California Federal Court rejects Prudential’s attempt to limit claim

Rosa Wood had carpel tunnel syndrome and left work in 1999 because of it. After receiving short term disability benefits and undergoing back surgery, Ms. Wood applied for long term benefits. Initially, Ms. Wood’s claim for benefits was denied however her plan eventually agreed to pay benefits for the first phase of long term disability. Under the first phase, claimants are entitled to benefits for seven to twenty-nine months based on their ability to perform any substantial gainful work. Prudential then denied long-term disability benefits to Ms. Wood during the second phase which would continue benefits beyond the twenty-nine months. After two internal appeals, Ms. Wood sued Prudential in Federal Court.

The court ruled that any “reasonable trier of fact would find Wood to be disabled” and rejected Prudential’s attempt to limit the claim. The judgment was based on evidence stating no factual dispute that Ms. Wood was diagnosed with carpal tunnel syndrome in 1999 and that she had spinal surgery in 2000 and continues to suffer from pain and numbness in her hands. Reports from all of Ms. Wood’s examining physicians support her disability claim with the exception of Dr. Teital who examined Ms. Wood at the request of Prudential. Dr. Teital did not find that Ms. Wood was exaggerating her symptoms.

Additionally, Prudential’s consulting physician, Dr. Ito, did not examine Ms. Wood nor did he dispute Ms. Wood’s diagnosis or the findings of pain from her other doctors. However, Dr. Ito apparently discounted Ms. Wood’s pain limitations on the basis that they were not supported by objective testing. Prudential’s policy did not require the type of testing Dr. Ito required supporting Ms. Wood’s limitations.

Further, Sandra Richter, a vocational counselor who met with Ms. Woods during her first phase of long term disability benefits, concluded that she is totally disabled. Two other vocational reports were written without meeting Ms. Wood and submitted during the evaluation of second phase LTD benefits. These reports were prepared based on limitations that did not include limitations of her use of extremities. Neither of these reports included analysis of the “gainful employment” language of Prudential’s policy which explained that “gainful occupation” is defined as an occupation that provides at least sixty percent of pre-disability earnings. Prudential must now pay all past due long-term disability benefits to Ms. Wood and re-calculate her claim for the future.

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