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:
- A determination in favor of the plaintiff against Prudential.
- Damages in the amount equal to the disability benefits to which she was entitled through the date of judgment and for the unpaid disability benefits pursuant to the provisions under ERISA.
- An award of Prejudgment and postjudgment interest.
- An Order compelling Prudential or the appropriate Plan fiduciary to pay continuing benefits in the future so long as the plaintiff remains disabled under the terms of the Plan.
- An Order compelling Prudential to retroactively and prospectively provide other such benefits as are available to the Long Term Disability recipients under other employee benefit plans including, but not limited to, healthcare coverage, dental coverage, and life insurance.
- An award of reasonable attorney fees and costs.
- Other such relief as the court deems just and proper.