Disability Insurance Blog



Monday, May 9th, 2011

Our client is a 53 year old woman who had a successful career as a billing analyst. The position required a high cognitive level, making informed decisions about complex financial transactions and fiscal responsibility for a multi-million corporation.

Her disability includes severe chronic pain that is the result of degenerative disc disease in the cervical and lumbar spine, spondylolisthesis, lumbar stenosis, facet arthropathy, and ligamentum hypertrophy. The excruciating constant pain made it impossible for her to concentration on complex transactions. Pain killers interfered with her ability to perform the mental tasks of her position.

Prudential denied her claim for disability benefits, relying exclusively upon the biased opinion of a paid medical consultant, who reviewed selective portions of her medical records. There was no in-person medical examination, even though the policy allowed for as many examinations as reasonably necessary at Prudential’s expense.

The improperly done medical assessment was matched by an equally improper and inadequate employment assessment. Prudential relied on the Medical Disability Advisor (MDA) guidelines. This is a notorious sourcebook in the insurance industry, created and edited by Dr. Pressley Reed, a non-practicing medical doctor whose company provides disability management services for insurers and administrators. The MDA purports to be edited by a long list of “medical specialists,” most of who are employed in the insurance field.

This is an extreme case of the inherent conflict of interest that exists when sources are being paid by the insurance company to provide a report that suits the insurance company’s end.

Prudential made no efforts to obtain any further testing, despite obvious and substantial discrepancies between the findings of our client’s treating physician and Prudential’s paper reviewing consultant, even though the policy allows for as many examinations reasonably necessary at Prudential’s expense.

Our defense was detailed and thorough, providing evidence of unequivocal objective medical support for her disability, including numerous MRIs of the lumbar spine and the cervical spine, medical records, supporting statements, and an independent medical examination report. Her benefits were reinstated and she is on claim.

If you have a condition that precludes you from performing the tasks of your occupation and the disability insurance company has denied your claim without an in-person physical exam, it is likely that their medical review is incomplete and/or inaccurate. Don’t accept the denial. You can fight back, and you don’t have to go it alone. Call our office today to learn how we can help.