At 37 years old, our client had already established an impressive professional career. As Global Head of Transfer Pricing for a major company with approximately $50 million in sales, she held a senior position involving substantial financial, regulatory, and managerial responsibilities. Her work required sophisticated analysis, international tax knowledge, strategic decision-making, and constant communication across multiple jurisdictions.
But chronic migraines, accompanied by debilitating pain, cognitive difficulties, and several other medical conditions, progressively undermined her ability to perform those responsibilities. Despite extensive medical treatment and documentation from multiple treating physicians, Prudential Insurance Company denied her long-term disability (LTD) claim.
Newfield Law Group challenged that determination. What followed was an extensive appeal process involving additional medical evidence, scrutiny of Prudential’s medical reviewers, and a detailed examination of the actual occupational demands of her position. Ultimately, the medical evidence established restrictions and limitations that prevented her from sustaining the requirements of her occupation, and Prudential reversed its denial.
The case illustrates the particular challenges faced by younger professionals with chronic migraines when they seek long-term disability benefits, especially when an insurer relies on the reporting of a pay-for-hire medical expert who ignores substantial evidence and standard understood guidelines for diagnostic evidence.
A High-Level Executive Position That Required Sustained Concentration
A Global Head of Transfer Pricing is not simply an accounting or financial analysis position. Transfer pricing involves establishing and maintaining pricing policies for transactions between related companies operating in different countries. These policies must support corporate business objectives while complying with complex international tax regulations.
Our client’s responsibilities included developing international pricing strategies, defending those policies during multijurisdictional tax audits, addressing advance pricing agreements, and managing disputes involving tax authorities.
This was a demanding executive position requiring sustained concentration, analytical judgment, detailed research, complex problem-solving, and the ability to make important decisions. It also required extensive computer use, reading, reviewing financial information, and participating in meetings and communications.
These responsibilities became increasingly difficult as her medical conditions progressed.
Chronic Migraines Cause Far More Than Head Pain
Our client experienced chronic migraines approximately 16 to 20 days each month. The attacks caused severe pain involving her head, neck, and shoulders. She also experienced myofascial pain syndrome, fibromyalgia, cervical spondylosis and arthritis, cervical facet pain, occipital neuralgia, atypical facial pain, and temporomandibular joint (TMJ) symptoms.
Generalized anxiety disorder was another documented condition, although her treating psychologist explained that her depression was secondary to her physical illness and was not the underlying cause of her functional limitations.
The impact of chronic migraines extends well beyond pain. Migraine disease can produce substantial cognitive difficulties, including:
- Reduced concentration and attention.
- Slowed information processing.
- Impaired memory and recall.
- Difficulty reasoning and analyzing information.
- Reduced executive functioning.
- Problems making decisions and completing tasks.
For someone whose occupation depends on evaluating complex financial information, exercising judgment, and making consequential decisions, these limitations can be professionally devastating.
Migraine symptoms can also make ordinary workplace conditions difficult to tolerate. Computer screens, bright lighting, noise, and prolonged visual concentration often aggravate symptoms. Medication taken to control a severe migraine can also cause significant side effects, including drowsiness and impaired concentration.
An employee who must stop working to manage an attack cannot necessarily resume complex professional responsibilities immediately afterward. The frequency, duration, and unpredictable nature of migraine episodes make consistent attendance and productivity particularly difficult.
Importantly, normal brain imaging does not establish that migraines are insignificant or that their functional consequences are absent. The American Headache Society recognizes that neuroimaging is not routinely necessary for patients with headaches consistent with migraine and a normal neurological examination. Migraine is primarily a clinical diagnosis based on medical history and clinical evaluation, not a condition that produces an abnormal MRI or CT scan.
Prudential Denied the Claim Despite Extensive Medical Documentation
In July 2024, Prudential denied our client’s LTD claim following a neurological file review by a physician it characterized as independent. The review emphasized the absence of evidence of a cerebrospinal fluid leak or increased intracranial pressure, as well as the purported absence of objective neurological deficits. Prudential also questioned the documentation supporting her cognitive complaints.
The insurer’s approach failed to address the central issue: whether the frequency and severity of her migraines, together with her other medical conditions, prevented her from performing the material duties of her occupation on a regular and sustained basis.
The medical evidence we provided was extensive. Our client had consulted numerous physicians and pursued different treatment approaches in an effort to improve her condition. She had undergone Botox injections, a treatment sometimes used to reduce the frequency of chronic migraines. Although the treatment provided some improvement, it did not restore her ability to work consistently.
Rather than meaningfully evaluate the combined effects of her conditions, Prudential relied heavily on its reviewing physician’s conclusions and gave insufficient weight to the opinions of her treating providers.
The distinction matters. Under ERISA, an insurance company may not fairly evaluate a disability claim by isolating individual test results while overlooking the broader medical record and the claimant’s actual functional limitations.
Challenging the Medical Review and Building a Stronger Appeal
Newfield Law Group appealed Prudential’s denial with a comprehensive submission documenting both the medical evidence and the practical consequences of our client’s conditions.
The appeal included:
- A detailed personal statement from our client describing her symptoms and their impact on daily activities and employment.
- A chronological history of her conditions and treatment.
- Medical records and supporting opinions from multiple treating physicians.
- Documentation from her psychologist explaining that depression was secondary to her physical conditions.
- Statements from her husband, parents, sister, and friends describing the effects of her illness.
- Evidence concerning the frequency of her migraines, medication requirements, and limitations on sustained activity.
We also challenged the methodology and conclusions of Prudential’s medical reviewer.
The reviewing physician had failed to give appropriate consideration to the treating physician’s opinions and the extensive clinical history. His conclusions raised serious concerns about the objectivity and completeness of the review. Newfield Law Group examined prior judicial criticism of similar medical-review practices, including decisions addressing the arbitrary disregard of treating-provider evidence.
The legal principles discussed in cases such as Fairbaugh v. Life Insurance Company of North America, 737 F. Supp. 2d 68 (D. Conn. 2010), and Cox v. Cigna Group Insurance, No. 5:09-cv-00082 (E.D. Ky. Feb. 24, 2010), underscore the importance of a reasoned evaluation of the administrative record rather than selective reliance on evidence supporting a denial.
Our position was straightforward: Prudential could not dismiss extensive medical support without adequately explaining why the treating providers’ findings and opinions were unpersuasive.
The initial appeal did not resolve the dispute. We continued pressing the insurer to consider the evidence it had overlooked.
A Second Neurological Review Changed the Outcome
Prudential subsequently arranged another review, this time by a different board-certified neurologist. The new reviewer reached a materially different conclusion.
After considering the medical documentation, the neurologist agreed that the evidence supported restrictions and limitations attributable to our client’s chronic migraines. The review also considered her other documented conditions, including fibromyalgia, myofascial pain, cervical spondylosis and arthritis, cervical facet pain, neck and shoulder pain, upper back pain, occipital neuralgia, atypical facial pain, TMJ symptoms, and generalized anxiety disorder.
This was an important development. The medical evidence that had been discounted during the original review now supported functional restrictions that Prudential could no longer reasonably disregard.
The reversal demonstrated why persistence and experience matter in disability appeals. A denial by an insurer’s medical reviewer is not necessarily the final word, particularly when the review does not adequately account for the claimant’s complete medical history.
Prudential Also Misidentified the Occupation
The appeal also revealed a significant problem with Prudential’s assessment of our client’s occupation. The insurer characterized her position as a “Transfer Pricing Manager,” describing it as a sedentary occupation involving computer use, financial analysis, research, documentation, review, and correspondence.
That description failed to capture the actual demands and responsibilities of her position as Global Head of Transfer Pricing. Although the work was classified as sedentary, that designation did not mean it was physically or cognitively undemanding. Her responsibilities required prolonged computer use, sustained visual concentration, complex analytical thinking, detailed research, and frequent communication. She also had to exercise independent judgment and make decisions affecting substantial corporate financial and regulatory interests.
The activities central to her occupation aggravated her medical conditions. Prolonged exposure to computer screens affected her visual tolerance and triggered or intensified her headaches. Lighting and noise also presented significant problems.
The restrictions ultimately recognized in the medical review included limitations on screen exposure, lighting, and noise, as well as additional absences estimated at approximately four days per month. These limitations were incompatible with the regular and sustained performance of her actual occupational responsibilities.
Prudential Recognized Restrictions but Raised Additional Obstacles
Although Prudential ultimately reversed its original denial, the matter was not entirely resolved. The insurer acknowledged medical restrictions and limitations, but additional questions remained concerning the basis and duration of her ongoing disability.
One particularly troubling issue involved Prudential’s attempt to characterize her disability as primarily related to anxiety and depression. This is not uncommon.
Many long-term disability policies contain a limitation restricting benefits for disabilities attributed to mental illness to 24 months. Insurers may therefore have a financial incentive to characterize a claim as psychiatric, even when the underlying disability is caused by physical conditions.
Our client’s treating psychologist specifically explained that her depression was secondary to her physical illness, not the underlying cause of her inability to work. Anxiety and depression may accompany serious chronic illness. Living with persistent pain, unpredictable migraine attacks, and the loss of one’s professional independence can understandably affect emotional well-being. That does not automatically transform a physical disability claim into a mental illness claim subject to a contractual time limitation.
A Successful Appeal Does Not Mean the Fight Is Over
This case demonstrates how difficult it can be for a younger professional to obtain long-term disability benefits, even when there is extensive medical documentation and a clear history of treatment.
Our client was only 37 when she became unable to sustain her demanding executive responsibilities. We believe younger claimants with high incomes face an additional concern: the potential financial exposure to an insurance company when benefits could continue for many years.
A successful appeal required much more than submitting another collection of medical records. We had to examine Prudential’s medical review, challenge its treatment of the clinical evidence, document the actual requirements of our client’s occupation, and explain why the restrictions and limitations prevented her from working consistently.
At Newfield Law Group, we understand that obtaining an initial approval is not necessarily the end of a disability insurance dispute. Insurers may continue to scrutinize claims, request additional medical information, and look for grounds to reduce or terminate benefits. We represent many claimants whose claims are always being checked, ensuring our clients have the peace of mind knowing we are looking out for their best interests.