Dan is 60 years old and was a cable splicing technician with a telecommunications company, where he worked for approximately 29 years until late 2015, when he was forced to stop working due to the debilitating effects of bilateral knee osteoarthritis and cervical and lumbar spondylosis. Since that time, he has also undergone total replacements of both knees and developed severe, debilitating chronic cervicogenic/occipital headaches that occur on a daily basis; moderate to severe bilateral carpal tunnel syndrome; and increasingly severe lower back and leg pain that persists despite a lumbar spinal fusion surgery in early 2018.
When Dan was forced to stop working, he applied for long term disability (LTD) benefits through his employer’s disability plan, which was insured by Prudential. Under the terms of the Prudential policy, Dan was entitled to receive LTD benefits for up to 24 months if he was unable to perform the material duties of his own occupation. Because Dan’s medical conditions prevented him from working in his own occupation as a cable splicing technician, Prudential awarded him LTD benefits, which it paid until May of 2018.
However, the terms of the Prudential LTD policy dictate that after 24 months of receiving LTD benefits, Dan was only entitled to continue receiving benefits if he could prove that he was disabled from performing any gainful occupation for which he was “reasonably fitted by education, training or experience.” As a result, Prudential terminated Dan’s benefits after 24 months, based on a vocational review that concluded that he was able to perform certain sedentary work for which he was qualified by his education and experience.
This transition from an “own occupation” to an “any occupation” definition of disability after 24 months of benefits is common in employer-sponsored LTD plans. Like Dan, many claimants see their benefits terminated when this change in definition takes place. It can be very difficult to prove that a disability prevents a claimant from working in any occupation.
Fortunately, Dan contacted O’Ryan Law firm to assist him in appealing Prudential’s termination of his benefits. By the time Dan contacted us, there was just over a month before the 180 day deadline to file his appeal. We requested a 90 day extension of time to file the appeal, but Prudential denied it. So we got to work. Within weeks, we were able to compile and submit an appeal to Prudential that was so thorough and compelling that Prudential approved the appeal and reinstated Dan’s benefits just three weeks later.
If your long term disability benefits have been terminated because the insurance company claims you aren’t disabled under an “any occupation” standard, call O’Ryan Law Firm for a free consultation.