A cancer survivor, suffering from also lupus, Hashimoto’s Disease (a thyroid disorder) and obesity, contacted the disability insurance law firm Frankel & Newfield after Prudential denied her long term disability benefits. Our client was a Vice President with a worldwide financial services company, but even her high level executive skills were no match for the wall of denial constructed by Prudential.
Frankel & Newfield submitted a vigorous appeal that attacked Prudential on several fronts. Prudential hired MCMC to conduct the medical review. MCMC is one of Prudential’s frequently used vendors, well known among the disability community for giving insurance companies what they pay so generously for – medical reviews that support the insurance company’s policy of claim denial.
According to its own website, MCMC’s objective is “to evaluate claims, review cases……that allow our clients to achieve positive outcomes through cost effective solutions.” With the peer review services in particular, MCMC’s stated goal is to provide assistance in “resolving disability claims questions in an effort to manage risk, control claim costs and increase productivity.”
In other words, the insurance companies are their target market and the goal is to limit the insurance company’s costs. This corporate mission is in complete opposition to the idea of the Independent Medical Review. MCMC’s success in the insurance industry is arguably the result of its ability to provide medical reports that can be utilized to deny or terminate claims, thereby reducing the costs of managing disability benefits.
We also attacked Prudential’s failure to provide the complete medical records for review. We see this happen many times: only a part of the medical records are provided to for review, and as a result, the medical professional does not get a total picture of the person’s true disability. The law requires that a set of complete medical records be reviewed by a qualified medical professional.
The next prong of our attack concerned Prudential’s’ failure to provide an accurate job description, making it impossible to evaluate the material tasks and duties of her job. The duties of a high level executive are not the same as a mid-level manager or a clerk. To perform at this high a level in a global firm requires high level analytical abilities and physical stamina. Not only did Prudential use an outdated Dictionary of Occupational Titles, but they used a generic classification of our client as a Manager with light duty tasks.
After we submitted the appeal, Prudential decided that it needed a proper Independent Medical Exam (IME), which was conducted. Benefits were approved, and our client is now on claim.
If your disability claim has been denied and you are not able to work, it’s a safe bet that the claim has not been evaluated properly and the insurance company is counting on your not fighting back. Call our office today and learn how we can help.