I’ve had the privilege of helping many claimants appeal unjust long-term disability claim denials. One such case that stands out involves a 54-year-old gentleman who had dedicated years to his role as a Tech Op Risk Management Lead at JP Morgan Chase Bank. Unfortunately, he developed bilateral carpal and cubital tunnel syndrome, conditions that severely affected his ability to work, especially given the sedentary and intricate nature of his job.
Despite this, the Prudential Life Insurance Company (Prudential) initially denied his long term disability insurance claim. When he first came to us, he was grappling with the frustration of having his long-term disability benefits denied. Prudential’s denial letter concluded that the claimant’s medical condition would not purportedly prevent him from performing his regular occupation. Therefore, the insurance company denied the claim and the claimant was without any income to support himself and family.
This was a devastating blow for someone whose daily life had become a battle against constant pain and physical limitations.
We immediately recognized the flaws in Prudential’s assessment in its denial letter. The decision seemed to hinge heavily on a narrow interpretation of medical reports and a disregard for the real-world impact of our client’s conditions on his job performance.
In short, Prudential failed to administer the disability claim with the required fiduciary care, particularly considering the totality of our client’s conditions and the subjective nature of his complaints.
Our approach was multifaceted:
- We submitted a detailed appeal, challenging the insurer’s decision and underscoring how it breached its fiduciary duties.
- We provided comprehensive medical evidence and expert testimonials illustrating our client’s severe limitations.
- We argued that Prudential had ignored crucial aspects of the claimant’s condition, including the significant pain and disability that stemmed from his syndrome.
- We insisted that Prudential schedule an in-person medical examination to objectively assess our client’s condition.
The doctor who performed the examination agreed that the claimant could not continue his current occupation because of his medical conditions. Faced with this additional evidence, Prudential had no choice but to overturn their initial denial of the claim. Prudential paid the long-term disability benefits he rightfully deserved, providing him with the financial support necessary to manage his health. He received tens of thousands of dollars in past-due benefits and could receive nearly a million dollars throughout the remaining benefit period.
At Ortiz Law Firm, we take pride in our ability to turn the tide for our clients, ensuring that they receive the benefits they need and deserve. This experience, like many others, motivates us to continue fighting for long-term disability claimants whose insurance companies have denied their claims.
