An attorney from California recently filed a federal lawsuit against The Prudential Insurance Company of America (Prudential). The Plaintiff, Brian W., was employed as a Field Technician by DRS Technologies, Inc. (DRS). This employment entitled the Plaintiff to short-term and long-term disability benefits under DRS’ Disability Plan.
In Brian W. v. The Prudential Insurance Company of America, Plaintiff filed this lawsuit to reinstate long-term disability benefits that were wrongfully stopped by Prudential.
Facts of the Case Against Prudential
Plaintiff’s employment as a Field Technician required much heavy work to be performed. On January 28, 2008, Plaintiff was injured in a motor vehicle accident that caused severe back pain. This pain eventually caused the Plaintiff to cease working on approximately March 15, 2008.
Plaintiff filed a claim for short-term disability benefits, which was approved by Prudential. Plaintiff had an MRI performed on his lumbar spine on May 20, 2008, which showed a significantly pinched nerve at the L4 level, as well as additional degenerative findings. As a result, Plaintiff filed an application for long-term disability benefits, which Prudential granted via letter dated June 13, 2008.
Plaintiff had two back surgeries between July 2008 and March 2009, but not enough improvement was gained to enable the Plaintiff to return to work. Prudential agreed that the Plaintiff continued to be disabled under the definition of disability that required him to be unable to perform his own occupation.
Termination of Future Long-Term Disability Benefits By Prudential
On December 10, 2009, Prudential informed Plaintiff via letter that his benefits would end on June 12, 2010, which was the end of the period of coverage for disability from his regular occupation. Prudential stated that Plaintiff could find employment in other occupations. Prudential also stated that Plaintiff could appeal this termination of benefits.
On April 20, 2010, the Social Security Administration (SSA) found Plaintiff to be totally disabled from any gainful occupation since March 17, 2008.
On May 3, 2010, Plaintiff appealed Prudential’s denial of long-term disability benefits, citing the SSA’s decision to grant Social Security Benefits to him effective March 17, 2008. Plaintiff also provided additional medical information that included a Physical Capacity Evaluation that determined that Plaintiff could only sit, stand, and walk less than one hour out of an eight-hour day.
Prudential obtained a medical record review from Thomas Muzzonigro, M.D. (Dr. Muzzonigro) on June 10, 2010. Dr. Muzzonigro never examined the Plaintiff, but did note that the Plaintiff had impairments. However, via letter dated June 15, 2010, Prudential upheld its original denial.
Plaintiff appealed this second denial via a fax sent to Prudential on July 8, 2010. He stated that he could not sit or stand for more than 30 minutes at a time and included a letter from Dr. Jacqueline Tai, M.D., who performed the Physical Capacity Evaluation on the Plaintiff, that supported this claim.
Prudential decided to obtain a Functional Capacity Evaluation (what is an FCE?) to fully evaluate the Plaintiff’s appeal. This led to a follow-up MRI on the Plaintiff’s spine. Plaintiff was scheduled to appear for a “Physical Work Performance Evaluation,” but due to being in severe pain and receiving an epidural steroid injection, Plaintiff never had the evaluation, and Prudential never rescheduled it nor told Plaintiff to have one on his own.
Prudential had Dr. Muzzonigro review the second MRI taken, which did not alter his original opinions. As a result, Prudential denied the Plaintiff’s latest appeal via letter dated October 12, 2010.
Plaintiff faxed additional medical information to Prudential on February 4, 2011. Prudential agreed to review the additional medical information and had it reviewed by Dr. Muzzonigro. Dr. Muzzonigro felt that the Plaintiff had degeneration of his lumbar spine, but despite this, Prudential delivered a final denial to the Plaintiff’s latest appeal on March 7, 2011. Due to exhausting all administrative remedies, Plaintiff has filed this ERISA lawsuit against Prudential.
Lawsuit Filed Against Prudential For Wrongful Termination Of Long-Term Disability Benefits
The lawsuit alleges that Prudential committed the following wrongful actions against the Plaintiff:
- Prudential never allowed the Plaintiff to have a Functional Capacity Evaluation or an Independent Medical Evaluation to support his claim
- Prudential’s interpretation of the terms of the Plan are incorrect, leading to their decision to wrongfully terminate Plaintiff’s long-term disability benefits
- Prudential violated ERISA regulations by continuing to use Dr. Muzzonigro during the Plaintiff’s second appeal
- Prudential never informed Plaintiff of what additional material or medical evidence was needed to perfect his claim to restore long-term disability benefits
Plaintiff Seeks Following Relief From The Court
Due to the wrongful actions committed by Prudential, Plaintiff asks for the following relief:
- To receive long-term disability benefits from June 13, 2010 to the present date at the rate of $3,582.25 per month, along with accrued interest
- To have Plaintiff’s eligibility for the Plan reinstated and to receive all future long-term disability benefits so long as Plaintiff remains eligible under the terms of the Plan
- To receive all associated benefits that are included within the terms of the Plan
- To receive compensation for reasonable attorneys’ fees and associated court costs
- To receive all other relief that the Court finds proper and just