Successful Appeal Results in $450,000+ in Long-term Disability Benefits
Our client was employed as an IT Business Analyst with Sprint PCS (now known as T-Mobile) in Overland Park, Kansas. She specialized in technical project management and logistics.
In 2018, she discontinued working due to right upper extremity pain for what was initially diagnosed as carpal tunnel syndrome. Overtime, her pain grew to became chronic and widespread. She was approved for long-term disability under her employer’s group policy with Prudential.
After seeing multiple providers, our client was diagnosed with cervico-occipital neuralgia, trigeminal neuralgia, cervicogenic headaches, migraines, restless leg syndrome, small fiber neuropathy, bursitis of hip, neck pain and low back pain. She attempted a variety of treatment options, including injections, physical therapy and prescription pain medication without relief.
Denial of Long-Term Disability Due to “Own Occupation” Provision
After receiving long-term disability for two (2) years, her benefits were suddenly terminated by Prudential. The claimant contacted our law firm to review her denial letter. Upon review, we noted that Prudential terminated her benefits by asserting the definition of “disability” had changed in the policy.
Under her policy with Prudential, the definition of being disabled in her policy changed from being unable to do one’s “own occupation” to “any occupation,” after twenty-four (24) months. This is a standard provision in many long-term disability policies governed by ERISA. Prudential denied the claimant’s future benefits by arguing that she could perform another sedentary occupation.
Prudential Reverses Denial After Successful Long-Term Disability Appeal
We obtained the claim file and guided our client on how to move forward. She obtained a functional capacity exam (FCE). The FCE noted that the claimant had a very low level of function and would be unable to maintain for eight hours any level of function on a consistent basis.
After reviewing the entire claim, we provided our client with guidance on moving forward. She obtained a functional capacity exam (FCE). The FCE noted that the claimant had a very low level of function and would be unable to maintain for eight hours any level of function on a consistent basis.
Specifically, she was unable to sit for more than 2 hours per day, and the severity of her pain prevented her from doing computer work that was required. In addition, the claimant was a high wage-earner. A vocational review showed that other occupations would not provide the requisite level of wages necessary to meet the policy definition of “any occupation.”
We prepared and submitted a comprehensive administrative appeal to Prudential, and the denial was overturned. The retroactive LTD benefit was $77,520. If the claimant remains disabled under the policy, she will be entitled to received approximately $450,000.
Hiring Our Long-Term Disability Attorney
If you have questions about long-term disability denials or appeals, call the Law Office of Kevin J. McManus at 816-203-0143. If you have been denied benefits, we will review your denial letter for free and give you a personalized strategy to move forward.
You can also download our free long-term disability book, Danger: Proceed at Your Own Risk. This guide shares insights regarding long-term disability appeals and why you should hire our long-term disability lawyer to handle such an appeal. We're here to help, and on your side!
In our client's own words, she was very pleased with the outcome!