Dell Disability Lawyers Win Disability Insurance Appeal Against Prudential for KPMG Employee
Our client, a former Managing Director – Tax Consultant for KPMG contacted our office after his claim for short term disability benefits was denied by Prudential. He spoke with Attorney Stephen Jessup, who has handled multiple cases for KPMG employees whose disability benefits had been denied by Prudential. In this case our client had filed for disability due to depression and generalized anxiety. Prudential had initially approved the client’s short term disability claim, and inexplicably to Attorney Jessup, denied the claim less than a month later. In doing so, Prudential determined that the provided medical information no longer supported restrictions and limitations despite staunch, ongoing support by our client’s Psychiatrist.
In supporting its denial, Prudential argued that because our client could perform basic Activities of Daily Living (drive, co-manage finances, care for his lawn, take out the trash, do dishes, read up to two hours a day, and attend his children’s sporting events) that he was functioning at a level that would allow him to perform his pre-disability occupational duties. Considering he was a managing director in the tax division for KPMG, which required an extremely high level of cognitive ability, this notion was ludicrous to Attorney Jessup. It was Attorney Jessup’s opinion that Prudential’s denial of the short term disability claim was an attempt by Prudential to force the client to return to work during the short term disability period to avoid the potential of having to pay a significant monthly disability benefit during the long term disability period to follow.
The administrative appeal
Once hired, the first thing Attorney Jessup did was secure a copy of our client’s full claim file from Prudential to obtain all medical and vocational reviews conducted by Prudential during the review of our client’s claim. Once received Attorney Jessup discovered that Prudential’s medical review of our client’s file consisted of a single review by a nurse. Prudential didn’t even bother to have our client’s medical information reviewed by a doctor, nor was there any indication that its nurse reviewer was even aware of the nature of our client’s pre-disability occupational duties.
Prudential’s Nurse cited as rationale for her opinion a lack of “objective evidence” to support our client’s subjective complaints of anxiety and depression. By arguing this Prudential’s nurse created a standard of disability that was not found in the policy. Attorney Jessup argued that the policy did not require “objective” evidence of a medical condition to be eligible for benefits and that creating this as a standard to determine eligibility for benefits was not only erroneous but prohibited by ERISA. Attorney Jessup pointed out that no one at Prudential advised our client of the requirement of “objective” evidence, or what would constitute “objective” testing to its satisfaction. Prudential’s nurse’s self-created requirement of “objective evidence” was even more problematic when considering that by its very nature, depression and anxiety are based on subjective complaints. As such, our client’s doctor was in the best position to assess the credibility of our client’s complaints and properly assess his functioning- not Prudential’s nurse.
Understanding the cognitively demanding nature of our client’s pre-disability occupation with KPMG as well as the nature of our client’s condition, Attorney Jessup had our client undergo neuropsychological testing to provide objective evidence of any cognitive limitations that may be resulting from his psychiatric conditions. The results of the testing showed that our client’s depression and anxiety had severely interfered with his concentration, memory, and executive functioning. After receiving the neuropsychological exam findings Attorney Jessup sent a detailed mental health questionnaire to our client’s treating psychiatrist to obtain additional information to prove beyond a doubt that our client would not be capable of returning to his former occupation.
Within a month of submitting the appeal we received confirmation from Prudential that it was overturning the denial of our client’s short term disability claim and was also approving his claim for long term disability based on the information submitted and argued by Attorney Jessup in the appeal. Attorney Jessup continues to represent our client against Prudential.
Prudential and KPMG Employees
As noted, this was not Attorney Jessup’s first client under the KPMG disability policy with Prudential. In multiple cases the nature of Prudential’s denial was very similar in nature and fact pattern to those of this client. As many people who make a claim under the KPMG policy are highly compensated, Prudential fights claims for benefits vigorously to avoid long term financial responsibility to the insured. As seen in this case, Prudential cut corners on the medical review which led to the denial of the claim and also attempted to create standards of disability not found under the policy. If you are covered under the KPMG policy with Prudential and are thinking about filing a claim, are on claim, or have been denied do not hesitate to contact our office and speak with Attorney Jessup to discuss how we can fight to ensure your benefits are paid.
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Policy Holder Rating
Denied but Not Denied but I am Denied
California State Disabilty "OFFSET" never mentioned or outlined when enrolling for STD coverage.
Prudential terminated my LTD, so now I have no income
Reply
Prudential cancelled my policy amid COVID crisis
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I was sold a policy that I cannot use and no one will show me the policy
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Prudential verbally approved my claim and then sent me a denial letter
Reply
It would cost me more to fight Prudential than to let them get away with their games
Prudential told me I would have a decision today, and now the need another week. Guess what, I'm still broke
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Q: I made a Short term disability claim with Prudential but they right away went to consider long term disability
Q: Prudential denied me STD due to a doctor who wrote personal things about me, like I still drive.
Q: Prudential is sending me to an IME but refuses to allow recording. Should I refuse to go to the IME?
Q: What can I do about my long term benefits that’s ending after 2 years?
Q: My mother paid many years for a long-term care policy. When she had to be put in an assisted care facility, Prudential won't pay. Do you accept cases like this?
Q: Can Prudential deny me if SSDI approves me?
Q: How does Prudential calculate attorney fees?
Q: Can I sue my PRUDENTIAL LTD for the cost of hiring a disability attorney to get my benefits reinstated?
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