LTD denial

[goodnite22980]

What is the name of your state? Virginia
I was in a MVA on 12/24/01, and was taken from the scene by ambulance, x-rayed, treated and released with acute neck and back pain, and given pain medication. I was on vacation till 1/3/02, at which time, although still in a lot of pain, I tried to return to work. Saw my family doctor on 1/4/02, and was sent to P/T 3 times per week, while still trying to work. In February, on the advice of P/T and doctor, I went out on FMLA. Have been out since, continue to go to P/T 3 times per week, take high doses of pain medication, but am still unable to sit, stand, drive for prolonged periods of time. Prudential has denied my LTD claim twice now saying 6-8 weeks is the normal time to recover from MVA. MRI is clear, but EMG has showed nerve damage. Have had Lumbar ESI once, and am scheduled for next one this month. What should be my next step in getting my claim approved. It is an ERISA policy.
Thanks

 

[CIAA]

Hello goodnite,

We are not attorneys and don't give legal advice. Based on our years of claims experience, I can tell you that acute back strains and sprains can result in disability of up to 4-5 months, depending on the severity/recurrence, job duties, concurrent conditions,etc. It does sound as if your disability has lasted longer than usual and this is what you and your doctors need to address. Does your doctor have an explanation as to why your condition has not responded to treatment to the point where you can return to work? Has it gotten any better at all? Do the nerve conduction studies show abnormalities that would account for the amount of pain that you are having?

What I'm saying is that in these types of ERISA cases you and your doctor have to provide as much objective evidence and medical explanation as you can. If the primary findings are subjective complaints of pain, little or no explanation of why you have failed to respond to treatment, coupled with a MVA where there is the possibility of secondary gain, the insurance company is going to be very resistant.