PRUDENTIAL TERMINATES CLIENT BENEFITS BASED ON PAPER REVIEW; WE WIN BACK HIS RIGHTFUL PAYMENTS
Wednesday, February 1st, 2012
Policyholders who are on claim and receiving benefits from their Long Term Disability insurance policy are usually stunned when suddenly the insurance company decides they are no longer disabled and terminates their monthly check.
Our client, a 49 year old man who suffers from debilitating migraine and cluster headaches, had been paid for a year by Prudential when he received a notice that his benefits had been terminated. He was especially surprised as he had been approved for Social Security Disability Insurance, which can be more difficult to obtain than private or employee-benefit disability.
Despite a regular treatment regime that included trigeminal nerve block injections, trigger point injections, oxygen, and various medications, Prudential decided that he was able to perform the material and substantial duties of his own occupation – despite the fact that Prudential paid benefits for almost a year.
We believe that the only thing that changed was Prudential’s desire to stop paying the high monthly benefit amount.
As Senior Director of Technical and Commercial Operations for a multi-site company, his job required frequent travel, a high level of analytical thinking and strong decision making skills. He was responsible for managing the daily operations of staff at corporate headquarters and predominately remote sites in three widely dispersed states and Europe. He had to travel at least monthly out of state and daily within his state of residence to create and maintain all systems and software documentation, ensure all license compliance programs, standard operating procedures, and computerized systems validation within the organization.
Prudential asked him to undergo neuropsychological testing, and the neuropsychologist determined that our client was not suffering from a somatoform disorder and that the symptoms the client was exhibiting were in fact related to his medical diagnosis of migraine and cluster headaches.
Prudential also arranged for him to be put under surveillance the day before the testing, the day of the testing, and the day following the neuropsychological testing. There was very little activity observed.
Prudential did numerous paper reviews of the client’s file, including three reviews by a doctor we know all too well who has an insurance company-based practice. We believe that Dr. Neuren has not treated a live patient in over eight years.
Dr. Neuren was employed as a Vice-President Medical Director by Unum from 2001 to 2005, and is an “independent” consultant for PDA, DRMS, Unum, Sun Life, CIGNA, and Prudential. He is well-known in the disability insurance arena for marketing himself as a disability consulting expert who has “completed thousands of disability consulting assignments over the past 10 years.”
A review of Dr. Neuren’s curriculum vitae revealed that he lacks any clinical experience or expertise with regard to cluster headaches, migraine headaches, chronic pain, or chronic fatigue. Despite his lack of credentials in this area of disability, Prudential retained him to determine whether or not our client was disabled. We made sure to bring to the court’s attention that in all of these “thousands” of consulting arrangements, Dr. Neuren has consistently provided opinions to his clients indicating that their claimants were not disabled.
We took on the fight with a highly aggressive appeal based on the medical records, focusing on the testimony of our client’s many physician specialists and Prudential’s failure to take his real medical condition into account. Our client is now back on claim, has been paid the monies that he should have been paid, and we are continuing to monitor his relationship with Prudential to ensure that he continues to receive his monthly benefits checks.
If your claim has been denied based on a series of paper reviews, don’t let the insurance company walk away with benefit money that is rightfully yours. Call our office today to learn how we can help you.