After exhausting all her ERISA disability administrative remedies, Mary L. Elchinger, a registered nurse, filed a lawsuit through her Ohio disability attorney at the Common Pleas Court of Franklin County Ohio against Prudential Insurance Company of America (Prudential) to seek relief from the court for Prudential denying her claim for long term disability benefits under an employer sponsored long term disability insurance plan.
The Facts of the Case
The plaintiff was a registered nurse working with Radiant Research Inc. while being employed with Radiant Research Inc, the plaintiff participated in a long term disability plan sponsored by Radiant Research Inc. that was issued and administered by Prudential under the provisions of the Employer Retirement Income Act (ERISA). In 2009, the plaintiff became totally disabled and applied for disability benefits under the plan.
The plaintiff was determined to be disabled under the plan through November 30th 2009. She managed to receive some disability benefits through November 30th 2009 but was denied further disability benefits from December 1st 2009 onwards. Despite making several ERISA appeals to Prudential and having medical evidence to support her disability status in the plan’s administrator records, Prudential continued to deny the plaintiff further payment of disability benefits.
The plaintiff alleged that Prudential utilized non-treating medical doctors that have a financial incentive in reaching a conclusion to deny the plaintiff’s claim for further disability benefits. Her request for information about the number of times that Prudential had utilized the services of these non-treating medical doctors was refused. Prudential also further refused to make known the financial benefits that these non-treating medical doctors received from Prudential’s repeated use of their services in evaluating disability claims under the plan.
To support her claim for long term disability benefits, the plaintiff had submitted an expert evaluation by a medical doctor which supported the fact that the plaintiff was disabled from December 1st 2009 onwards. In addition, the plaintiff also provided to Prudential a copy of the Social Security Administration (SSA) determination that the plaintiff was deemed disabled by the SSA since March 2nd 2009. Despite all evidences that supported the plaintiff status as being disabled, Prudential continued to deny the plaintiff further payment of disability benefits. As a result, after exhausting all her administrative remedies under the plan, the plaintiff had no recourse but to seek relief from the Court by filing an action against Prudential.
Relief Sought under the Lawsuit
In the lawsuit, the plaintiff’s Ohio disability lawyer argued that the plaintiff’s disability benefits were wrongfully and unlawfully terminated. Despite all the medical evidence submitted, Prudential had failed to conduct a full and fair review of the plaintiff’s appeal. In addition, it was alleged that Prudential failed to have the plaintiff physically examined by its panel of non-treating medical doctors but instead exerted effort to conduct secret surveillances on the plaintiff. Because of the conduct of Prudential, it was argued that Prudential did not exercise proper discretion and because it is both adjudicator and payer of the claim, it had operated under a structural conflict of interest. As such, the plaintiff is seeking the following reliefs from the court:
- Recovery of past due monthly disability benefits
- Recovery of ongoing and future disability benefits in an amount exceeding $25,000.
- An equitable order to compel Prudential to pay past due and ongoing disability benefits.
- An award of attorney fees
- Pre-judgment interest
- Cost of this legal action
- And any other equitable relief deem appropriate by the Court