In the recent case of Victoria Haner Vs The Prudential Insurance Company Of America And Crestwood Behavioral Health Employee Benefit Plan, filed by a California disability attorney at the District Court for the Southern District of California, the plaintiff Victoria Haner is seeking a declaration from the Court that she meets the definition of disability and thus is entitled to disability benefits under an employee benefit plan issued and administered by the Prudential Insurance Company Of America (Prudential).
The Alleged Facts Of The Disability Denial Case Against Prudential
The plaintiff was formerly a Program director for Crestwood Behavioral Health, Inc. Her duties at the lockdown psychiatric facility included:
- Directing and coordinating all aspects of case management;
- Insuring Compliance with established procedures and policies;
- Sitting tor extended periods of time; and,
- Maintaining the physical and cognitive ability to assist in emergency situations such as pushing a wheelchair or bed, or appropriately intervening with clients who may physically and/or verbally act out.
While employed with Crestwood Behavioral Health, Inc, the plaintiff participated in an employee welfare benefit plan established and maintained by Crestwood Behavioral Health, Inc and issued by Prudential. Prudential is also said to be the Claims Administrator for the Plan.
When the plaintiff subsequently became disabled, she filed a claim for disability benefits with Prudential and was approved for disability benefits from October 30th 2007, to June 9th 2009.
Denial of Disability Benefits by Prudential
On June 9th 2009, the plaintiff alleged that Prudential unlawfully, unreasonably, arbitrarily and capriciously terminated her disability benefits. Subsequently, the plaintiff appealed the denial for disability benefits and was informed on January 8th 2010 by Prudential that her appeal was unsuccessful. According to the denial letter;
January 8th, 2010:
We have determined that our decision was appropriate and have upheld our decision to terminate your claim for LTD benefits… Since you have new completed the first level of Appeal, you may file a lawsuit under the Employee Retirement Income Security Act (ERISA).
Arbitrary, Capricious, Unlawful and Unreasonable Behavior of Prudential
The plaintiff alleged that Prudential’s actions were arbitrary, capricious, unlawful and unreasonable as Prudential:
- Failed to impartially review the opinions her board certified treating physicians.
- Failed to have the plaintiff examined by a physician with the proper credentials for the medical conditions that disabled the plaintiff.
- Failed to take into consideration the effect of pain upon the plaintiff’s ability to perform the substantial and material duties of any occupation.
- Failed to provide the plaintiff with copies of the documentation relied upon by Prudential to deny the plaintiff’s claim.
- Failed to thoroughly and impartially investigate the plaintiff’s occupation as a Program director with client care responsibilities of a lockdown psychiatric facility.
- Failed to thoroughly investigate plaintiff’s medical conditions.
- Failed to take into consideration the side effects of the plaintiff’s prescribed narcotic pain medication upon her ability to perform the substantial and material duties of her occupation.
- Selectively reviewed the medical records and other documentation in the determination of the claim.
- Additionally, Prudential knew, or should have known that the documentation submitted to and/or obtained by Prudential clearly substantiated the Plaintiff’s disability, including, but not limited to, the following:
– postlaminectomy syndrome of lumbar region;
– degeneration of lumbar or lumbosacral intervertebrai disc;
– spinal stenosis of cervical region.
As a result of Prudential’s actions, the plaintiff alleged that she has been deprived of said benefits from June 9th 2009, to the present date. In addition, the plaintiff argued that she has been forced to incur attorney’s fees to pursue litigation against Prudential.
Claim For Relief By The Plaintiff
As such, the plaintiff is seeking the following relief from the Court:
- The award of disability benefits not paid to the plaintiff from June 9th 2009 to the date of Judgment inclusive of interest.
- Alternatively, remand the plaintiff’s claim to the Plan Administrator for a determination of Plaintiff’s claim consistent with the terms of the Plan.
- An order determining that the plaintiff is entitled to disability benefit payments and premium waiver so long as she remains disabled as defined in the Plan.
- An award for reasonable attorneys’ fees.
- An award for any other relief deem just and proper by the Court.