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Prudential Decides to Terminate Long-term Disability Claim of Disabled Chevy Chase Bank Manager That It Had Paid for 11 Years, But It Overturns Decision After Attorney Dell & Schaefer’s Appeal

Attorney Cesar GavidiaAuthor: Attorney Cesar Gavidia

Our client, Connie, worked as a Manager for a Chevy Chase Bank branch in Virginia. In 2006, at the age of 25, she suffered a stroke which caused her to lose vision in her left eye and left her with cognitive and memory issues.

It was determined that her stroke was caused by, Thrombotic Thrombocytopenic Purpura (TTP), a rare blood disorder that causes the blood to clot in small blood vessels throughout the body, limiting (or blocking) the flow of oxygen-rich blood to the body’s organs, such as the brain, kidneys, and heart. After her stroke, she also complained to her doctors that she was having difficulty thinking and “figuring things out”. Her physicians referred her to a neuropsychologist, who performed a neuropsychological examination showing that the stroke had indeed caused cognitive and memory impairments.

Connie soon had to inform her employer that she would not be returning to work and would need to file a long-term disability claim with her employer’s long-term disability insurer, Prudential Insurance Company of America (“Prudential”). After receiving the claim, Prudential and its medical consultant reviewed Connie’s records, and in particular the results of the neuropsychological examination. It did not take long for Prudential to conclude that Connie was totally disabled from her own occupation as a Branch Manager.

For the next 11 years not much changed. Connie continued to suffer with her loss of vision and the cognitive impairment left by the stroke. As part of its claim review to determine if Connie was disabled from Any Gainful Occupation for which she would be qualified based on education, training or experience, Prudential required Connie to attend a neuropsychological examination with its own hand selected neuropsychologist. The neuropsychological examination confirmed that Connie continued to suffer cognitive impairment. The results confirmed that there were cognitive changes affecting her motor, sensory, arithmetic, attention, and vigilance related skills which were sufficiently severe as to undermine her ability to function. Prudential’s neuropsychologist that Connie had reached maximum medical improvement from the effects of her stroke and no additional improvement was anticipated.

Which brings us to 2017, and yet another medical review by Prudential. This time, instead of requiring Connie to attend another neuropsychological examination, Prudential referred the medical file to a neurologist for a paper review to determine whether Connie was capable of effectively engaging in sustained work activities. Prudential’s neurologist, despite never examining Connie, and likely never so much as reviewing the results of her past neuropsychological examination determined that with the exception of no driving , operating heavy machinery and working at heights, Connie was capable of working in a gainful occupation.

After getting over the shock and dismay that the benefits that she had received from Prudential for the past 11 years were suddenly discontinued Connie hired Attorneys Dell & Schaefer to prepare her administrative appeal.

Attorney Gavidia and his team, which included his Appeal Specialist and Legal Assistant, worked to collect the medical records and evidence and prepare the first of two appeals available to Connie under her long-term disability plan with Prudential. Within a month after submitting her long-term disability appeal, Prudential informed Attorney Gavidia that it was overturning its previous decision and would be reinstating Connie long-term disability benefits.

Connie’s claim is currently being managed by Attorney Gavidia and his team in order to ensure that Prudential cannot once again terminate her disability claim and cause a massive and traumatic interruption in her life. Feel free to contact our Disability Attorneys for a free consultation on this or any matter relevant to your disability claim.