Long Term Disability Claim Denied

[Myztique]

What is the name of your state? My state of residency is New Jersey.



I have Prudential Insurance and filed a claim for Long Term Disability Insurance due to an injury I sustained which caused damage to my back. They denied me for this coverage stating that I can continue to do sedentary work. However, I have appealed this decision and they continue to state that their physician (whom I have never seen) states that I can do sedentary work, wheareas my own physician states that I am totally disabled.

I cannot sit or stand for any prolonged period of time due to pain and discomfort. However, they believe I can perform duties as a general clerk, optical bench worker and/or assembly product.

I worked as an accumulator shipper for 23 years and have paid into this insurance policy since then. Now, in my time of need I feel as if they are looking for reasons to deny my claim.

What should I do ?

Is there anyone else who had similar problems with insurance companies?

 

[CIAA]

Myztique,

If this is employer based coverage it is , with rare exceptions, subject to ERISA which is not good for claimants. If you have any level of appeal left you should immeditely get professional help, as the information and disputes submitted up through the appeal level is usually the only evidence admissible in a law suit.

Unfortunately, the U.S. Supreme Court's May, 2003 decision in Black & Decker v Nord ruled that the opinion of a treating physician carries no more weight than the opinion of any other qualified physician. Therefore any objection to be made about a consulting or examinig physicians' practice, credentials, credibility, what they reviewed, what records they didn't review, etc. should all be explored and appropriately pled in the appeal process. Try talking to a good ERISA attorney.

 

[tigger22472]

If your doctors are saying that you can not work have you filed with the social security administration? It too is a LONG LONG process that sometimes makes you feel like you aren't getting anywhere but if you are truely disabled(not saying you aren't.. just know there are some out there with false claims) EVENTUALLY it will come through. My husband just recently was approved. Don't get frustrated when they deny you at least the first time out. My husband broke his neck in 5 places, had 60% spinal cord damage, is diagnosed as an incomplete quad and was still denied first time out. I know many that have been denied twice and saw a judge and got it immediately. You have to see THEIR doctors that they send you to. My husbands case too nearly a year and that was fast by their standards.

 

[Myztique]

Thank you for the advice and the words of encouragement.


When they sent us back the information it states: "You may also file a lawsuit under the Employee Retirement Income Security Act (ERISA). " What does this mean?


I have filed for social security and am awaiting for their decision.

 

[tigger22472]

I'm not sure the answer to your question but if you'd like advice on the Social Security thing feel free to e-mail me... [email protected]