After receiving long-term disability benefits from Prudential beginning on April 17, 2000, for thoracic outlet syndrome, pronater teres syndrome, and carpal tunnel syndrome, Wayne Urso’s benefits were cut off, despite support from his doctor. Mr. Urso’s doctor gave him restrictions that prevented him from continuing to work in his position as a computer programmer. Prudential claimed that Mr. Urso was no longer disabled under the terms of the plan and cut off his disability benefits on April 17, 2002.
Because of his job loss, Mr. Urso sold his house and moved from Manchester, New Hampshire, to Errol, New Hampshire, approximately three hours away, in an effort to reduce his expenses and ease his financial burden caused by his inability to work. Prudential claimed that Mr. Urso was still able to work, and found positions in Manchester where Mr. Urso could have work, and reasoned that he could have continued to work in Manchester had he not been disabled.
Mr. Urso appealed this decision in March of 2002, but Prudential denied him again in April 2002. Through his attorney, Mr. Urso appealed again, but was denied a second time on October 29, 2002. Prudential claimed that neither physical conditions nor his depression kept him from working. In the meantime, Mr. Urso was approved for Social Security Disability Insurance in July 2002.
In making its decision to deny Mr. Urso his disability benefits, Prudential performed a review of his medical records and conducted disability surveillance of him, but did not elect to have Mr. Urso examined independently. Surveillance revealed that Mr. Urso was the president-elect of his Kiwanis club, and was performing some work independently. Dr. Cowl, who performed the review of the medical records, felt that Mr. Urso could work in the positions identified for him by Prudential, although with some restrictions.
After suit was filed, Prudential performed another review and found that Mr. Urso was entitled to two years of benefits for his depression. However, disability benefits for mental conditions were capped for two years, and Prudential refused to pay benefits beyond the two-year limit. Mr. Urso then filed suit again. At trial, the court found that Mr. Urso had carried his burden to show that he was disabled according to the plan terms, and Prudential did not have sufficient evidence to show that he could perform any occupation. In approving Mr. Urso’s claim for long-term disability benefits, the court noted that Prudential had failed to perform a vocational assessment of him.
See Urso v. Prudential Ins. Co. of Am., 2008 DNH 4 (D.N.H. 2008).