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.