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December 2012 Archives

Prudential Long Term Disability Denial of Benefits for Fibromyalgia (CFIDS) and Chronic Fatigue Syndrome Overturned on Appeal

As those who suffer from medical conditions such as fibromyalgia and chronic fatigue syndrome know, these illnesses can incapacitate an individual physically and mentally. No current treatment has proven totally effective against these infirmities and in many cases the illness becomes worse over time. Many clients come to us at DI Law Group   complaining that despite having provided their insurance company with medical evidence proving that they are no longer able to work, the insurance carrier has either failed to make a decision and is "surveillance" the claim or has unfairly denied benefits claiming there is insufficient evidence upon which to grant benefits. One such client, "Ms. Doe", a professional who truly enjoyed her occupation and worked as long as physically possible, contacted us after her claim for benefits had been unfairly denied by Prudential. Included with her application were medical records with examination findings confirming her medical diagnoses and detailing her physical limitations and decline. During its investigation of the claim, Prudential put her under surveillance, sent her ongoing requests for information, had one of their own "independent" physicians review her medical records and the surveillance tape, and misrepresented her occupation and limitations to the vocational specialist assigned to review her claim. Not surprisingly, Prudential's physician determined that there was no medical evidence to substantiate her reported complaints of pain, fatigue, and limitations and thus found that she could return to her job on a full time basis.

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