Dabdoub Law Firm recently represented a client in his claim for both short-term disability (STD) and long-term disability (LTD) benefits from The Prudential Insurance Company of America (“Prudential”).
Prudential denied our client's claims for STD and LTD benefits, despite his entitlement to the waiver of life insurance premium (WOLP) benefits. This initiated his claim, and our firm requested all the necessary documents to validate the WOLP claim. While Prudential already possesses evidence pointing indisputably towards our client's disability under the terms of its long-term disability insurance policy, our legal team supplied further medical and non-medical evidence supporting his LTD claim.
Challenging Prudential's Unjust Termination and Denial of Claims
We assert that Prudential unjustly terminated our client's STD claim and denied his LTD claim. Upon reviewing the additional medical and non-medical evidence we have provided, we believe Prudential has no other reasonable recourse but to approve the claim, pay benefits retroactively, and continue payments as they become due.
Our client had to relinquish his position as a Community Manager, forfeiting the stable income and accompanying benefits that came with it. Alongside dealing with anxiety and depression, he also struggles with comorbid obesity and chronic pain affecting his lower back, bilateral knees, and bilateral shoulders.
His medical records are laden with evidence affirming his complaints of pain, limited range of motion, and chronic fatigue. His medical history includes total knee replacement surgery and revision, right knee replacement surgery, and various levels of degenerative disc disease with facet arthropathy, foraminal stenosis, and disc protrusion with annular fissure.
Our Legal Team Provides Objective Medical Evidence of Disability
For objective medical evidence substantiating our client's disability, Prudential need not rely solely on our client's medical providers. A Functional Capacity Evaluation (FCE) was performed, and Therapist Oyer noted that our client exerted maximum effort on 80% of the tasks, signifying a valid and good effort. He further concluded that our client did not demonstrate the ability to meet the full range of the SEDENTARY classification level due to confirmed abnormal physiology, either due to his back or left hip.
An independent occupational therapist, David Bledsoe, OTR/L, CIR, reviewed the FCE and interpreted the data. Mr. Bledsoe affirmed the validity and consistency of the FCE and its representation of our client's physical abilities. The FCE results, coupled with the opinions of our client's treating physicians, establish his inability to work even at a sedentary level. Mr. Bledsoe noted that our client showed severe limitations in all physical tests, particularly from bilateral shoulder and knee pain, left hip issues, and lower back pain. These conditions hindered sustained postures, ambulation, and activities like crouching, kneeling, and crawling. The evaluation was deemed valid due to consistent efforts throughout and the assessment of a significant number of tests (40) on the Functional Capacity Evaluation (FCE). This resulted in the client's inability to stand or sit for extended periods.
Prudential's decision to ignore the objective medical evidence, comprehensive office notes, and clear conclusions of our client’s treating providers supporting a finding of total disability is unreasonable. We urge Prudential to seize this final opportunity to conduct a thorough and fair review of our client’s LTD claim. Upon doing so, we are confident that Prudential will indeed conclude that our client is totally disabled under the terms of the LTD Policy and thus entitled to LTD benefits.
Help from a Lawyer with Expertise in Disability Insurance
Disability insurance law is complex. Hiring an experienced disability attorney is important. Because all disability lawyers at this law firm focus on disability insurance claims, we proudly offer significant expertise in disability insurance law.
The Dabdoub Law Firm has:
- Experience with every major disability insurance company;
- A proven track record of success by winning major disability lawsuits; and
- Recovered millions of dollars in disability benefits for clients.
We never charge fees or costs unless our clients get paid. Our firm can help at any stage of your disability insurance claim, including:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; and/or
- Filing a lawsuit against your disability insurance company.
Because federal law applies to most disability insurance claims, our lawyers are able to represent clients across the country.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Consultations are free.
