The BenGlassLaw long-term disability team represents clients all across the United States.
A federal judge in Kansas recently returned our client to “on claim” status and awarded him his backpay benefits, plus attorney fees and interest, after Prudential Insurance had denied his long-term disability claim for a reason the judge said was “borderline frivolous”.
If the claimant stays on claim for the duration of policy, he is eligible for over $760,000 of total benefits.
Background of the Claim
Joseph K. worked as a Network Services Manager for Foley Enterprises. Prudential was the insurance company administering the short and long-term disability claims.
Joseph developed a number of debilitating conditions, including ankylosing spondylitis, chronic iridocyclitis, arthropathic psoriasis* and memory issues. After struggling to keep up with work and taking some time off from time to time to rest, he was terminated on January 17.
He submitted a disability claim to Prudential Insurance and the claim was denied. Prudential argued that since he was paid up until his last day of work, he did not have a disability as that term is defined in the policy. Prudential claimed that all claimants need to also have an income loss to prove disability.
Once he was terminated from his job, Prudential argued, he was no longer eligible for benefits. Notably, Prudential did not dispute that Joseph could not do his job due to his many medical conditions, because it never actually reviewed and made a decision about the contents of the medical records.
The Court’s Rulings
The federal judge called Prudential’s interpretation of the policy a Catch-22 and borderline frivolous. Under that thinking, the judge ruled, no one who was paid up until the last day at work, but who then later made a claim, could ever recover benefits.
Prudential asked the court to remand the case to Prudential so that it could look at the medical records more closely. The court said it would not be appropriate to give Prudential a second bite at the apple since, in its denial letter, it had not relied on the argument that the medical records were not sufficient (Long-term disability law requires the insurance company to put all reasons it is denying a claim into a denial letter that is easy for the claimant to understand).
BenGlassLaw attorneys Damon Miller and Melissa Ryan briefed the case and represented the client in Kansas. Kansas-based long-term disability attorney Kevin McManus also assisted on the case and was our local counsel in Kansas federal court.
The Medical Conditions at Issue
*Ankylosing spondylitis (AS) is a form of arthritis that primarily affects the spine, although other joints can also be involved. It causes inflammation of the vertebrae that can lead to severe, chronic pain and discomfort. Over time, the inflammation can lead to the fusion of vertebrae, which diminishes the spine’s flexibility and can result in a hunched-forward posture. The condition can also cause inflammation, pain, and stiffness in other areas of the body, such as the shoulders, hips, ribs, heels, and small joints of the hands and feet. In some cases, the eyes can be affected, leading to a condition known as uveitis.
Chronic iridocyclitis is a form of uveitis, which is inflammation of the uvea, the middle layer of the eye that includes the iris (the colored part of the eye), the ciliary body, and the choroid. Iridocyclitis specifically refers to inflammation of the iris and the ciliary body. When this condition is chronic, it means that it persists for a long period or it recurs frequently.
Chronic iridocyclitis can cause a variety of symptoms, including:
- Pain in the eye or brow region
- Redness of the eye
- Blurred vision
- Sensitivity to light (photophobia)
- Floaters (small spots or lines moving in one’s field of vision)
Arthropathic psoriasis, commonly known as psoriatic arthritis (PsA), is a type of inflammatory arthritis that affects some individuals who have psoriasis, a condition characterized by red patches of skin topped with silvery scales. Psoriatic arthritis can occur in any part of the body, including the fingertips and spine, and ranges from relatively mild to severe. It can cause swelling, pain, and damage to joints, and in severe cases, it can lead to significant and permanent joint damage if not treated appropriately.
The symptoms of psoriatic arthritis can vary but often include:
- Joint pain, swelling, and stiffness
- Swollen fingers and toes (dactylitis), giving them a sausage-like appearance
- Skin lesions characteristic of psoriasis, such as red, scaly patches
- Nail changes, including pitting, discoloration, and separation from the nail bed
- Reduced range of motion in the affected joints
- Morning stiffness and tiredness
- Tenderness around joints and tendons
- In some cases, eye inflammation (uveitis)
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BenGlassLaw fights for wrongfully denied workers across the nation.
Since 1995, BenGlassLaw has been helping sick, injured, and disabled workers fight unfair claim denials, get the benefits they paid for, and get their lives back on track. We are passionate about restoring our client’s denied benefits because insurance policies should be part of the solution, not a cause of additional stress. What makes our team unique?
- Our Experience. We file more disability appeals and lawsuits than any other firm in the Mid-Atlantic. (Source: Pacer, the official government site for Federal Court lawsuits)
- Our Leadership. Our work in ERISA Law is recognized and respected across the nation. We speak at national events and teach other national disability attorneys about our own techniques and processes for handling ERISA and life insurance denials.
- Ongoing Support. Once we get our clients back on claim, it’s never them vs the insurance company again. For as long as our client receive benefits, we handle the insurance company — which is why we manage over $33 million in future disability benefits on behalf of our clients.