Federal ERISA Lawsuit Filed Against Prudential After It Denies Long-term Disability Benefits to Insured With Parkinson’s Disease

Mr. G had previously worked as a foreman for a large fertilizer company. One day at work Mr. G suffered a fall into a bin of fertilizer. Although Mr. G suffered some injuries, he soon began developing serious neurological symptoms which included parkinsonian type symptoms, seizure episodes and muscle spasms. Initially, he believed his symptoms were related to his fall into the bin of fertilizer, however, they persisted and worsened. His symptoms forced him to cease working and file a long-term disability claim under his employer’s long-term disability insurance plan funded and administered by Prudential.

Prudential Denies Disability Claim After Medical Consultant Notes that Insured Can Get Into Raised Truck

Shortly after submitting his disability claim, Prudential approved Mr. G’s benefits for approximately 3 months before abruptly terminating his claim and informing him that he was not disabled under the terms of the group disability policy. Although Prudential attempted to cite several, mostly vague, reasons it did not believe Mr. G met the definition of disability, the primary reason seemed to be based on the fact that Mr. G’s physicians were perplexed and not prepared to diagnose him with a definitive diagnosis. On his own, Mr. G set out to appeal and challenge Prudential’s unreasonable and baseless decision.

After submitting his first appeal, Prudential assigned a medical consultant to conduct a paper review of Mr. G’s medical records. The medical consultant concluded that Mr. G’s medical condition did not restrict or limit his ability to sit, walk, reach, lift, carry or perform upper extremity activities. They also noted that recent surveillance video showed Mr. G as having the ability to get into a raised truck. On this basis, Prudential and its medical consultant denied Mr. G’s first appeal.

Following the denial of his first appeal, Mr. G contacted Attorneys Dell & Schaefer and hired Attorney Cesar Gavidia who promptly took over the case and began preparing Mr. G’s second appeal to Prudential. Although Attorney Gavidia could have immediately filed suit against Prudential after denying Mr. G’s initial appeal, new medical evidence existed that had not been provided to Prudential showing that Mr. G’s tremors were worsening and that his treating physician had prescribed a walker with wheels and a seat as a result of his progressive weakness and impaired gait resulting from a now definitive diagnosis of Parkinson’s Disease. Despite the new evidence and confirmed diagnosis of Parkinson’s Disease, Prudential denied the appeal submitted by Attorney Gavidia and his team.

Federal ERISA Lawsuit Filed Against Prudential For Wrongful Denial of Long-term Disability Benefits and Violation of Federal Law.

After receiving the denial of Mr. G’s second appeal Attorney Gavidia prepared and filed a lawsuit in federal court against Prudential alleging that the disability insurance company violated ERISA by arbitrarily and capriciously denying Mr. G’s long-term disability insurance benefits. In addition to demanding that Prudential pay all benefits owed under the plan, the lawsuit requests that Prudential pay Mr. G’s attorney fees and costs. Mr. G’s case is currently pending in U.S. District Court.

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  • Thank You for sharing Mr. Gavidia. I would have thought he would qualify for benefits based on the seizures alone, assuming he is in the “own occupation” phase. Based on my many years of experience as a vocational counselor for disability insurance carriers, I can’t imagine a physician releasing an individual with a seizure disorder to return to work in a fertilizer plant setting.

    Joseph A.Jan 6, 2016  #1