At first glance, Long-Term Disability Claims/Denials seem to be a simple issue of contract law. Usually, for the first 24 months, the definition of disability is whether or not you can perform your own job. So, if you can't work, all you have to do is provide a form signed by your doctor that you are disabled and furnish "proof of disability" and magically the insurer will pay your claim!
Prudential Insurance Company recently overturned a long term disability denial for our client under an own occupation period of disability. Our client worked for a large hospital system as a vascular lab technologist. The client was suffering from relapsing, remitting Multiple Sclerosis with optical neuritis and migraines. Prudential originally denied benefits based upon their opinion that the medical records showed no evidence that the claimant's physical condition has significantly changed from baseline or that she was experiencing active flare of her Multiple Sclerosis symptoms. On appeal, our long term disability team prepared documents and obtained support from the claimant's treating neurologist and other physicians in support of her claim for benefits under the plan. Following the submission of the appeal documents, Prudential reversed their decision to deny the client benefits and admitted that client was, in fact, disabled under the terms of the plan.
One of the issues that can keep attorneys up at night are client's statutes of limitations. Behind the scenes, careful due diligence on everyone of our client's cases is performed in order that the statute of limitations is properly documented and preserved so that our clients have a right to proceed on their actions.