Our client was a certified public accountant (CPA) and an owner of an accounting firm. Due to the untimely death of her child, she suffered from a number of mental illnesses including depression, anxiety, and post-traumatic stress disorder. She also suffered from physical conditions including crohn’s disease, anemia, and colitis. As a result of her mental state and physical ailments, she was unable to continue working as a CPA and had to dissolve her ownership in the business.
She was under the treatment and care of her primary care physician as well as a psychiatrist. She was prescribed various medications for her symptoms but she was still unable to perform her duties as a CPA and a business owner.
She applied for and received disability insurance benefits under her individual disability insurance policy issued by Prudential. However, Prudential later terminated her benefits indicating her medical evidence no longer supported disability, as defined in the policy. In response to the termination, her doctors submitted letters which indicated she is still disabled and unable to perform the duties of her job. In fact, she had a difficult time functioning on a daily basis.
Our firm appealed the termination of benefits on her behalf. Because this was an individual insurance policy it is governed by state law and there is no requirement to go through an administrative appeal. She had the option to file a lawsuit, but wanted to give Prudential an opportunity to reinstate her benefits without litigation.
Admittedly, there was a period of time our client was not seeking treatment. At that time she was so severe she could not bring herself to seek treatment. However, that does not mean that she was cured or not suffering from mental illnesses, but Prudential used this as a reason for terminating her benefits.
We submitted various medical evidence in support of our clients continued disability. Specifically, doctors notes and office notes indicating she still suffers from severe mental illness and cannot function on daily basis, nonetheless perform the duties of her job. She is still under the care of her physicians and being medicated for her various conditions.
Upon receipt of our appeal and review of the provided documentation, Prudential reversed its decision and reinstated benefits.
Because each client’s case is unique and has different facts, results similar to those in other clients’ cases are not guaranteed.
