Wisconsin disability attorney and client sue Prudential Life Insurance for its “baseless” denial of ERISA disability benefits

Claiming that Prudential violated ERISA by improperly refusing to pay entitled disability benefits under her long term disability and life insurance policy, Della Davis and her Wisconsin disability attorney filed a complaint against Prudential.

In the compliant which was filed in the United States District Court of the Western District of Wisconsin, Davis and her Wisconsin disability attorney request that the court:

Documented Medical Records Confirm Disability Attorney’s Client’s Disability

Diagnosed with various medical conditions, including “cervical radiculopathy, cervicalgia, herniated disks, degenerative disc disease, spondylosis and osteoarthritis, foraminal stenosis, chronic thoracolumbar strain, degenerative changes in the lumbosacral spine, fibromyalgia, bilateral carpal tunnel syndrome (CTS), right shoulder pain with impingement syndrome, deltoid atrophy, arthritis of the left knee, sleep apnea, chronic fatigue syndrome, vertigo/imbalance disorder, and thoracic outlet syndrome,” Davis repeatedly appealed Prudential’s denial of her disability benefits. In fact, even in the face of overwhelming medical documentation and proof of Davis’ many attempts at treatment, Prudential informed Davis in its May 16, 2006 denial letter that, “she could self-accommodate for the CTS” and that “no severity of symptoms objectively supported with diagnostics relating to the other medical conditions” were considered severe enough to prevent Davis from functioning in a sedentary position.

Appealing many times to Prudential to reconsider her claims and award her disability benefits from 2006 through 2011, Davis has now exhausted her administrative appeals and has been forced to retain a Wisconsin disability attorney to argue her case. Employed with the Detroit Area Agency on Aging (DAAA) as a Pre-Screener since October 2001, Davis stopped working on March 22, 2006 when after numerous tests, treatments and attempts to remedy her medical problems, she was unable to sit for prolonged periods of time. On April 5, 2006, Davis filed a Group Disability Insurance Employee Statement (“Disability Statement”) with Prudential to apply for her disability benefits. Davis’ Disability Statement informed Prudential that she was disabled by Fibromyalgia “a chronic disease that is aggravated by stress, exhaustion and other factors. When aggravated it causes extreme pain, exhaustion [and] muscle weakness.” Along with her claim, Davis provided Prudential with an Attending Physician Statement from her treating physician verifying her condition but Davis was denied short term disability benefits.

On May 22, 2006, Davis’ physician informed Prudential that “on serial physical examination,” Davis was found to have profound limitations due to her physical conditions and that the medication she takes causes sedation and a lack of alertness. Consequently, Davis appealed the denial of her short term disability benefits based on her physician’s statements , continued in therapy, had other testing conducted and was proclaimed to be “totally incapacitated”; after which, Prudential overturned its earlier decision and granted Davis her short term disability benefits on July 13, 2006. Davis continued to see her physicians, supplied Prudential with her progress or lack thereof, and was awarded long term disability benefits on September 8, 2006 that became effective on September 19, 2006.

On September 8, 2006, “Prudential required Ms. Davis to apply for Social Security Disability Income (SSDI).” Consequently, in December 2006, the Social Security Administration (SSA) determined that Davis was disabled from working at any job and awarded her disability benefits. Then, around November 22, 2006, Prudential informed Davis that for her life insurance benefits to continue without her requirement to pay the premiums, she would have to remain totally disabled. And, in December 2006, SSDI did indeed declare Davis totally disabled and awarded her retroactive SSDI benefits back to September 2006. As a result of the SSDI award, Prudential immediately demanded that Davis repay Prudential $1,310.28 for overpaid to her of long term disability benefits.

Continuing to see her doctors in an attempt to alleviate the debilitating pain of her various conditions, Davis’s condition did not improve, and she was subsequently diagnosed with several other complications that required injections, pain medications, and therapy, none of which worked very well. With ample documentation of Davis’ years of ongoing medical evaluation and treatment, Prudential informed Davis in November 2007 that her claim for long term disability was under review. After requiring Davis to undergo an Independent Medical Evaluation (IME) with the evaluator’s notes that stated “there were no objective findings to support your inability to perform activities,” Prudential terminated Davis’ long term disability benefits in February 2008. Consequently, her group life insurance policy was discontinued as well.

Davis continued her doctor’s visits, underwent surgery on her right shoulder, attended physical therapy, and filed an appeal with Prudential. And, on December 10, 2008, Prudential reinstated Davis eligibility for additional long term benefits and reinstated her claim, informing Davis that it had determined that Davis is “currently disabled from performing any gainful occupation.” In Janurary2009, Davis inquired as to why Prudential had not responded to her appeal for continuation of her group life insurance benefits and that benefit was also reinstated.

Prudential’s Denial of Long Term Disability Benefits Based on a One-Hour IME

In its ongoing quest to deny Davis her disability benefits, Prudential required Davis to undergo an IME evaluation, a “cursory examination that lasted less than one (1) hour.” In the doctor’s report, he contradicted himself by stating in one portion of his report that Davis “has good communication and cognition skills” and then stating, “She is not a very good historian and has difficulty recalling recent events” and has “memory difficulty.” In contradiction to Davis’ treating physicians opinions, the IME evaluator ignored many of Davis’ conditions and did not properly give weight to her symptoms, diagnoses and treatment outcomes and opined that Davis was capable of working. Davis’ long term disability benefits and her life insurance benefits were terminated as a result of this one-hour evaluation.

Evidence is Lacking in Support of Prudential’s Denial of Client’s Disability Benefits

With documentation upon documentation of Davis’ disabilities, video surveillance that verified her severe problems, and numerous diagnostic tests confirming those problems, Davis supplied Prudential with an Affidavit of her condition on February 11, 2010 to no avail. In addition, on February 18, 2010, Davis’ physician noted that Davis now suffers from borderline Adult Onset Diabetes Mellitus (AODM) in addition to her other painful conditions. Again Prudential denied Davis’ April 2010 appeal stating that it attributes Davis’ “conditions/impairments to behavioral or psychological conditions.” Completely disregarding Davis’ medical documentation of physical problems, Prudential stated in its denial letter that “Ms. Davis is a somatoform which means that she tends to express emotional discomfort in physical symptoms, that she tends to over-perceive and over-express her symptoms relative to the majority of people in the society, and that she probably has had such a tendency all her life.” None of Davis’ medical records referred to Davis as having any mental or psychological problems except in reference to the effects of medication causing some sedation effects.

In their complaint, Davis and her disability attorney, allege that Prudential’s evaluation of Davis “is completely baseless.” A case of extremely differing takes on the same information, this court appearance should prove to be an interesting battle between Davis and her Wisconsin disability attorney and Prudential.

Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

View videos, articles, resolved cases and claimant reviews about your specific disability insurance company.

Leave a comment or ask us a question

There are 2 comments

  • Barb,

    Your concerns are valid. There is no US Department of Insurance. There is a Department of Labor which can enforce ERISA violations but they are understaffed and overwhelmed. Each state has their own Department of Insurance and these departments can put pressure on disability insurance companies that act unreasonably. The disability industry claims that they approve more than 70% of the people that apply for disability insurance. By being aware of the scrutiny that you could face, then you will have a much better chance of avoiding problems with your disability company. If we can assist you, then give us a call.

    Gregory DellMar 3, 2012  #2

  • After reading this article, I have extreme concerns regarding my recent post regarding my Prudential Long Term Disability and SSDI. I am the sole support of my self and my disabled over-21 years old son. I am already in financial debt including medical and personal finances. To read the many people that are having to engage attorneys to their entitled rewards causes my head to spin. Why hasn’t the U.S. Department of Insurance taken issue with repeated claims against disability insurance companies?

    BarbMar 3, 2012  #1


Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.


Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us