Prudential Plays Down Serious Autoimmune Disorders to Terminate LTD Benefits

Although her body is steadily failing her, our client continues to work part-time because her career as an occupational therapist in Naples, Florida gives her a reason to live. In the meantime, she collects long-term disability (LTD) benefits and Social Security Disability Insurance (SSDI) to make ends meet.

Prudential originally accepted our client’s claim for short-term disability (STD) benefits and paid LTD benefits for 7 months before inexplicably terminating them. In its review, Prudential failed to consider the seriousness of our client’s medical conditions, which include dysautonomia, Postural Orthostatic Tachycardia Syndrome (POTS), Ehlers-Danlos syndrome, tachycardia, mast cell activation syndrome, migraines, and gastroparesis.

Even though our client’s body no longer engages in the automatic actions most of us take for granted, Prudential insisted she could return to work. 

Several Specialists Affirm Our Client’s Disability

Our client has been treating with one of the top dysautonomia specialists in the country, who has consistently supported her claims for disability benefits. According to this specialist, our client cannot regulate her heart rate, blood pressure, digestion, dilate or constrict her pupils, or regulate her temperature or kidneys due to dysautonomia and POTS; her immune system is incredibly sensitive due to mast cell activation syndrome, which puts her at risk for anaphylactic shock; and Ehlers-Danlos syndrome leaves her with practically untreatable chronic pain.

While seated, our client does not get enough blood flow, which can lead to fatigue and cognitive impairment. Walking can cause our client’s blood pressure to drop, which can result in a loss of consciousness. Other activities can lead to dizziness and muscle spasms.

Additionally, the following symptoms make it impossible for our client to fulfill the duties of any full-time occupation:

  • Bladder infections
  • Urinary urgency or incontinence
  • Chronic sinusitis
  • Recurrent sore throat
  • Night sweats
  • Abdominal cramping
  • Headaches
  • Anxiety
  • Chronic diarrhea
  • Nausea and vomiting
  • Visual disturbances
  • Weight loss
  • Depression
  • Candida
  • Vertigo
  • Chronic fatigue
  • Severe malaise
  • Lymph node enlargement
  • Nerve pain
  • Constipation
  • Syncope
  • Brain fog
  • Postural tachycardia

As our client explains, she feels like she has a cold or flu every single day of her life. She can no longer keep up with her active lifestyle, nor work full-time in any capacity. Even getting out of bed takes several hours because of unpredictable spikes and falls in her heart rate.

In personal videos, our client demonstrates how high her heart rate gets while she is lying in bed or watching television. Any wrong move could cause her to lose consciousness, which means she can hardly shower, get dressed and go grocery shopping – much less handle a full-time job.

Multiple medical professionals have affirmed our client’s disability, and her suffering is hard to ignore. A former colleague and physical therapist was able to explain just how dedicated our client was to her job and just how serious her symptoms are.

Even the Social Security Administration (SSA) confirmed that our client is totally disabled. Why did Prudential terminate her benefits?

Prudential Approves Benefits, Then Terminates Them for No Reason

Our client worked through her medical conditions for as long as she could – until she suffered a transient ischaemic attack (TIA), sometimes known as a “mini-stroke.”

At this point, our client filed for short-term disability (STD) benefits, which Prudential immediately granted. When the period for STD benefits expired, Prudential quickly instated long-term disability (LTD) benefits and encouraged our client to apply for SSDI. The SSA granted SSDI, which resulted in an overpayment of LTD benefits.

Prudential quickly remedied the situation. Then, 7 months into paying LTD benefits, the insurance company terminated our client’s benefits. Instead of making an effort to understand our client’s very serious conditions, Prudential hired a doctor to review her records and failed to recruit a specialist and give our client’s case a full and fair review.

Ultimately, Prudential relied on a paper-based medical review from an unqualified doctor to deny our client’s claim, ignoring the opinion of several experts that our client was – and remains – totally unable to work.

Currently, our client is struggling through 6 hours per week of part-time work because it helps her maintain her will to live. For Prudential to ignore evidence of her disability and insist she return to work full-time is wrong, unreasonable, and a clear violation of ERISA Law.

Dabdoub Law Firm gave Prudential another chance to conduct a full and fair review. The insurance company quickly reversed its decision and reinstated LTD benefits.

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