Discover a disability insurance case in which disability insurance attorney Rachel Alters successfully overturned a denial by Prudential Financial for a senior technology engineer who had been suffering from severe mental health conditions, including anxiety, depression, and PTSD, along with back problems. The claimant had worked for the company for over a decade and initially received disability benefits after Prudential approved his claim. However, after about five months of payments, the insurer abruptly terminated his benefits, claiming—based on a paper review by a consulting physician—that he was capable of returning to work, even though his condition had actually worsened and his medications had been increased.
After obtaining the full claim file, Rachel Alters discovered that Prudential relied on selective excerpts from medical records and ignored the broader evidence showing the claimant’s declining condition. To challenge the denial, she worked closely with the claimant’s treating physicians to create detailed, customized medical questionnaires that addressed the insurer’s stated reasons for denial and documented the claimant’s functional limitations. These tailored physician statements were significantly more comprehensive than standard insurance forms and were designed to anticipate and rebut the opinions of the insurer’s reviewing doctors. The appeal package took months to assemble and included extensive medical documentation and physician support.
The appeal was ultimately successful, and Prudential reversed its denial within about 45 days, reinstating the claimant’s benefits based on his mental health conditions. However, the insurer did not yet approve benefits based on his physical back condition. This distinction is important because many group disability policies limit benefits for mental health claims to 24 months, while physical disabilities can qualify for benefits until retirement age. As a result, the legal team plans to continue building medical evidence related to the physical condition to potentially extend the claimant’s eligibility for long-term benefits.