Long Term Disability Law Blog
This case involved a former advisory manager at KPMG whose short-term disability claim was approved by Prudential, but his long-term disability claim was denied despite no improvement in his condition. He had been struggling with severe mental health issues, including anxiety and depression related to personal circumstances, and had been consistently treating with a licensed clinical social worker and a primary care physician. Prudential relied on a paper review from an outside psychiatrist—who never examined the claimant—to argue there was insufficient evidence of disability, disregarding strong, long-term support from his treating providers.
On appeal, the legal strategy focused on strengthening and reframing the existing medical evidence rather than introducing entirely new testing, since mental health claims lack objective proof like MRIs or lab results. The attorney emphasized detailed, consistent opinions from treating providers and highlighted the flaw in relying on a non-examining consultant over professionals who had treated the claimant for years. The appeal also argued that Prudential failed to justify how the claimant could suddenly recover at the transition from short-term to long-term benefits, reinforcing that his condition and limitations remained unchanged.
The appeal was successful within about 40 days, with Prudential reversing its denial and approving long-term disability benefits. The case underscores key lessons for claimants: ensure strong and consistent medical support (ideally including a psychiatrist for mental health claims), understand that insurers often rely on biased file reviews, and recognize the importance of detailed documentation from treating providers. It also highlights the need for ongoing treatment and thorough medical records to maintain benefits, especially since mental health claims are often limited to 24 months and subject to continued scrutiny.