A disability insurance lawsuit was recently filed at the District Court for the District Of Massachusetts by a Massachusetts disability attorney for a former employee of the Diebold Incorporated against the Prudential Insurance Company of America (Prudential) concerning a claim for disability benefits under the Diebold Incorporated Long Term Disability Plan.
The Facts Of The Case – Diebold Incorporated Long Term Disability Plan
In the case of Cheryl Shea vs. Prudential Insurance Company of America and Diebold Incorporated Long Term Disability Plan, the plaintiff Cheryl Shea worked at the Diebold Incorporated and became eligible for coverage in the employee welfare benefit plan that was insured and underwritten by Prudential for Diebold Incorporated’s employees.
Application for Long Term Disability Benefits With Prudential
On August 16th 2007, the plaintiff stated that she stopped working due to headaches, fatigue, vertigo, vestibular imbalance, and mild diffuse pain, caused at least in part by heavy metal toxicity. In addition, she also suffered from profound dizziness which was triggered by any visual stimulation, including the use of a computer. Subsequently, the plaintiff filed a timely claim for disability benefits with Prudential under the abovementioned policy.
Denial of Claim for Long Term Disability Benefits by Prudential
However, the plaintiff’s claim for disability benefits was denied by Prudential on March 26th 2008 on the ground that she was not totally disabled under the terms of the Plan. The plaintiff contended that Prudential’s decision was based solely on the results of a March 26th 2008 review of the plaintiff’s medical records conducted by Prudential’s nurse who concluded that there was a lack of evidence to demonstrate the plaintiff’s inability to work.
ERISA Appeal of Disability Benefit Denial
The plaintiff made an appeal to Prudential on March 31st 2008 to its decision to deny her claim for long term disability benefits. To support her appeal, she submitted voluminous medical and vocational information which included objective verification of her functional limitations in the form of physical therapy records and vestibular therapy records. Nevertheless, Prudential denied the plaintiff’s appeal on May 1st 2008 based on a review of the plaintiff’s medical record by Prudential’s neurologist who never met or examined the plaintiff physically.
The plaintiff also contended that Prudential’s neurologist never contacted any of the plaintiff’s numerous treatment providers to discuss about the plaintiff’s medical condition or functional limitations. Although the long term disability benefits plan did not require an insured to provide “objective evidence” supporting a claim for disability benefits, the Prudential’s neurologist concluded that there was no “objective evidence” to support the plaintiff’s claim of disability.
The plaintiff alleged that Prudential’s determination that the plaintiff’s was not eligible for benefits because she failed to provide “objective evidence” supporting her disability was contrary to the medical evidence in the possession of Prudential. The plaintiff made a second appeal to Prudential regarding it prior decision to deny her claim for long term disability benefits on May 15th 2008. Another review was conducted by Prudential’s neurologist on June 9th 2008 who concluded as he had in his prior review that the plaintiff was not disabled. Hence, on July 1st 2008, Prudential upheld its prior decision to deny the plaintiff her claim for long term disability benefits and refused to consider any further information in support of the plaintiff’s claim.
Legal Basis For Disability Lawsuit Against Prudential
In the lawsuit, the plaintiff challenged Prudential on several legal grounds:
- Unreasonable and unlawful denial of her disability benefits despite the substantial medical evidence demonstrating her qualifications for said benefits.
- Unreasonable interpretation of the Plan provisions governing her claim for benefits.
- Pattern of rejecting and ignoring the substantial evidence supporting her total disability due to her physical condition.
- Failure to provide her with a full and fair review of her claim.
- Failure to provide a reasonable claims procedure that would yield a decision on the merits of her claim.
Relief Sought By The Plaintiff
As a result of Prudential’s action, the plaintiff was forced to file legal action against prudential to:
- Recover long term disability benefits due her under the long term disability benefits Plan.
- Enforce the present rights existing under the long term disability benefits plan Clarify rights under the terms of the Plan.
- Recover interest, costs and attorney’s fees as provided by ERISA.
- To obtain any other relief as the court deems just and reasonable.