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Did Prudential Hire a Blind Guy to Review a Video Evaluation?

Wednesday, April 4th, 2012 | Uncategorized | 2 Comments

I represent a man named Steve Gupton (Mr. Gupton has given me permission to post this). Mr. Gupton’s physicians believe that he has a neurological condition called Multiple System Atrophy (MSA). MSA is a degenerative neurological disorder associated with the degeneration of nerve cells in specific areas of the brain. This cell degeneration causes problems with movement, balance and other autonomic functions of the body such as bladder control or blood pressure regulation.

Mr. Gupton filed a claim for long term disability with Prudential. Prudential then engaged in the usual tactic of asserting that his condition is mental and is thus limited by the terms of the policy to only two years of benefits. In my opinion, Prudential does not want to pay this claim because Mr. Gupton is relatively young and his monthly benefit would be significant.

Prior to his disability, Mr. Gupton was making nearly $80,000.00 per year as a salesman – living independently in Greene County, Tennessee. Now Mr. Gupton has moved in to live with his mother in South Carolina and receives Social Security disability benefits. Mr. Gupton applied for, and received, Social Security disability on the first try without the assistance of an attorney.

Prudential has gone to great lengths to deny Mr. Gupton’s claim. It paid a neuropsychologist $4,500.00 for a report that said Mr. Gupton was faking his condition and symptoms. It hired private investigators to stake out Mr. Gupton’s house. Mr. Gupton believes that they are still watching his mother’s house as I type this today.

But to the blindness thing. This posting is for the purpose of showing anyone who comes to this site, including the general public, the truth about Prudential’s behavior in Mr. Gupton’s claim.

Prudential has ignored a landslide of support for Mr. Gupton’s neurological disability. For example, as part of our proof, we submitted a video-taped neurological evaluation performed voluntarily and without charge by Mr. Gupton’s treating neurologist – Dr. Jacques. On February 23, 2011, Prudential sent a denial letter for the claim relying upon the opinion of its medical “file reviewer.” I’ll not pull punches here – Prudential’s consultant should not practice medicine on any human or animal if his observations related to the video evaluation are truly reflected in the denial letter. You make the call.

Here are some direct quotes from the denial letter, our response and the relevant clip from the video evaluation.

PRUDENTIAL’S ASSERTION:

-On page 8, third paragraph, the denial letter sets forth the observation of Prudential’s “file reviewer:”

“Dr. Jacques asked Mr. Gupton to touch his nose with the pointer finger. . . . Mr. Gupton was able to touch the tip of his nose very precisely on the first attempt with the right hand, and on the second attempt with the left hand.”

OUR RESPONSE:

Viewing the video at the 2:00 – 2:10, Mr. Gupton was all over the place with his fingers before “precisely” landing on the end of his nose.

\"Precise\" Nose Touching?

PRUDENTIAL’S ASSERTION:

-On page 8, fourth paragraph, the denial letter sets forth the observation of Prudential’s “file reviewer:”

“. . . Then Mr. Gupton performed finger to nose to finger maneuver, fine motor finger tapping of both upper extremities, and rubbing his heel up and down his shin. All these maneuvers were performed with significant tremor of both upper extremities and both lower extremities but the heel rubbing over the shin was fairly precise. . . .”

OUR RESPONSE:

While the Prudential consultant seemed to notice tremor, we vehemently disagreed that anything about the testing was “precise.” Observing these tests on the video from 2:20-3:27, if that heel rubbing can be called “precise,” I guess “imprecise” would be closer to an all out seizure. Mr. Gupton’s heel rubbing is anything but exact and sharply defined.

Precise Shin Rubbing?

PRUDENTIAL’S ASSERTION:

-On page 8, fourth paragraph, the denial letter sets forth the observation of Prudential’s “file reviewer:”

“. . . Then Mr. Gupton was asked to walk on a straight line, heel to toe. The camera did not show the whole body but demonstrated only the feet which were placed fairly precisely on the line. . . .”

OUR RESPONSE:

Again with the “precisely” wording. How about the stumble before it all started? How about Dr. Jacques holding his arm the whole time? This test can be observed from 3:30 – 3:56 on the video.

Precise Line Walking?

PRUDENTIAL’S ASSERTION:

-On page 8, sixth paragraph, the denial letter sets forth the observation of Prudential’s “file reviewer:”

“Mr. Gupton was able to stick out his tongue, feel light touch in all three trigeminal branches on both sides, was able to close his eyes tight, and to shrug his shoulders symmetrically. . . .”

OUR RESPONSE:

I am not sure what this statement is intended to convey but Dr. Jacques had to tell Mr. Gupton to keep his tongue hanging out. She also had to tell him to put his shoulders back down. These tests can be found at 5:28-6:04.

Huh? Is Mr. Gupton Doing Good Prudential?

PRUDENTIAL’S ASSERTION:

-On page 9, first full paragraph, the denial letter sets forth the observation of Prudential’s “file reviewer:”

“. . . He knew that if a person stands on a cliff he would grab him. While answering this question, Mr. Gupton’s tremor decreased substantially. . . .”

OUR RESPONSE:

First, it took ten seconds for Mr. Gupton to come up with that answer. From 10:39-10:49 on that video. Second, of course you would not observe shaking during this time period (10:19-10:49) because Mr. Gupton was sitting down, because his left hand was resting in his lap and because his right elbow was resting on the examination table and his right hand was almost constantly glued to his face. HOWEVER, it can be clearly observed that at 10:21 and 10:24, Mr. Gupton’s right hand and pointer finger were shaking.

This is a cliff hanger

PRUDENTIAL’S ASSERTION:

-On page 9, second full paragraph, the denial letter sets forth the observation of Prudential’s “file reviewer:”

“Mr. Gupton was able to show how to squeeze toothpaste on a toothbrush and started showing how to brush his teeth but showed how to brush using his finger and not the toothbrush. Dr. Jacques inquired if Mr. Gupton does have trouble brushing his teeth since his hands experience shaking problems. He answered “yes” to this leading question.”

OUR RESPONSE:

First, thankfully Mr. Gupton did not have a real toothbrush and toothpaste. He might have trashed the examination room. Mr. Gupton’s pretend teeth brushing can be observed at 9:41 – 10:16.

To Prudential: Gingivitis is the number one cause of tooth decay

But never mind about this trifling visual proof, how about scientific support for Mr. Gupton’s MSA diagnosis? Prudential’s Medical Director, Dr. Richard Day, noted that there is specific criteria to make the diagnosis of MSA including “neuropathic demonstration of CNS alpha-synuclein-positive glial cytoplasmic inclusions with neurodegenerative changes in striatonigral or olivopontocerebellar structures.” Dr. Day also noted that, “This information is not in the medical records reviewed. Because of this lack of information the criteria for this condition is not met.” Thus the claim was denied. The only problem is that you can only get “neuropathic demonstration of CNS alpha-synuclein-positive glial cytoplasmic inclusions with neurodegenerative changes in striatonigral or olivopontocerebellar structures” THROUGH POST MORTEM HARVESTING FROM THE BRAIN! But you would be dead and the policy says that’s when benefits stop so you lose any way!

Behold what you are in for if you file a disability claim with Prudential! If you want to know more of the story, read the final submission letter I sent to Prudential included in this blog. If you want the complete picture, wait a few months after this post and check the Pacer system in the federal courts for the administrative record. By then, the case will have been removed by Prudential lawyers from pesky state court to the federal court.

If you want to know, here are some of Prudential’s paid external and internal medical advocates in Mr. Gupton’s case:

Dr. Leonid Topper

Dr. Richard Day

Dr. Melvyn Attfield

Robert Moss, Ph. D.

Dr. Charles S. Jervey

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2 Responses to “Did Prudential Hire a Blind Guy to Review a Video Evaluation?”

  1. william e. skuban says:

    Thank God that we have bought off politicians who have spent millions of our tax dollars to fight that awful “ObamaCare” . It is much better to have a caring sincere insurance company carefully and respectfully review our claims than to have a #$@
    gubermint bureaucrat do so.

  2. admin says:

    Either way you are screwed in my humble opinion.

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John B. Dupree, Attorney at Law

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