Discover a disability insurance case in which disability insurance attorney Rachel Alters successfully overturned a denial by Prudential Financial for a senior technology engineer who had been suffering from severe mental health conditions, including anxiety, depression, and PTSD, along with back problems. The claimant had worked for the company for over a decade and initially received disability benefits after Prudential approved his claim. However, after about five months of payments, the insurer abruptly terminated his benefits, claiming—based on a paper review by a consulting physician—that he was capable of returning to work, even though his condition had actually worsened and his medications had been increased.

After obtaining the full claim file, Rachel Alters discovered that Prudential relied on selective excerpts from medical records and ignored the broader evidence showing the claimant’s declining condition. To challenge the denial, she worked closely with the claimant’s treating physicians to create detailed, customized medical questionnaires that addressed the insurer’s stated reasons for denial and documented the claimant’s functional limitations. These tailored physician statements were significantly more comprehensive than standard insurance forms and were designed to anticipate and rebut the opinions of the insurer’s reviewing doctors. The appeal package took months to assemble and included extensive medical documentation and physician support.

The appeal was ultimately successful, and Prudential reversed its denial within about 45 days, reinstating the claimant’s benefits based on his mental health conditions. However, the insurer did not yet approve benefits based on his physical back condition. This distinction is important because many group disability policies limit benefits for mental health claims to 24 months, while physical disabilities can qualify for benefits until retirement age. As a result, the legal team plans to continue building medical evidence related to the physical condition to potentially extend the claimant’s eligibility for long-term benefits.

When someone becomes disabled and unable to work, they may turn to their disability insurance for financial support. Unfortunately, not all claims are approved. Such was the case for Ms. A., whose disability claim was denied by Lincoln, her insurance provider. According to Lincoln, Ms. A.’s occupation as a “Medical Social Worker” was classified as sedentary work, meaning her job primarily involves sitting. Based on this classification, Lincoln denied her claim. However, Ms. A.’s actual job duties were closer to that of a Coordinator of Rehabilitation Services, which is classified as a light work occupation. This classification involves walking or standing to a significant degree, not just sitting.

Ms. A. did not take this decision lightly and took action to appeal the decision. She underwent a Functional Capacity Evaluation (FCE) to assess her ability to work. The FCE identified various limitations in her mobility, strength, and positional tolerance, among other factors. The results of the FCE concluded that Ms. A.’s abilities and tolerances fell below those associated with sedentary level work. She could not safely lift or carry any weight and could not productively sit, stand or walk without extended rest breaks in between.

PA-C Sanchez, who reviewed the FCE results, confirmed Ms. A.’a functional impairments. He attested to her inability to perform the main duties of her occupation as a Care Transitions Coordinator due to her chronic medical conditions and associated deficits. In addition, he confirmed that Ms. A. will experience good and bad days, require frequent unscheduled interruptions of work, frequently miss work, and be an unreliable employee.

Based on these findings, Ms. A. requests that Lincoln overturn their erroneous decision to deny her claim for benefits, approve her claim for long term disability benefits, forward back benefits owed, and reimburse premiums paid after disability onset. She also requests a copy of any reports created by Lincoln or its agent concerning her claim so that she may respond accordingly prior to the final determination on her claim. Additionally, she requests contact from Lincoln to arrange conferences with her treatment providers if necessary.

It is unfortunate that Ms. A. had to go through this process to receive the support she needs. Still, it is essential to recognize that insurance companies often rely on generic occupational classifications rather than considering the actual job duties of the claimant. In this case, Ms. A.’s FCE results provided concrete evidence of her functional impairments, and her treating provider confirmed her inability to perform her job’s main duties. Therefore, it is crucial to consider all available evidence before denying a disability claim.

This case involves a diesel fleet mechanic with severe degenerative disc disease and sciatica whose physically demanding, heavy-duty job became impossible due to chronic back pain supported by clear objective medical evidence (MRIs and imaging). He initially hired a non-specialized law firm that submitted a weak short-term disability insurance application with limited records, leading to a quick denial. They also handled the appeal and long-term disability claim poorly, both of which were denied, and then dropped him. By the time he sought new help, he was beyond the usual 180-day ERISA appeal deadline, but temporary COVID-related Department of Labor deadline extensions preserved his right to appeal.

We rebuilt the claim properly: obtaining full medical records, detailed support letters from treating doctors, a functional capacity evaluation showing he could perform only sedentary work (not his heavy mechanic job), and highlighting flaws in New York Life’s denial, which relied only on in-house nurse and doctor reviews with no independent specialists or functional testing. The comprehensive appeal led New York Life to overturn the denial, pay back long-term and even short-term benefits, and the same evidence supported a Social Security Disability approval. Going forward, the key issue will be the policy’s switch after 24 months from an “own occupation” to an “any occupation” standard, requiring continued strong medical proof to show he cannot perform other gainful work, even at a sedentary level.

This discussion covers a long-term disability case involving a registered nurse whose claim with Lincoln Financial was initially approved but later denied at the 24-month mark, when the policy definition changed from “own occupation” to “any occupation.” The nurse suffered from lumbar spine issues and knee problems that made the physically demanding duties of hospital nursing—lifting patients, standing, and constant movement—impossible. While Lincoln paid benefits during the “own occupation” period, they later argued she could perform sedentary nursing-related roles (like triage or chart review) based on a paper medical and vocational review, without fully accounting for her pain, functional limits, or medication side effects.

On appeal, we built a much stronger evidentiary record. We obtained an in-depth functional capacity evaluation, supportive reports from treating providers, and expert vocational input showing she could not reliably perform even sedentary work. The appeal emphasized that disability isn’t just about the ability to sit—it also involves concentration, cognitive stamina, and consistent performance, all of which were impaired by chronic pain and medication. With this comprehensive approach, Lincoln overturned the denial and reinstated benefits, though the claimant must continue providing ongoing proof. The case highlights how insurers often target claims at the “any occupation” transition and why detailed medical, functional, and vocational evidence is critical.

We discuss a successful appeal against Unum Insurance Company on behalf of a woman in her 40s who worked as a county transportation manager. After suffering a traumatic brain injury from a fall, she was initially approved for disability benefits and paid for six months. Despite ongoing cognitive impairments, memory loss, and difficulty concentrating—conditions critical to her demanding and safety-sensitive job—Unum terminated her benefits based solely on paper reviews by peer-review doctors who concluded she had recovered, without conducting any neuropsychological testing.

Long term disability attorney Rachel Alters appealed the termination by identifying this key gap in Unum’s evaluation and obtaining a comprehensive neuropsychological exam, which showed severe cognitive dysfunction preventing the claimant from performing not only her own occupation but any gainful work. The appeal succeeded, and Unum reinstated benefits. The case highlights the importance of objective cognitive testing, detailed medical documentation, and proactive claim management—especially for claimants with cognitive impairments—to both win appeals and protect benefits as the definition of disability later shifts from “own occupation” to “any occupation.”

The video discusses a resolved disability insurance lawsuit against New York Life involving a high-level software engineer who was denied both short-term and long-term disability benefits. Despite suffering from severe lower-back pain, radiculopathy, rare Tarlov cysts, and Ehlers-Danlos syndrome, New York Life denied her claims based on a paper-only peer review and ignored extensive objective medical evidence. Her medical conditions caused significant pain and cognitive difficulties that prevented her from performing the demanding analytical and programming duties of her job, and her treating physicians strongly supported her disability claim.

After her appeals were denied, the attorneys filed an ERISA lawsuit seeking recovery of both short-term and long-term benefits. Although ERISA cases carry litigation risks and limited remedies, the strong medical record made the case compelling. During court-required mediation, the claimant chose a lump-sum settlement to avoid uncertainty and further risk, resulting in a favorable resolution without a trial.

Long term disability attorney Stephen Jessup discusses a successful appeal against Lincoln Financial for a resort general manager whose disability claim was terminated after his colon cancer went into remission. Although Lincoln initially approved benefits, it later denied the claim based on an internal paper medical review, ignoring ongoing disabling symptoms such as severe fatigue, pain, bowel incontinence, and chemotherapy-induced peripheral neuropathy. Attorney Jessup overturned the denial by submitting functional capacity testing and strong rebuttal letters from treating physicians. Lincoln reversed its decision and reinstated benefits within seven days, highlighting a common insurer practice of cutting off cancer claims at remission and the importance of thorough medical and functional evidence in appeals.

Disability insurance attorney Greg Dell and Steven Dell discuss a successful disability claim for a dentist insured by Protective Life and Unum. The dentist, still working but impaired by chronic orthopedic issues, sought guidance before stopping work.

Steven helped carefully prepare and submit comprehensive claims to both insurers. Unum approved the claim, while Protective initially denied it based on a paper medical review. By proactively gathering strong medical evidence and securing a rebuttal from the treating physician, Steven convinced Protective to reverse its denial and pay back benefits. The case highlights the importance of early legal guidance, thorough documentation, supportive treating doctors, and ongoing claim management to secure and maintain disability benefits.

Disability insurance attorneys Gregory and Steven Dell discuss a recently resolved MetLife disability insurance claim involving a young entrepreneur diagnosed with Dissociative Identity Disorder (DID). The claimant’s symptoms—including dual personality manifestations, severe anxiety and depression, disorientation, and hallucinations—significantly impaired his ability to run multiple businesses. His father initially helped file the claim but soon realized the complexity and sought legal assistance.

Steven took over the case early, collecting extensive documentation such as psychiatric records, financial statements, and occupational details to prove disability under an individual (not employer-provided) disability policy. After he notified MetLife, they initially paid but soon terminated benefits, claiming the medical records were insufficient.

The main issue was that the treating psychiatrist’s notes were too brief and lacked detail about symptoms, limitations, and treatment. Steven arranged a paid consultation with the psychiatrist, explained what the insurer required, and requested a thorough summary and more detailed future documentation.

MetLife then required a third-party psychiatric review and an independent medical examination (IME). Although the IME report wasn’t fully supportive, it validated enough concerns for Steven to send it back to the treating psychiatrist, who produced a detailed rebuttal.

Ultimately, MetLife reversed its termination and approved ongoing monthly benefits.

We discuss a federal court victory against Unum in a disability case involving a McKinsey consultant with a mental-health claim. Despite Unum’s multiple medical paper reviews and denial tactics, the judge conducted a de novo review, gave greater weight to treating specialists who had examined the claimant, and ruled in her favor. The decision highlights that mental-health disability claims—though subjective and difficult—can succeed when supported by thorough medical documentation, and reflects growing judicial scrutiny of Unum’s denial practices.