Successful Appeal Against Prudential Gets Breast Cancer Survivor Back on Claim for LTD Benefits
Author: Attorney Alex Palamara
Nearly ten years after initially beating breast cancer, our client was distraught to hear that she had a reoccurrence of the disease in 2015. She quickly underwent a left mastectomy, chemotherapy and radiation therapy, followed by a course of lymphedema therapy. In 2016, she had expander placement but unfortunately she suffered from a non-healing wound in her left chest from the expander that had to eventually be removed in 2017. Continued chemo treatment in 2017 and other issues left her with a severely impacted left upper extremity and peripheral neuropathy, as well as severe restrictions and limitations.
Thankfully, her employer, Saint Clare’s Health System/Catholic Health Services, provided coverage for their employees under a long term disability insurance policy with Prudential. Shortly after leaving work in February of 2015, our client made a claim for Long Term Disability (LTD) Benefits and Prudential initially agreed to award benefits which began in August of 2015. Benefits continued all the way through the end of February of 2018.
Unfortunately for our client, by way of a denial letter dated March 26, 2018, Prudential stated that based upon a review by its clinical team, it found that while she had medically supported restrictions and limitations, these would no longer preclude her from performing full time sedentary work. Knowing there was no way she could return to work of any kind due to her pain, fatigue, concentration issues, etc., our client found Dell & Schaefer and requested that they assist her with an appeal.
Appeal by Attorney Palamara
After receiving the denial letter, the former employee of Saint Clare’s Health System/Catholic Health Services spoke with Attorney Alexander Palamara. From the initial phone call, Attorney Palamara realized the gravity of the situation and the harm being done to the claimant. He knew that benefits needed to be reinstated as quickly as possible as they were certainly justified in this situation.
A review of the medical records and the claim file that Prudential provided confirmed the Attorney’s thoughts that this denial was flat out wrong. Prior to filing the appeal, Attorney Palamara reached out to a few of the treating providers to build an even stronger case for the appeal. Each of the providers was more than willing to give written support for this claim.
A timely appeal was filed to challenge Prudential’s denial letter. This appeal first noted that two of Prudential’s own reviewers had previously concluded that our client was completely disabled from any gainful occupation. The Appeal then heavily criticized the new reviews that Prudential was relying upon to now deny the claim. The appeal also showed that Prudential was unreasonably selecting certain medical records to support its decision while clearly ignoring objective documentation showing that her issues remained. The appeal also laid out strong support from the treating providers and overwhelming objective evidence that should not have been and could no longer be ignored.
Claim is Re-Approved:
On January 4, 2019, we received word that Prudential had completed its review and decided to reinstate benefits. The re-approval was a nice holiday surprise for our client who was relieved to be back on claim. While she knows that the fight for her benefits will continue until she is able to return to work, she knows that the people at Dell & Schaefer will do whatever it takes to keep her on claim.
If you have been denied disability benefits by Prudential or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schafer for a free consultation.