A New York attorney recently filed a federal lawsuit against The Prudential Insurance Company of America (Prudential). The Plaintiff, Gaye D., was employed by KeyCorp as a District Manager/Area Retail Leader. Her employment enabled Plaintiff to be covered by KeyCorp’s long-term disability Plan, which was funded by Prudential.
In Gaye D. v. The Prudential Insurance Company of America, Plaintiff seeks the payment of owed long-term disability benefits and reinstatement of future long-term disability benefits that were wrongfully ended by Prudential.
Case Facts Against Prudential
Plaintiff was employed as a District Manager/Area Retail Leader by KeyCorp until she became disabled in or around January 2008. Plaintiff was originally diagnosed with a herniated disc problem in October 2005. An MRI confirmed that the Plaintiff had a bulging disc at the C5-6 level.
Plaintiff was referred to Dr. Liu, who recommended physical therapy, but this was unsuccessful in relieving the pain. As a result, Plaintiff began receiving Epidural Steroid Injections every six months.
In June 2007, Plaintiff began experiencing severe pain in her lower back that radiated into both of her legs. This was due to bulging discs and disc degeneration. This led to the Plaintiff having difficulty sitting, standing, and walking. Dr. Liu suggested that the Plaintiff take some time off of work to allow the swelling to subside, so the Plaintiff took four weeks off from work.
Plaintiff returned to work on or about August 20, 2007, but began experiencing pain after just one week of work. This led to Plaintiff being absent on sick leave for six weeks, continuing with physical therapy and injections.
Dr. Liu first recommended to Plaintiff in October 2007 that Plaintiff should consider going out on permanent disability as her condition would not improve with time and could get worse with additional work. Plaintiff chose to ignore this advice and continued working for three more months.
Plaintiff had difficulty managing her pain and returned to see Dr. Liu in January 2008. Dr. Liu gave Plaintiff more shots and again suggested permanent disability, but Plaintiff again refused and returned to work. Plaintiff had to see Dr. Liu again in April 2008. Dr. Liu clearly advised Plaintiff that she would be unable to walk without pain and her pain would continue to worsen if she didn’t go on permanent disability. Plaintiff finally agreed to stop working in April 2008.
Plaintiff applied for long-term disability benefits, which Prudential granted from April 2008 through December 23, 2009.
Termination of Long-Term Disability Benefits By Prudential
Via letter dated December 24, 2009, Prudential informed Plaintiff that her long-term disability benefits would run out on December 23, 2009 despite the fact that Plaintiff’s medical condition had not improved since she began receiving benefits in April 2008. Prudential based its decision on a 20-minute independent medical examination (click here for more information on Independent Medical Examinations (IME)) that suggested that Plaintiff could sustain part or full-time light capacity for an eight-hour day.
Plaintiff filed an administrative appeal that challenged Prudential’s decision via a letter to Prudential on January 26, 2010. Prudential denied this appeal via letter dated April 30, 2010. Plaintiff issued a second appeal on November 26, 2010, arguing that Prudential’s decision to uphold its denial based on video surveillance of the Plaintiff and the independent medical examiner’s report were both flawed. Prudential issued a final denial of benefits on February 24, 2011. Due to exhausting all administrative remedies, Plaintiff has filed this lawsuit against Prudential.
Lawsuit Filed Against Prudential For Improper Termination Of Long-Term Disability Benefits
The lawsuit claims that the following wrongful actions were committed by Prudential against the Plaintiff:
- Prudential wrongfully terminated Plaintiff’s benefits despite the fact that the Plaintiff’s condition had worsened since she first received benefits in April 2008 until the time the benefits were terminated on December 23, 2009
- Prudential wrongfully upheld its denial of benefits largely based on one independent medical examination that only involved a 20-minute examination of the Plaintiff
- Prudential wrongfully upheld its denial of benefits based on video surveillance that often showed the Plaintiff’s husband or son moving in the video without pain, not the Plaintiff, who appeared to be in pain and lifted nothing more than a light garbage bag and a purse
- Prudential did not properly evaluate the Plaintiff’s medical evidence, including the reports from Dr. Liu, who had examined her regularly since 2005
- Prudential did not correctly assess the demanding physical demands of the Plaintiff’s occupation when denying her future long-term disability benefits, claiming that the demands were “light work”
Following Relief Sought By The Plaintiff Against Prudential
Due to the improper actions by Prudential, Plaintiff asks for the following relief from the Court:
- Prudential pays all owed long-term disability benefits from December 24, 2009 to the present date, along with all accrued interest
- Prudential pays all future long-term disability benefits so long as Plaintiff remains eligible under the terms of the Plan
- Prudential pays all reasonable attorney fees
- Prudential pays all associated court costs related to this lawsuit
- Prudential pays all other relief deemed fair and just by this Court