• Prudential Pays Disability Benefits For 12 Years, Then Denies Based On Neuro-Psych Report

Prudential Wrongfully Relies on Neuropsychological Report to Deny LTD Benefits After 12 Years

Initial denial

Mr. Paquin became disabled in 2003 after contracting encephalitis from a mosquito infected with the West Nile virus. The infection resulted in brain damage and cognitive impairment rendering Mr. Paquin unable to continue working as a business development director for his employer, Transistor Devices. He qualified for short term and long term disability benefits under his employer sponsored disability plans and received benefits until January 2015.

After nearly 12 years on January 7, 2015, his disability company, Prudential, terminated Mr. Paquin’s benefits based on a neuropsychological evaluation. His subsequent administrative appeals were unsuccessful forcing Mr. Paquin to file an ERISA lawsuit in a Colorado federal district court.

The Court’s review of Mr. Paquin’s claim

After reviewing all the medical evidence available in the file the court ruled in Mr. Paquin’s favor finding the evidence overwhelmingly supported a conclusion that Mr. Paquin was permanently disabled. The court was impressed by the length of time Mr. Paquin was considered disabled by Prudential and pointed out that Prudential had documented in the claim file as recently as 2014 – months before the termination of benefits – that Mr. Paquin’s cognitive issues were not likely to improve and that there were no gainful employment options for him.

While Prudential had relied on the report of a neuropsychologist who felt Mr. Paquin was not as impaired as he claimed the court observed that none of the other doctors or treating professionals who had evaluated and treated Mr. Paquin during the previous 11 years had thought or suggested that Mr. Paquin was malingering in any way.

Three of Mr. Paquin’s doctors had also rebutted the neuropsychologist’s findings and found her conclusions were “flawed if not outright incorrect.”

Ultimately, the court found Prudential’s decision was unsupported by substantial evidence and was an abuse of discretion.

This case is not unlike many cases denied by Prudential. It is important to remember that no matter how long you’ve been on claim you are not safe from Prudential cutting off your benefits. Prudential is notorious for referring claimants for neuropsychological examinations which often yield reports that the claimant is malingering despite the absence of any reports of malingering by any treating physician.

This case was not handled by our office but Attorneys Dell & Schaefer have extensive experience dealing with Prudential and we are very familiar with their tactics used to deny claims. If you have a Prudential disability claim at any stage feel free to contact one of our attorneys to discuss your options.

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When I first called Dell & Schaefer from half way across the country, Steven Dell called me backed and he took my case very seriously and acted quickly to help me apply for benefits. His work got me the benefits I deserved. When I stopped getting benefits because the insurance company thought they no longer had to pay them, Steven Dell appealed the decision in a timely fashion all the while reassuring me as I panicked. His knowledge of the law and of my policy made my appeal very strong.

When they denied my appeal he was immediately on the phone with the attorneys for the insurance company and with very strong arguments, he negotiated a significant settlement for me. All during this time he responded to my emails and phone calls in a timely fashion and he was able to reassure me regarding the time that the process took. His staff was also very pleasant and helpful, especially Merlin.

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