Disabled IKA Works, Inc. employee sues the Prudential Insurance Company of America to compel payment of disability benefits under an ERISA plan

A disability attorney recently filed a lawsuit at the District Court for the Eastern District of North Carolina on behalf of a client against the Prudential Insurance Company of America (Prudential). In Cynthia Grimsley Vs the Prudential Insurance Company Of America, the plaintiff filed the complaint to seek the recovery of disability benefits under the Employee Retirement Security Act of 1974 (ERISA) from a Prudential issued Disability Plan.

The Alleged Facts of the Disability Case Against Prudential

The plaintiff was formerly an employee of IKA Works, Inc. while employed at IKA Works, Inc, the plaintiff participated in an ERISA welfare benefit plan called the “Short Term Disability and Long Term Disability Coverage for All Full-time Employees whose annual Earnings are $45,000 or more” which was funded by an insurance policy issued by Prudential.

According to the lawsuit, on October 1st 2007, the plaintiff ceased working due to being disabled within the definition of the Plan. She timely filed a claim for disability benefits under the long term disability plan and was approved for long term disability benefits payments until December 31st 2008.

Prudential Discontinued Long Term Disability Benefits

However, on January 6th 2009, the plaintiff was informed by Prudential that it was denying the plaintiff’s claim for long term disability benefits beyond December 31st 2008. The January 6th 2009 letter also stated that “After completion of the first level of appeal, you “¦ may file a lawsuit under the Employee Retirement Income Security Act (ERISA).” It is likely that benefits were denied due to a change in the definition of disability after 24 months of payments.

Appeals to Prudential’s Decision To Deny Long Term Disability Benefits

The plaintiff stated that she made an appeal to Prudential’s January 6th 2009 decision to deny her long term disability benefits but was informed by Prudential on March 17th 2009 that she was unsuccessful in her appeal. She made a second appeal through her North Carolina Disability Lawyer on September 3rd 2009. Prudential again denied the plaintiff’s second appeal on March 8th 2010. In the denial letter, the plaintiff was told that “This decision is final and cannot be appealed further to Prudential…” and she “may file a lawsuit under the Employee Retirement Income Security Act (ER1SA).”

Cause Of Action for Plan Benefits against Prudential

The plaintiff argued that under the terms of the ERISA Plan, she was entitled to receive long term disability benefits in the event she became disabled within the definition of the Plan. She alleged that even though she became disabled, Prudential had failed to provide payment of disability benefits under the terms of the Plan and hence breached the terms of the Plan. The plaintiff further alleged that Prudential’s decision to deny her claim for disability benefits was wrong and that Prudential’s decision making processes were arbitrary and capricious. Prudential had made its determination to deny the plaintiff’s claim for disability benefits without any evidence supporting the decision.

As a result of Prudential’s actions, the plaintiff claimed that she has suffered damages in the amount equal to the amount of benefits to which she would have been entitled under the Plan. The plaintiff also claimed that she will continue to suffer damages in the future, under the Plan in form of future benefits and interest payable to her by Prudential.

Relief Sought By the Plaintiff

As a result of exhausting all her administrative remedies, the plaintiff is seeking from the Court the following:

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Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Prudential. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Prudential.

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Our lawyers help individuals that have either purchased a Prudential long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

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Celestine D.

I am a 61 year old Senior Business Analyst. I had been working at a health insurance company for approximately 11 years when I became disabled and have had numerous, bulging disks, nerves that were severely impinged, and active arthritis and degenerative disk disease throughout my spine. I underwent back surgery for L1 thru L5 infusion which included insertion of 2 titanium rods and 6 pins. I continue to undergo physical therapy 3 xs per week. Not to mention the surgery left me worse than before the surgery considered a FAILED BACK SURGERY. I’m unable to sit or stand for more than 2 hours with getting up. I am unable to walk for more than 1 city block. I also have many other medical conditions. After collecting LTD from Lincoln Financial for about 3 years, the harassment began. They decided that I was no longer disabled. In short they felt I was capable of returning back to the work force. (Social Security Disability deemed me permanently disabled)

After fighting with Lincoln and exhausting my appeals I decided to research and hire an attorney. I selected Dell & Schaefer based on their website, case success statistics, and the speed at which they returned my calls and emails.

Let me tell you, my experience in working with Rachel Alters and her assistant Michal Mizrahi is nothing short of outstanding. They responded quickly to phone calls and emails and were mindful of my concerns and information needs. Talking with the both of them made me feel confident and assured they were doing the best for me. I cannot say enough good things about Michal. She anticipated my needs and was proactive in keeping me informed as my case progressed. What a TEAM they make. Any time I reached out with questions or concerns they were very responsive and always left me feeling satisfied that I had the best in my corner. Rachel is an angel. She is so down to earth compassionate, professional and trustworthy attorney. Rachel was there to guide me from the start and helped me get through this stressful and lengthy process.

While attempting to handle it on my own, my long-term-disability claim had been denied two previous times. With the help of Rachel Alters and her team, I was able to obtain a settlement I never would have been able to get without their assistance. Rachel and her team far exceeded my expectations in every capacity. She was focused, clear, responsive, efficient and above all exceedingly knowledgeable.

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