We recently helped a client get her long-term disability (LTD) benefits reinstated after they were wrongfully terminated by Prudential—without having to complete a formal appeal. This case highlights the importance of experienced legal help when insurance companies create confusion or apply the wrong standards.
Background: Mental Health and Long COVID
Our client had been receiving LTD benefits from Prudential for over two years due to disabling mental health conditions and long COVID symptoms that prevented her from working in her own occupation. Despite her continued limitations, Prudential terminated her claim.
Client Attempted to Appeal Alone
Before hiring us, the client attempted to appeal on her own. In response, Prudential initiated two rounds of peer review reports and even commissioned a vocational analysis. Faced with this overwhelming and one-sided evidence gathering process, the client decided she needed legal support and hired our firm.
Our Legal Strategy
Once retained, we immediately requested an extension of time to respond to the new evidence and supplement the appeal. As we reviewed the claim file, we discovered that Prudential was using inconsistent definitions of “disability” across its communications. Some letters referred to an “own occupation” standard, while others seemed to reference an “any occupation” standard.
The confusion appeared to stem from the client’s coverage under a “buy-up” plan rather than the standard “core” plan. Under the buy-up policy, a more favorable “own occupation” definition applied for a longer period.
We submitted a letter to Prudential pointing out this inconsistency and asking for clarification about which standard of disability was being applied. We emphasized that, based on the policy terms and the client’s medical evidence, she clearly met the “own occupation” definition of disability.
The Outcome: LTD Benefits Reinstated
Just days after receiving our letter, Prudential reversed its denial decision and reinstated our client’s LTD benefits—without requiring us to complete the appeal.
Let Us Help You Fight a Wrongful LTD Denial
If your long-term disability benefits have been denied or terminated, and you’re overwhelmed trying to fight back on your own, let us help. The Ortiz Law Firm has the experience to challenge inconsistent decisions and hold insurance companies accountable. Call (888) 321-8131 for a free case evaluation.
