Insurance companies like Prudential make it easy for employees to buy group short term and long term disability benefits insurance through their employers. The problem is, they often make it as difficult as possible for an employee to collect on a claim after they become too sick or injured to work.
Prudential Unfairly Denies Our Client’s Claim for LTD Benefits
Marc Whitehead & Associates recently represented a 59 year old man from Sarasota, FL in his appeal of Prudential’s decision to deny his claim for long term disability (LTD) benefits. Our client suffered from degenerative disc disease of the spine and lower back pain from Reiter’s Syndrome.
Our client rated his pain as a 7/10 in severity and described it as constant. His pain symptoms included sensations of sharp and dull pain, as well as pins and needles sensation legs and back. And while our client did not have any specific muscle weakness, there were times when he felt as if his legs just “gave out.” His condition was treated with steroids and other medications; the treatment for his acute pain caused by his condition included powerful painkillers such as opiates.
Although our client submitted his application for disability benefits within the specifications of the policy and within the correct timeframe, Prudential denied the claim for benefits stating that our client was not disabled under the terms of the plan.
There was no real justification for the denial. It was obvious that the insurance company had failed to take into account the significant and ongoing medical limitations of our client’s physical impairments; nor had they considered the severe impairments caused by our client’s medications.
By thoroughly researching every medical document and carefully reviewing each statement made by the disability insurance company, we knew we would be able to create a solid argument against Prudential’s LTD denial of our client’s claim for benefits.
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Appeal of Prudential LTD Denial Filed by Marc Whitehead & Associates
We began our appeal with an explanation of the disabilities our client faced and how they affected his day to day life.
We went into great depth explaining how our client experiences acute pain throughout the day and how the debilitating pain in his back is most severe when standing, leaning backwards, walking and lifting and are only improved by bending forward, lying down, and sitting in a reclined position. Because of these limitations, there would be no possibility of our client being able to perform his own occupation.
We addressed the fact that our client’s Prudential LTD denial did not take into account the impairments caused by our client’s medications. These medications included epidural steroid injections into his spine, SI joint injections and lumbar facet injections. The only thing that helps his pain is the use of nonsteroidal medications, as well as opiates. The opiate medications caused our client to experience symptoms of fogginess, dizziness, and lack of awareness. These symptoms alone made it impossible for our client to return to work.
We made sure Prudential was provided with comprehensive medical documentation of the disabilities suffered by our client and the negative side effects sustained due to narcotic pain medication.
Social Security Disability Decision Aided in Reversal of Prudential LTD Denial
We also pointed out that our client has qualified for disability benefits through the Social Security Administration.
Prudential had persisted in denying our client’s LTD benefits, asserting that he can perform the duties of a sedentary occupation. However, the Social Security Administration has already agreed that our client is disabled from any occupation at any level and granted his disability benefits before his Prudential LTD insurance benefits were denied.
Not everyone with a disability qualifies for SSA benefits. Rather than require that a claimant be unable to perform the material duties of his own occupation, the Social Security Act requires that a claimant for disability benefits be unable to perform the material duties of any occupation for which he is reasonably suited.
And by “any” the SSA literally means any occupation existing in significant numbers in the national economy and within the claimant’s functional capacity.
In our appeal, we were able to prove that due to the approval of Social Security disability benefits, Prudential cannot state with enough evidence that our client was not disabled.
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Prudential’s LTD Denial Video Surveillance is De-Bunked
Prudential pointed to video surveillance footage as proof that our client was not disabled and could still work.
Many insurance companies make use of surveillance in their examination of a claimant’s disability. They will usually hire a company to follow the claimant if they should leave their home, keep notes as to where they went, and note how long they were there.
Seeing a video of yourself can be incredibly intimidating and that is what most insurance companies are trying to do.
In our appeal, we noted that Prudential makes much use of the video surveillance taken over a series of 3 days. A total of approximately 2 minutes and 23 seconds of video tape was obtained. We demonstrated that a few minutes of activity over a two day period does not add up to the ability to work 8 hours per day, 40 hours a week, week after week on a continuous basis.
Prudential claimed the video footage indicated that our client did not seem to be in terrible pain. However, if Prudential had fully reviewed the medical documentation they would have known that our client does not claim to be in debilitating pain every moment of every day but that he is in enough disabling pain to keep him from working his own occupation.
The Prudential surveillance report stated that they had spoken with some of our client’s neighbors. One of the neighbors had told investigators that they had seen our client carrying boxes, making use of the complex swimming pool and shopping at Walgreens and local grocery stores.
Our appeal explained how this report was not based on video surveillance, but on the speculation by our client’s neighbors and their assessments of his physical activities. We went into great detail as to how our client refuted these statements.
Even though Prudential had obtained video of our client performing day to day activities, the tactic of using it to disprove our client’s disability was far from effective in this case. Our disability attorneys have extensive experience when it comes to debunking the use of video surveillance by insurance companies.
Ultimately, our appeal was able to prove that Prudential’s denial of LTD benefits was incorrect, unwarranted, and unlawful. Our client was awarded his benefits.
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Attorneys for Prudential LTD Denial Claims
These delays and denials are used by Prudential and other insurance companies as a way to discourage policyholders from pursuing an LTD benefits claim. One of the key factors to having your claim approved is to let the insurance company know you are serious. They have to be made to understand that you intend to demonstrate conclusively that you are disabled under the terms of the policy. If litigation is called for to overturn Prudential’s LTD denial, they must know you intend to have the best possible lawyer on your side to challenge the denial and win the case.
If you believe that your long term disability insurance benefits have been wrongfully denied or terminated, don’t give up! Contact the law offices of Marc Whitehead & Associates by calling 800-562-9830 or visiting disabilitydenials.com to schedule a free consultation to discuss appealing your denial of disability benefits.
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