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Our client, a Penn Medicine telecommunications manager, received a denial letter from Prudential disability just 4 months after being approved!
The case involves a client who worked as a telecommunications manager at a large hospital system. She suffered from arthritis and Charcot-Marie-Tooth disease, a progressive neurological disorder causing pain, fatigue, and muscle loss, which was exacerbated by a fall.
Her disability claim with Prudential was initially approved, and she received benefits for four months (after a three-month elimination period). However, Prudential then suddenly denied her claim, stating nothing had changed medically.
Prudential’s denial was based on a “paper review” by an occupational medicine doctor who did not examine the client but concluded she could perform her job, which the doctor incorrectly classified as sedentary. The attorneys criticize insurance companies for using such doctors and paper reviews, arguing these doctors often serve to deny claims and medical records are intended for patient treatment, not to prove disability to reviewers.
To appeal the denial, attorney Alex Palamara and his team built a strong case by:
- Sending the client for independent physical testing (Functional Capacity Evaluation) which showed she had below-sedentary work ability.
- Arranging a cognitive functional assessment with a clinical psychologist, which confirmed cognitive impairment impacting her job performance.
- Consulting a vocational rehabilitation consultant who reviewed the job description and confirmed the role was not sedentary (closer to light duty) and the client couldn’t perform it with her limitations.
- Obtaining Prudential’s claim file and the reviewing doctor’s report to identify weaknesses in their reasoning.
- Collaborating with the client’s treating doctor, providing them with the results of the independent assessments and getting their supportive opinion that directly countered Prudential’s doctor.
By submitting this comprehensive evidence package that exposed the flaws in Prudential’s denial, they successfully convinced Prudential to reverse the decision and reinstate the client’s benefits within just four weeks. The attorneys emphasize the importance of a thorough appeal process for ERISA-governed disability claims.