Prudential reverses denial on second appeal & pays $175,000 in past due disability benefits to OBGYN

Medical Condition and Occupational Duties
Our Client, an OBGYN (hereinafter referred to as “Dr. OBGYN”), was employed by a hospital when he began to experience anxiety and depression following the filing of a malpractice lawsuit. Our client began drinking alcohol on a daily basis and was subsequently hospitalized for three months as a result of alcoholism, anxiety, depression and suicidal thoughts. Prior to claiming disability Dr. OBGYN’s substantial and material duties involved the delivery of babies, gynecological surgeries and on-call requirements.

Procedural History

Our Client’s disability plan was provided as an employee benefit from his employer, which meant that his disability plan was governed by ERISA. As a result of having a disability plan governed by ERISA, our client was required to exhaust his administrative remedies and file two written appeals with Prudential before he could he file a lawsuit. Attorneys Dell & Schaefer was retained on this case following Dr. OBGYN’s initial denial of benefits by Prudential.

In Prudential’s initial denial letter they claimed that Dr. OBGYN was disabled during the three month period of time that he was hospitalized, but that he was capable of returning to work immediately following his hospital discharge. Prudential’s opinions were reached based upon a paper review of Dr. OBGYN’s medical records by a doctor employed by Prudential doctor. Prudential denied the first appeal on the basis that Dr. OBGYN was only disabled when he was drinking and therefore he should be capable of working. Prudential completely ignored the fact that a substance abuse disorder is a disabling condition. Prudential never examined Dr. OBGYN in order to evaluate his medical condition.

Through a coordinated effort between our law firm and Dr. OBGYN’s treating doctors, we were able to present Prudential with additional medical information in support of the claim for long-term disability benefits. The additional medical information and our extensive second appeal letter were submitted to Prudential in a timely manner. Within 45 days of receiving the second appeal letter, Prudential reversed their previous two denials and determined that Dr. OBGYN was eligible for disability benefits. Since Dr. OBGYN suffered from a mental nervous and substance abuse disorder, the disability policy limited him to two years of disability benefits. Dr. OBGYN was awarded more than $175,000 in past due disability benefits.

This Prudential ERISA appeal was handled by Attorney Gregory Dell.

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Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

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