Prudential Reinstates Long Term Disability Benefits on Appeal to Sales Manager Who Suffered Multiple Strokes

Our client was a Regional Director of Sales for one the largest data processing groups in the world. To say that he was at the pinnacle of his career is an understatement. After knowing a life of work and success in the work place it was a devastating blow when it all came to an end following two Left Capsular Infarctions (Stroke) within several weeks of each other. Despite his best efforts and desire to recover and return to work it soon became apparent that the lingering physical effects of the strokes as well as the effect they had on his memory and cognitive functioning that this would not happen. It was then that he turned to his employer’s short and long term disability policies.

Short Term Disability

Our client made application for short term disability benefits through the Reed Group, a third party administrator hired by his company to evaluate and make recommendations as to approving or denying short term disability benefits. His claim for short term disability benefits was approved and his experience with the Reed Group was relatively benign in comparison to what was to come with Prudential and his claim for long term disability benefits.

Long Term Disability Application

More often than not the same insurance company will review claims for both short and long term disability. This obviously helps keep the claim process between the two stages somewhat continuous. However, as was the case with our client, the fact that two different companies were involved essentially made the process of applying for benefits under the long term disability policy a completely new process. Armed with a plethora of medical records and reports from his doctors that indicated he would not be able to return to his former occupation and the fact his short term disability claim was approved relatively smoothly, it seemed that there would be little trouble in getting his claim for long term disability benefits approved. Unfortunately, Prudential would use every tactic in its arsenal to deny his claim.

The Denial of Benefits

Prudential’s denial letter contained all too familiar language to anyone whose claim has been denied: a lack of “objective evidence” that evidenced “restrictions and limitations” to our client’s ability to perform the duties of his “sedentary occupation.” In denying the claim, Prudential completely ignored the reports of our clients doctors and physical therapists that noted loss of physical and cognitive capabilities following the strokes, and minimized his incredibly demanding job to nothing more than requiring the ability to sit at a desk all day. Prudential completely fulfilled its purpose of adding insult to injury.

Attorney Stephen Jessup was assigned to file the Administrative Appeal on our client’s behalf. Upon receipt and review of the claim file, Attorney Jessup discovered that Prudential relied solely on the opinion of a nurse case manager in denying the claim and that no attempts to speak with our client’s doctors were ever made. In preparing the appeal Attorney Jessup arranged for our client to undergo Neuropsychological testing to document any and all cognitive impairments stemming from the strokes, as well as a full Functional Capacity Evaluation with a board certified Occupational Medicine doctor in order to accurately document the litany of physical impairments that would prevent him from returning to his former occupation. After receiving the reports and test results Attorney Jessup then contacted our client’s doctors to obtain additional letters of support that would completely undermine the review conducted by Prudential’s nurse. Confident in the sufficiency of evidence in support of disability obtained during the appeal process, Attorney Jessup filed our client’s appeal. Faces with an overwhelming amount of information and being attacked as to the subpar review conducted on our client’s claim, Prudential notified our Office prior to the expiration of the 45 day deadline that it was overturning the denial of our client’s claim for long term disability benefits.

Has your claim been denied?

Our client’s story is a reminder that an insurance carrier will attempt to minimize any medical condition in an attempt to deny a claim for benefits in hopes that the insured will not fight back. Depending on your policy you may only have one chance to prove your case before having to file a lawsuit. Do not take an appeal lightly, as failure to properly document your file could have adverse effects on your legal rights. If your claim for long term disability benefits has been denied please feel free to contact our Office to discuss how we may be able to assist you.

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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.

Reviews   *****

Patricia E.

After fighting with UNUM for over a year over whether I was disabled (I had been determined to be disabled by the Federal Government and had a letter stating such), I finally decided to hire an attorney. Being skeptical and wary of money grubbing lawyers, I researched various firms over 2 months, interviewing prospective attorneys over the phone. I selected Dell & Schaefer based on their website, case success statistics, and the speed at which they returned my calls and emails.

My experience in working with Rachel Alters and her assistant Michal Mizrahi is nothing short of outstanding. They responded quickly to phone calls and emails and were mindful of my concerns and information needs. Even when Ms. Alters was out of the office for personal reasons, she would make sure that my questions were answered thoroughly in a timely manner. I cannot say enough good things about Michal. She anticipated my needs and was proactive in keeping me informed as my case progressed.

In the end, Rachel and Michal were successful at reaching a good settlement for me with UNUM and I am very satisfied.

Resolving disputes with insurance companies is always stressful and unpleasant. I strongly suggest that if you find yourself in that place, that you seriously consider Dell and Schaefer, and if possible, Rachel Alters. She made what could have been a horrible situation not only bearable but brought to a successful conclusion in a timely manner. I am clear that I would never had had such a positive outcome without their help and expertise.

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