Prudential Insurance Company of America (Prudential) finds itself in court having to defend against two separate lawsuits for denying long-term disability benefit payments to two different claimants.
Richard Timms of Minnesota filed an ERISA lawsuit against Prudential with the help of his Minnesota disability lawyer in United States District Court in the District of Minnesota because Prudential denied Mr. Timms' claim for long-term disability benefit payments.
Mr. Timms was the participant in a group plan for long-term disability insurance as an employee of Ricoh Printing Systems America. During the time he was a participant of the plan, Mr. Timms worked for Ricoh until he became disabled on June 9, 2008. Mr. Timms subsequently filed a claim for long-term disability insurance benefits with Prudential.
Prudential approved Mr. Timms' claim and paid him benefits through September 30, 2009.
However, Prudential terminated his long-term disability benefit payments as of October 1, 2009 and informed Mr. Timms of this action in a letter dated October 20, 2009. Prudential base their decision to terminate Mr. Timms' benefits based on the "own occupation" standard per the terms of the long-term disability insurance plan he had while working for Ricoh.
Mr. Timms appealed Prudential's decision on March 24, 2010. Prudential responded to Mr. Timms' appeal stating the original decision to deny his claim was upheld. On November 22, 2010, Mr. Timms made his second appeal to Prudential regarding his claim. Finally, Prudential informed Mr. Timms in a letter dated February 25, 2011 that "[his] benefit denial was appropriate."
Since Mr. Timms had exhausted all of his administrative remedies with Prudential, that left him no other course of action but to file a civil complaint against Prudential in order to receive the long-term disability benefit payments that are due him.
Mr. Timms, with help of his disability lawyer, is asking the court to award him all back payments of long-term disability benefits, attorney fees and court costs, and any other form of relief the court deems fit.
To the south and east of Minnesota, Nancy Tatera, with the help of her Illinois disability attorney, has also filed an ERISA lawsuit against Prudential for denying her claim for short-term and long-term disability benefit payments.
Ms. Tatera worked as a customer service representative with W.W. Grainger until May 13, 2009 when she became disabled as a result of diabetic retinopathy, vitreous degeneration, and vitreous opacities.
Diabetic retinopathy, as the name would suggest, is a disabling condition that occurs as a complication from diabetes that damages the blood vessels in the eyes that can produce blindness as a result. Vitreous degeneration and vitreous opacities can cause "floaters" or microscopic fibers that clump together, thus obstructing a person's vision.
Shortly after ceasing work, Ms. Tatera filed a claim for short-term disability benefit payments with Prudential. Prudential paid on Ms. Tatera's short-term disability claim from May 14, 2009 through September 14, 2009. Effective September 15, 2009, however, Prudential decided they would not continue to pay short-term disability benefits to Ms. Tatera, and that her claim for long-term disability benefits was denied. Prudential informed Ms. Tatera of their decision in a letter dated October 29, 2009.
In response to Prudential's decision, Ms. Tatera sent Prudential a letter of appeal on November 7, 2009 and submitted additional documentation regarding her inability to work with reasonable continuity.
Prudential deliberated Mr. Tatera's appeal by having one of their medical consultants review the documentation sent to them by Ms. Tatera. Prudential relied on the opinion of their medical consultant, who did not physically examine her, and upheld their original decision to deny Ms. Tatera's short-term and long-term disability benefit claims. Prudential notified Ms. Tatera of their decision in a letter dated May 21, 2010.
Ms. Tatera, through her disability lawyer, appealed Prudential's decision on January 5, 2011, and submitted even more evidence regarding her inability to work with any continuity as result of her disabling conditions. Prudential, once again, upheld its decision to deny short-term and long-term disability benefit payments to Ms. Tatera on March 22, 2011.
Ms. Tatera alleges in her civil complaint against Prudential that their decision was contrary to the evidence she and her treating physician submitted when making her claim for benefits. Additionally, Ms. Tatera filed for, and was approved to receive, Social Security disability income going back to May, 2009. Nevertheless, Prudential still refused to approve Ms. Tatera's claim for short-term and long-term disability benefits.
As a result, Ms. Tatera filed a civil complaint against Prudential in United States District Court for the northern district of Illinois in the Eastern division. For her relief, Mr. Tatera is seeking the following:
- all short-term and long-term disability benefit payments dating back to September 15, 2009
- prejudgment interest of 9% per year on all unpaid benefit payments
- attorney's fees
- any other form of relief the court deems fit