Prudential Insurance Company of America (Prudential) was sued by two Plaintiffs in the District Courts in Arizona for the failure to provide long-term disability benefits as stated under the terms of their respective plans. In the aforementioned cases that were filed through their respective disability attorneys, it is claimed that Prudential violated the terms of the respective plans by wrongfully denying long-term disability benefits.
The First Case
In Henry J. v. Prudential Insurance Company of America and Rain Bird Corporation, the Plaintiff was employed by Rain Bird Corporation (Rain Bird). This employment allowed Plaintiff to be covered by Rain Bird’s short-term disability policy and long-term disability policy, both of which were fully insured and covered by Prudential.
Plaintiff became disabled due to serious medical conditions, causing him to cease working as a Senior Tooling Engineer on or about June 7, 2010. Plaintiff remains disabled to this day from those conditions. Plaintiff applied for short-term disability (STD) benefits, providing medical records to support his claim. Prudential approved his STD benefits via letter dated June 14, 2010 for the period between June 14, 2010 through August 1, 2010.
Plaintiff timely filed an appeal to prevent the cessation of benefits, again submitting relevant medical records and Attending Physicians’ Statements from his treating physicians. Prudential denied Plaintiff’s appeal on August 7, September 8, and November 22, 2010, as well as on June 30, 2011. Plaintiff believes that these denials were largely due to the “paper reviews” of Samuel H., M.D., who is believed to be a long-time consultant for the disability insurance industry, which may have influenced his opinions in an effort to save Prudential money.
Plaintiff also submitted a claim and medical records to the Social Security Administration (SSA). Despite a more limiting disability definition to determine its decisions than Prudential’s, SSA approved Plaintiff’s claim. Despite this, Prudential informed Plaintiff of its final denial of his claim for short-term disability benefits and not allowing for a claim of long-term disability benefits. It also informed Plaintiff of the exhaustion of his administrative remedies, leading to the filing of this lawsuit.
The Second Case
In James O. v. Prudential Insurance Company of America and U.S. Airways, the Plaintiff was employed as a Tour Sales Representative by U.S. Airways, making him eligible and covered under a group long-term disability insurance policy that was fully insured and administered by Prudential.
Plaintiff became disabled on or about March 29, 2010 due to serious medical conditions. He is still disabled according to the terms of the policy as of this date. Plaintiff filed for long-term disability (LTD) benefits immediately due to the fact that the policy did not provide short-term disability benefits. Plaintiff submitted medical records to Prudential to support his claim.
Prudential denied his claim for LTD benefits via letter dated January 10, 2011. Plaintiff filed timely appeal and submitted additional medical and vocational evidence that showed he met the disability definition as defined in the policy, including a statement from Plaintiff’s treating board certified internist.
Plaintiff also included a May 27, 2011 Functional Capacity Evaluation Report authored by a physical therapist that stated that it was his opinion that the Plaintiff would be unable to perform “sedentary work on a regular full-time basis.” Plaintiff also included a vocational report from a certified vocational expert dated August 22, 2011, in which is stated that “… it is unmistakable that the Plaintiff would be able to engage in any work related activities.”
Despite the evidence, Prudential denied Plaintiff’s appeal via letter dated September 13, 2011. Prudential alerted Plaintiff that he could file a lawsuit pursuant to ERISA. As a result, Plaintiff has filed this lawsuit against Prudential.
Plaintiffs Seek Following Relief In Lawsuits Filed Against Prudential
In the previously mentioned cases, Plaintiffs want the following relief provided to them via a judgment against Prudential:
- Plaintiffs meet any definition as stated in the respective policies for both STD and LTD benefits
- Prudential must pay all benefits that have been accrued to this point, along with accrued interest
- Prudential must continue to pay all benefits for so long as Plaintiffs meet the disability terms as defined in the policies
- Prudential must pay all attorneys’ fees and court costs
- Prudential must provide all other relief that Court finds to be proper and just