In the case of Chris Lenwell Vs the Prudential Insurance Company Of America; Morrison & Foerster, LLP Long Term Disability Plan, filed at the District Court for the Northern District of California by a California disability attorney, the plaintiff brought a civil action against the Prudential Insurance Company Of America (Prudential) for allegedly violating the provisions of the Employee Retirement Income Security Act of 1974 (ERISA).
The Alleged Facts of the Case Against Prudential
The plaintiff was employed as a technology manager at the law firm Morrison & Foerster, LLP. As an employee of Morrison & Foerster, LLP, the plaintiff was entitled to disability benefits in the event of becoming disabled under the Morrison & Foerster, LLP Long Term Disability Plan. This Plan was sponsored by the plaintiff employer and funded by Prudential through a group insurance contract. According to the lawsuit, Prudential is also the Claims Administrator for the Plan. Accordingly, as Prudential is the claims administrator and payer of benefits, the plaintiff argued that Prudential operates under an inherent conflict of interest. Because of this conflict of interest, a skeptical review of Prudential’s claims decisions is warranted.
In the lawsuit, the plaintiff claimed that he became disabled in February 2009. The plaintiff also stated that prior to his disability claim; he had been diagnosed and treated for HIV since the early 1980s. However, his symptoms of fatigue and diarrhea have increased prior to the onset of his disability claim, and have not remitted since that time.
Receipt Of Short Term And Long Term Disability Benefits
On February 9th 2009, the plaintiff began receiving short term disability benefits from Prudential. He started receiving long term disability benefits from May 9th 2009 onwards. The gross amount of the plaintiff’s long term disability benefits was $6,252 per month.
Denial Of Long Term Disability Benefits
On March 25th 2010, the plaintiff was informed by Prudential that it was terminating the Plaintiff’s long term disability benefits effective April 1st 2010. Prudential alleged that the plaintiff’s symptoms no longer prevented him from working. This termination was in spite of the fact that the plaintiff has experienced no change in his medical conditions. In addition, the plaintiff alleged that Prudential’s claim notes repeatedly detailed that the plaintiff is unable to work due to his chronic fatigue and the side effects from his drug regime, including diarrhea, loss of energy, and memory loss, all of which were reported to be progressive in nature.
Nevertheless, the plaintiff submitted a request for a review of Prudential’s decision to terminate his benefits on October 22nd 2010. Additional information and medical documentation were also submitted by the plaintiff to support his appeal. Included in the list of information submitted was a Functional Capacity Evaluation and Work Tolerance Screening finding.
On December 6th 2010, Prudential informed the plaintiff that it was reaffirming its prior decision to terminate the plaintiff’s disability benefits. In response, the plaintiff submitted a second appeal to Prudential on January 19th 2011. Apart from additional medical documentation submitted to support his appeal, the plaintiff also provide evidence of a fully favorable Social Security Administration determination that the plaintiff was totally disabled from any gainful occupation in the national economy. However, Prudential again rejected the plaintiff’s appeal on April 18th 2011.
Claim for Relief by the Plaintiff
The plaintiff argued that at all times, he has been disabled and is entitled to disability benefits under the above mentioned long term disability benefits Plan. The plaintiff contended that Prudential have violated and continue to violate, the terms of the Plan and his rights. Having exhausted all his administrative remedies, the plaintiff is seeking from the Court the following relief:
- A declaration that Prudential have violated the terms of the Plan by terminating the plaintiff’s long term disability benefits.
- An order for Prudential to pay long term disability benefits to the plaintiff under the term of the plan from April 1st 2010 through the date of judgment inclusive of prejudgment interest.
- A declaration that the plaintiff is entitled to receive future disability benefits under the terms of the Plan.
- An award of reasonable attorneys’ fees and costs of the suit.
- Provide any other such relief deem equitable and just by the Court.