Two separate Plaintiffs have filed federal ERISA lawsuits in California against the Prudential Insurance Company of America for failing to pay disability benefits under ERISA regulations. In the cases that were filed with the help of their California disability attorneys, Prudential is alleged of wrongfully denying the claims of both Plaintiffs for long-term disability (LTD) benefits.
The Northern California District Prudential Case
The plaintiff was employed by Townsend and Townsend and Crew LLP as a Senior Patent Prosecution Secretary, thereby granting her the benefits of its long-term disability plan, which was administered by Prudential.
Plaintiff filed a claim for disability benefits with Prudential under terms of the Plan on or about December 10, 2009. Plaintiff had become ill for a prolonged period due to her total disability. On or about January 20, 2010, Prudential denied Plaintiff’s claim for long-term disability benefits.
From January 20, 2010 to the present day, Plaintiff has been and continues to be disabled as defined by the terms of the Plan. Plaintiff has also complied with all terms and conditions of the Plan.
Plaintiff filed an appeal on or about June 21, 2010, including additional documentation of her disability and a request to pay her benefits. On or about August 18, 2010, Prudential denied her appeal. Plaintiff filed a second appeal on or about March 18, 2011; this second appeal was denied by Prudential on or about May 18, 2011.
Due to the exhaustion of her administrative remedies, Plaintiff has filed this lawsuit against Prudential, specifically for failing to pay the benefits that were promised under the Plan and for not providing adequate medical and other documentation to substantiate why her claim for benefits was denied.
The Central California District Prudential Case
The plaintiff in this case was a Project Manager for Loyola Marymount University since 1981, thereby making the Plaintiff eligible for the Loyola Marymount University Flexible Benefits Plan (Plan), which was insured by Prudential.
If totally disabled while covered under this LTD plan, Plaintiff was entitled to 60% of his monthly earnings, with a maximum monthly LTD benefit of $7,500. The maximum benefit duration would be from the time of 90 days after the total disability until the Plaintiff’s normal retirement age (determined by the Social Security Act).
Plaintiff became disabled due to symptoms from a massive heart attack and cardiac arrest. He filed a claim with Prudential for payment of benefits under terms of the Plan. Prudential paid disability benefits to Plaintiff from around November 9, 2009 to on or about February 21, 2010.
Prudential arbitrarily and capriciously stopped benefit payments under the terms of the Plan on or about February 1, 2010. On or about November 4, 2010 and July 27, 2011, Prudential upheld its initial denial of Plaintiff’s benefits.
Plaintiff has exhausted administrative remedies and has filed this lawsuit against Prudential, claiming that Prudential’s reviewing physicians failed to discuss the claim with Plaintiff’s board certified treating physicians, failed to have Plaintiff undergo a functional capacity evaluation, and failed to impartially review the opinions of the board certified treating physicians. It also claims that Prudential employed medical examination and record review companies and doctors whose income were mostly derived from insurance companies and whose examinations and medical records were of a questionable nature in terms of both impartiality and credibility.
Relief Sought in the Lawsuits
In both cases, the Plaintiffs want the following relief from Prudential in their respective lawsuits:
- A judgment that the Plaintiffs are to immediately regain their status under their respective LTD Plans, and to gain all future benefits so long as the Plaintiffs fit the respective terms under their LTD Plans.
- A judgment that the Plaintiffs are entitled to all past benefits due to them, including all prejudgment interest.
- Complete reimbursement for all attorney fees and costs.
- Any and all other just and proper relief that the court deems appropriate.