Prudential Insurance Company Denies Long Term Disability Benefits To Man Despite Two Back Surgeries

Robert Hamill has been denied his long term disability benefits since August 2009. Having exhausted all avenues of collection of his disability benefits, Hamill and his disability attorney filed a lawsuit against Prudential Insurance Company on February 14, 2011 in the Supreme Court of the State of New York, County of Richmond.

Prudential was served the complaint on March 10, 2011 and promptly responded by removing Robert Hamill v. Prudential Insurance Company of America from the Supreme Court of the State of New York to the United States Eastern District Court of New York, stating that federal court was the proper venue for trying this case. As a case that involves long term disability benefits under a group employee benefit plan, ERISA provisions govern Hamill’s lawsuit, making the lawsuit’s original jurisdiction a federal court matter.

Removal of the case to the Eastern District Court of New York

According to 28 U.S.C. ยง 1441(a), (b), and (c), since Hamill’s disability plan is an employee benefits welfare benefit plan under which Hamill is attempting to recover long term disability payments, the case is a federal issue, and consequently, belongs in the Eastern District Court of New York. By law, ERISA lawsuits are the exclusive jurisdiction of federal courts, making Prudential’s removal of the case valid.

Hamill and his New York disability attorney file their complaint

Regardless of the venue, Hamill’s complaint remains the same, Prudential terminated Hamill’s long term disability benefits. Hamill and his disability attorney filed Hamill’s complaint in response to Prudential Insurance Company’s denial of Hamill’s long term disability benefits in August 2009.

Background of the case

In January 2009, Hamill discontinued working at Modell’s Sporting Goods as a General Manager when he could no longer work due to chronic back and leg pain. His back and leg pain were the result of herniated and bulging discs. After undergoing two surgeries to resolve the issue, Hamill was still unable to work. Armed with numerous Statements of Claim and medical documentation of his disability as well as proof of his Social Security disability award, Hamill applied for long term disability benefits under his employer’s Prudential Plan.

Presented with documented paperwork that clearly showed that Hamill was entitled to long term disability benefits under his plan, Prudential denied Hamill his disability benefits. Hamill’s New York disability lawyer notes in the complaint that Prudential “unjustifiably and in bad faith denied said benefits.”

Hamill appealed the denial, but was again denied benefits by Prudential. Hamill fulfilled all the requirements prescribed by the insurance provider, met the criteria for award of long term disability benefits under his policy, and provided the insurer with verification of his Social Security disability award that he obtained in August 2009. Still Prudential was not swayed to pay Hamill his disability benefits, leaving Hamill no option but to file an ERISA lawsuit.

In the complaint, Hamill asks the Court to award him with his long-term disability employee benefits from August 2009, when he qualified for those benefits, plus interest. He bases his claim on Prudential’s blatant violation of ERISA requirements and also asks for attorney’s fees due to “Prudential’s bad faith actions.”

About the Author

Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. For a free consultation, please call 800-828-7583.