For years, a successful sales professional built a career around managing important customer relationships. The job required more than making calls. It meant traveling to customer locations, walking large industrial facilities, navigating stairs, and solving problems in person.
Then Long COVID changed what her body could handle.
She continued working as long as she could, but persistent fatigue, cognitive difficulties, dizziness, and severe symptom flare-ups after physical activity eventually made it impossible to keep up with the demands of her occupation.
Her employer-sponsored long-term disability plan was insured by Prudential. After initially paying benefits, Prudential terminated them. And even after an earlier appeal resulted in a reversal, the insurer denied her benefits again.
BenGlassLaw stepped in—and ultimately got her benefits reinstated.
Case Snapshot
- Occupation: Sales Professional
- Insurance Company: Prudential
- Medical Condition: Long COVID and related ongoing symptoms
- Claim Type: ERISA Long-Term Disability
- Key Issue: Prudential’s changing characterization of the claimant’s condition and its handling of the appeal
- Outcome: Benefits reinstated and past-due benefits paid after BenGlassLaw filed suit
When Long COVID Made Her Job Impossible
The claimant’s work depended on being able to travel, visit customer facilities, walk extensive distances, climb stairs, concentrate, and respond to problems throughout the day.
Long COVID affected those abilities in several ways.
She experienced profound fatigue, cognitive difficulties, dizziness when upright, and crashes after even modest physical exertion. The problem wasn’t simply whether she could sit at a desk or complete an occasional task. Her job required sustained physical and mental effort, often away from home.
She had tried to keep working, but eventually her symptoms made the essential demands of her occupation unsustainable.
Prudential initially approved her long-term disability claim and paid benefits. Then the insurer changed its position.
Prudential Terminated Her Benefits and Recast the Claim
Prudential eventually decided that the claimant was no longer disabled from performing her own occupation.
At the same time, the insurer increasingly characterized her condition as an adjustment disorder—a mental health label—even though the claimant and her treating providers identified Long COVID as the condition preventing her from working.
That distinction mattered. Under the terms of her plan, the claimant understood that a mental-health classification could trigger a limitation on benefits after 24 months.
This wasn’t the first time Prudential had denied her. She had already challenged an earlier denial successfully. But only months after that reversal, Prudential terminated her benefits again.
A second denial meant another fight to protect benefits she had relied on.
How BenGlassLaw Challenged Prudential’s Decision
We approached the matter as an ERISA appeal, focusing on the medical evidence, the claimant’s actual functional limitations, and the way Prudential evaluated the claim.
We obtained the plan documents and complete claim file, then developed a detailed record that included:
- Medical opinions from her treating Long COVID physician
- A Functional Capacity Evaluation and standardized cognitive testing
- Observations and supporting information from other treating providers and therapists
- Statements from therapists addressing whether mental health conditions contributed to her inability to work
- A personal statement, supporting letters from people close to her, and a symptom journal
The appeal challenged Prudential’s failure to adequately account for the medical evidence and its characterization of the claimant’s disability. It also argued that the insurer had not provided the full and fair review required under ERISA.
That procedural argument mattered. The appeal relied on Fourth Circuit authority addressing how failures in the claim-review process can affect an insurer’s decision.
We also tracked Prudential’s deadline to decide the appeal. When the insurer failed to meet that deadline, we moved the case into federal court.
Prudential Reversed Its Decision After BenGlassLaw Filed Suit
BenGlassLaw filed suit in federal court. The very next day, Prudential reversed its denial.
The claimant’s long-term disability benefits were reinstated. She received a back-benefits payment covering the months during which Prudential had stopped paying her, and her monthly benefits resumed.
The result restored the benefits she had been entitled to receive under the plan while she continued to face the effects of Long COVID.
Our team’s work did not end with the reversal. We continue to work toward protecting her benefits for as long as she remains eligible under the policy.
A Prudential Denial Doesn’t Have to Be the Final Word
An insurance company can approve a long-term disability claim and later change its decision. It can also characterize a medical condition in a way that affects how it evaluates the claim or applies policy limitations.
That is why a strong appeal must do more than repeat a diagnosis. It should connect the medical evidence to the actual demands of the person’s occupation, address the insurer’s reasons for terminating benefits, and identify problems in the claim-review process.
If you’re facing a Prudential long-term disability denial, learn more about how to handle a Prudential disability denial and the steps involved in appealing a long-term disability denial.
BenGlassLaw represents long-term disability claimants throughout the United States. If Prudential or another insurance company has denied or terminated your benefits, contact our team to discuss your options.
Every disability claim is different. The outcome described here depended on the specific policy, medical evidence, administrative record, and facts of the case. Past results do not guarantee or predict a similar outcome.