Woman with multiple sclerosis files long term disability benefit denial lawsuit against Prudential Insurance Company

Multiple sclerosis is a chronically disabling condition which is commonly misunderstood by disability insurance companies. Let’s take a look at a case handled by our law firm following denial of long term disability benefits by Prudential. A successful, bright Bank Manager with a flourishing career in the banking industry was diagnosed with multiple sclerosis in 2001. She was shocked and distraught by her diagnosis, but did not let it get in the way of her career as she was determined to beat her disease. However, as the years went by, her symptoms began to progress, and in 2008 everything began to go downhill. As a result of multiple sclerosis, she began to notice that she could no longer handle the stress of her demanding job. She suffered cognitive impairments such as memory loss, loss of organizational skills and difficulty with executive level functioning. Physically, she experienced dizziness, loss of balance, pain all over her body and fatigue.

Treating Physician Advises Claimant To Stop Working Due to Multiple Sclerosis

According to her primary care physician and treating neurologist, this was the normal progression of her disease. It was her neurologists’ recommendation to resign from her position as she was now stricken with full-blown multiple sclerosis and was no longer physically or mentally capable of performing the material duties of her occupation or any gainful occupation. She had a hard-time walking, used a cane or walker to ambulate, could only sit, stand or walk for short periods of time, could not climb stairs, could not multi-task and needed assistance with her activities of daily living. Life as she once knew it no longer existed.

Denied, Approved, and Then Denied Again After Two Year of Benefits

One of the benefits provided by her employer was a group long-term disability insurance policy which provided benefits should she become ill or injured and no longer able to perform her job. With the assistance of her physicians, she applied for long-term disability benefits. Prudential initially denied her claim, stating that it did not believe she was disabled due to MS. She appealed the decision, was approved for two years under the “own occupation” definition, but after 24 months was again denied benefits when definition of disability changed. Prudential took the position that she was no longer disabled and was able to perform a sedentary job 40 hours a week. Prudential ignored the opinions of our client’s treating physicians, failed to have her examined by their own physicians and ignored the Social Security Administration’s decision to approve her benefits, all a breach of its fiduciary duty to our client.

Claimant Hires Attorneys Dell & Schaefer Following Prudential Claim Denial

Understandably distraught, she found Dell & Schaefer on the internet and retained them to fight for her rights to her long-term disability benefits. Her disability attorney, Rachel Alters, prepared a detailed ERISA appeal on her behalf. She underwent a functional capacity evaluation wherein the physical therapist found her unable to perform even sedentary work as a result of her many restrictions and limitations due to MS. Prudential reviewed her appeal and once again decided to uphold their decision to deny her benefits. The only remain option was to file a lawsuit.

Dell & Schaefer believed this decision was unreasonable as well as arbitrary and capricious. Attorney Alters filed an ERISA disability lawsuit in the United States District Court alleging that Prudential violated ERISA regulations by improperly denying her benefits. Attorney Alters took the position that her client’s condition rendered her disabled from any gainful occupation, her condition would most likely progress and that the termination of her LTD benefits was unreasonable. The lawsuit was resolved pursuant to a confidential agreement.

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FAQ

Do you help Prudential claimants nationwide?

We represent Prudential clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Prudential disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Prudential. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Prudential.

How do you help Prudential claimants?

Our lawyers help individuals that have either purchased a Prudential long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Prudential:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Patricia T. (Florida)

If you think the insurance company is going to be FAIR, you are WRONG! Get an attorney, I recommend Dell & Schaefer. They entered my life approximately 4 years ago. I was in the mid years of my life, moving along routinely finishing up my 29th year of continuous employment as a professional Acute Care Registered Nurse, looking ahead to planning my future and possibilities ahead of me. I had planned to work at least another 15 years and maybe more if I could. I was hitting the peak of my value in the health system that employed me and I loved my job. Income was never an issue for me, as in my profession I could always find work and make as much income as I needed raising a family etc… But just incase, my father always taught me to have a safety net. So every year for 29 years, around benefit time I would fill out the forms and check the boxes for STD and LTD and pay the monthly dues for those policies in case I would ever need them, never expecting to use them. Well life had other plans for me.

My illness began slowly, I made adjustments to my work schedule and life schedule hoping that would allow me to stay employed. I didn’t want to give up the money, my benefits, the years experience I had, the value I had to contribute etc… That lasted for about a year and half then suddenly my body just couldn’t do it anymore. My illness exacerbated, necessitating me to leave work. I went out on my STD policy and initially Aetna the carrier of the policy was cooperative and approved my claim. After several months when I didn’t improve my STD policy was over and it was time to begin my LTD. At this point Aetna suddenly switched and began to deny all my claims for the same illness they had previously approved. I was shocked and bewildered, I could not believe how Aetna could be doing such a thing. What was happening, how could they just say NO! This wasn’t fair, I paid into this for 29 years… and was lost as to what to do.

I did some research on line, and found out this was a common thing all insurers were doing to people who had these kind of policies. What a rip off I thought. Here I thought I had a safety net. I was so angry and realised I was disillusioned about this system and having a safety net. I sat and cried fluctuating between anger, sadness, worry, the gamut of feelings. What should I do I thought, I need help and help fast. I couldn’t live without income. I did some more research and found Dell & Schaefer, I went through their website reading all the information and decided I need to call them to see if they could help me. My illness was not listed as a common illness for disability approval.

When I called them, they put me through immediately to someone and took some information. Later that day an attorney called me back and went through my situation explaining to me all my options and that they could help me. I wasn’t ready to make a decision on the spot, so I told them I would call them back. I was skeptical because at this point I didn’t trust anyone for numerous reasons and felt like all the systems I had faith in were failing me. Is this going to be another rip off, I thought?

After thinking about it for a day or two and consulting friends and family, I nervously called back Dell & Schaefer and I told them my concerns, we talked some more they never pressured me. I reluctantly agreed, not because of something they said, it was my own issue with trust now clouding my decision. Reflecting back that was the best decision I ever made. My attorney in the firm was Alex Palamara, I dealt with him exclusively and he always called me back, emailed me and let me know what was happening promptly. Nothing was ever too small for him to answer and he had compassion when I would complain about how unfair Aetna was being with their denial of my case. And YES, they did deny, and are still trying to find ways to deny me to this day 4 years later. Through the hard work and timely action taking by the attorney my appeal was reversed and my claim continues to be approved with the help of the attorney. I no longer have random calls from Aetna asking me repetitive questions that I already answered numerous times and the firm continues to coordinate the yearly reviews with Aetna and my physicians. I faced another denial at the two year mark when the policy changes the definition of gainful employment. Yea isn’t that beauty they sneak into the policy that you have really don’t understand. Alex anticipated that fought that and I have had a seamless benefit check now for 4 straight years.

I will not give up my representation, as educated as I am, in no way am I versed in disability law and the new ways insurance companies try to get out of paying the policy we have paid our hard earned money into for a safety net. I know things will not be easy and I will have to fight to continue my benefits, having Dell & Schaefer gives me security that someone will be there fighting for me and my benefits. I can’t thank them enough, I find them to be prompt, compassionate, knowledgeable and very fair with their fees. If you are thinking about hiring an attorney for representation you will be pleased with this firm. As a side note, my last years of employment I worked for a large hospital system, my job was coordinating with the hospital, physicians and Insurance companies to make sure the hospital would get paid. Specifically, I worked on denials of patients inpatient hospital bills. The insurance company would deny claims for the most unbelievable reasons. They know some people will just give up and not fight, that’s what they are counting on. I didn’t think they would do the same thing with STD and LTD policies, I was wrong and naive. Do yourself a favour, HIRE an attorney immediately from the beginning, otherwise the carrier will jerk you around till you give up, and you may inadvertently say or fill out a form wrong or miss a date and boom you are denied. You will never get your benefit you paid into. Hire Dell & Schaefer.

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