An attorney recently filed a federal lawsuit in the Ohio district court against The Prudential Insurance Company of America (Prudential) and Clopay Corporation Long-Term Disability Coverage (Clopay). The Plaintiff, Kimberly G., was employed as a Customer Service Representative at Clopay Corporation, providing her with short-term with Principal Financial and long-term disability benefits with Prudential.
In Kimberly S. v. The Prudential Insurance Company of America and Clopay Corporation Long-Term Disability Coverage, Plaintiff seeks long-term disability benefits she is entitled to that were wrongfully denied by Prudential.
Facts of the Case Against Prudential and Clopay
Plaintiff was employed as a Customer Service Representative with Clopay until October 2008 when she was forced to stop working due to degenerative disc disease, foraminal stenosis, retrolisthesis, and spondylosis in her neck, along with degenerative disc disease in the lumbar spine at L5-S1.
Plaintiff made a claim for benefits under the Plan on October 7, 2008. Principal paid the short-term disability benefits for the following 26 weeks because she could not perform the duties of her own occupation.
Plaintiff was expecting to receive long-term disability benefits from Prudential beginning April 5, 2009. However, Prudential denied her claim on March 8, 2010, citing that she was late in filing her claim, she was not disabled through the elimination period, and she was not disabled at the time when her long-term disability benefits were to begin.
Plaintiff filed an administrative appeal that challenged this denial via hired counsel through an extensive appeal that was sent to Prudential on November 3, 2010. This appeal included sworn testimony from Plaintiff’s treating physician, updated medical records from all of the Plaintiff’s treating physicians, medical descriptions, and more.
On September 30, 2010, Plaintiff underwent a lumbar fusion surgery, with the results being sent to Prudential at their request. Despite this, however, Prudential again denied Plaintiff’s claim on March 8, 2011, basing this mostly on two physicians who claimed that Plaintiff could have worked in a sedentary occupation until Plaintiff’s lumbar fusion surgery on September 30, 2010.
Prudential gave Plaintiff a second voluntary appeal, which allowed Plaintiff to submit a second appeal on August 29, 2011. This appeal included a full copy of the short-term disability file as produced by Principal, updated medical records from two of Plaintiff’s treating physicians, and a letter from Clopay regarding discrepancy in Plaintiff’s rate of pay.
Prudential sent this information to the same physicians who reviewed the medical information in the first appeal. The new information did not change the physicians’ prior opinions. As a result, Prudential denied this second appeal on October 26, 2011. Plaintiff has exhausted all administrative remedies and has filed this lawsuit against Prudential.
Lawsuit Filed Against Prudential For Denial Of Long-Term Disability Benefits
The lawsuit claims that Prudential committed the following wrongful actions against the Plaintiff:
- Prudential didn’t carefully and fully evaluate the Plaintiff’s claim and medical evidence in denying the Plaintiff’s claim for long-term disability benefits
- Prudential’s denial was due in part to its inherent conflict of interest as both administrators and payers of claims
- Prudential did not provide sound basis for denying Plaintiff’s long-term disability benefits
Plaintiff Seeks Following Relief From Prudential
Due to the unreasonable and wrongful actions of Prudential, Plaintiff asks for the following relief from the Court:
- For Prudential to pay all owed long-term disability benefits, along with all accrued interest from the date the benefits were to start to the present date
- For Prudential to pay all future long-term disability benefits as long as Plaintiff remains eligible under the terms of the Plan
- For Prudential to pay all attorney fees that have been incurred by the Plaintiff in filing this lawsuit
- For Prudential to pay all associated court costs that have been incurred by the Plaintiff in filing this lawsuit
- For Prudential to pay all other relief that the Court declares to be right and proper