and forwarding all back benefits owed.

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FAQ

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, GoToMeeting.com 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.

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