What You Should Know:
- A former senior producer in New Jerseywas forced out of work due to debilitating symptoms tied to Long COVID.
- Prudential initially approved her long-term disability (LTD) claim but terminated benefits nearly two years later without proof of improvement.
- Objective testing, including a Two-Day Cardiopulmonary Exercise Test (CPET), confirmed she cannot sustain sedentary work.
- She submitted a strong appeal supported by medical experts and specialists, with the help of experienced disability attorneys.
From Creative Leader to Long COVID Survivor
As a successful senior producer in the fast-paced digital media world, this claimant thrived in a role that demanded constant collaboration, long hours, and creative execution. But in 2022, her life changed dramatically after developing symptoms of Long COVID, a condition now recognized for causing prolonged physical and cognitive dysfunction.
Despite initial approval of long-term disability (LTD) benefits, Prudential abruptly terminated her claim a couple years later. The decision came with no clear justification or medical improvement even though her health had continued to decline.
The appeal we submitted on her of our New Jersey client included comprehensive medical testing and expert reports that confirm: she is disabled and unable to return to work in any capacity.
CPET Testing Confirms: She Can’t Work In Any Job, Even A Sedentary One
As part of the appeal workup, the claimant underwent a Two-Day Cardiopulmonary Exercise Test (CPET) with Dr. Betsy Keller, a recognized expert in exercise physiology and disability evaluation. The results were conclusive:
“Efforts to persist in work will exacerbate her illness symptoms... and will worsen over time, making it impossible for her to perform a job.”
Key findings from the CPET included:
- Abnormal hemodynamic and ventilatory responses to exertion
- Objective evidence of post-exertional malaise (PEM)
- Reduced oxygen utilization and poor cardiovascular recovery
- High effort and validity of test results — with no indication of malingering
These results are commonly seen in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID. Dr. Keller concluded that she was not capable of sustaining any reasonable sedentary work.
Neuropsychological Testing Reveals Cognitive Deficits
To further support her claim, the claimant underwent a neuropsychological evaluation by a board-certified expert in brain function and behavior. The findings showed:
- Impaired attention, processing speed, and executive functioning
- Difficulty managing tasks, decision-making, and problem-solving
- Cognitive fatigue interfering with sustained mental activity
These impairments directly undermine her ability to meet the demands of a high-level creative role or any desk job requiring consistent focus and productivity.
An independent file review by another neuropsychologist affirmed these findings and emphasized that her condition was not expected to improve in the near term.
Additional Vocational and Medical Evidence Supports Disability
In addition to the CPET and neuropsych testing, her appeal included:
- A vocational evaluation confirming she could not perform her prior job or any similar occupation
- Updated medical records from treating physicians who have monitored her condition for nearly three years
- A symptom log detailing daily limitations in mobility, stamina, and mental clarity
- Personal declarations and letters of support from family members witnessing the profound impact of her condition
Despite her desire to return to work, the evidence shows that doing so would cause physical and cognitive harm. Indeed, it was obvious she is totally disabled from working in any occupation.
ERISA Requires Prudential to Provide a Full and Fair Review
Prudential is not only the insurer but also the decision-maker under the terms of the employer-provided LTD plan. As a fiduciary under ERISA, Prudential is legally obligated to:
- Conduct a full and fair review of all medical and non-medical evidence
- Avoid arbitrary or selective interpretation of the claimant’s file
- Consider the totality of the evidence, including expert assessments and objective testing
The claimant’s appeal emphasizes, and Prudential recognized, that its initial termination failed to meet this standard and that reinstating her benefits is the only reasonable outcome.
Lawyers with Expertise in Disability Insurance Claims
This law firm has always focused only on disability insurance law. Because we specialize in long-term disability, our clients get the benefit of:
Having an attorney who is an expert in long-term disability claims;
Having an attorney who has experience with every major disability insurance company; and
Being backed by a law firm that has a proven track record of winning tough disability lawsuits.
Call the Dabdoub Law Firm to get experienced disability lawyers on your side. We can help with:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
The firm represents clients nationwide with disability claims governed by federal law, even if we are not located in your state.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Pay no fees or costs unless you get paid.