A 42 year old woman suffered from co-morbid conditions of Chronic Fatigue Syndrome and Lyme disease. We had initially successfully appealed her claim for benefits under the Prudential disability insurance policy. After being on claim for several years, however, Prudential terminated her claim during the “any occupation” phase, finding her no longer eligible for benefits, despite no improvement in her condition.
To accomplish this, Prudential relied upon a report from a well-known insurance pandering paper reviewing physician who determined that the testing, which previously was sufficient for Prudential to accept liability, was no longer “valid.“ Prudential was only too pleased to embrace this report as a good reason to terminate the claim.
Under our direction, our client had gone for Cardiopulmonary Exercise Testing (CPET), considered to be the gold standard for developing evidence to support dysfunction from Chronic Fatigue Syndrome. The CPET results were criticized by the paper-reviewing doctor and Prudential subsequently engaged another doctor to review and embrace the erroneous report concerning the CPET testing.
These two reports formed the basis of Prudential’s termination of the claim.
We fought back on behalf of our clients, first by securing a for the report from the CPET physician who performed the initial test to validate the results and refute Prudential’s doctor. This report, along with other physician support and additional evidence we gathered, created a record we were confident would succeed in litigation.
Given the significant financial exposure Prudential faced if we were successful in court, we were able to negotiate with our adversaries early in litigation, providing the client with closure, certainty, and the ability to move on with her life.