Our client was a Territory Sales Specialist for a major medical supply company, responsible for sales spanning a large geographic area with incredibly high sales quotas. Physical requirements of her occupation required here to travel extensively, drive long distances on a day to day basis, carry samples and products that could weigh in excess of thirty pounds, and give presentations and demonstrations. Her job required her to have a strong understanding of all aspects of her company’s products, and keep current with all advancements in the field of medicine as it relates to her company’s products.
Our client had suffered from neck and back pain since she was involved in a car accident several years ago. Throughout the years she sought treatment, but remained focused on her career, pushing aside the discomfort she was experiencing. However, by 2008 the pain had become unbearable, and it was having a severe impact on her ability to perform her occupation. An MRI of her cervical spine revealed multiple disc bulges and an extrusion at the C6-7 level with evidence of narrowing and compression of the spinal cord, which caused radiating pain to her arms.
Our client filed a claim for disability benefits under her company’s long term disability policy with Prudential. During this time she was released from employment and no longer had adequate health insurance to treat regularly to treat her condition properly. At first Prudential provided benefits under reservation of rights pending more medical information. She attempted to keep up with all of Prudential’s requests, but soon became overwhelmed. In September of 2008, Prudential terminated her benefits, citing the “Proof of Claim” and “Appropriate Care” provisions contained in the policy.
No longer able to deal with the constant harassment from Prudential, she contacted the law firm of Attorneys Dell and Schaefer. Dell and Schaefer immediately contacted Prudential, requested all claim information and requested Prudential no longer contact our client. Through no fault of her own, due to her lack of adequate health insurance to cover the cost of treatments, a review of the medical records made it apparent that the course of treatment our client had been receiving would make it difficult to satisfy the “Proof of Claim” and “Appropriate Care” provisions under the policy. Armed with the limited information available, Dell and Schaefer filed an Appeal with Prudential.
Based upon the information presented and the arguments for disability benefits contained in the appeal, Prudential reversed their prior denial of long-term disability benefits and agreed to conduct further review for disability benefits for 2009. Steven Jessup, of Attorneys Dell & Schaefer was the lead attorney on the file and continues to manage the claim on a monthly basis.