A Microsoft account representative and her disability lawyer filed suit against Prudential Insurance and Tanaka’s employer under the Employee Retirement Income Security Act of 1974 (ERISA) on August 1, 2011 in an effort to get a Federal Court to order the insurer to pay her entitled disability benefits. The Employee became disabled in March 2006 due to the worsening of her fibromyalgia condition which included symptoms of pain, fatigue and cognitive dysfunction. Initially approved for receipt of her disability benefits in May 2007 retroactive to September 13, 2006, Tanaka thought she was set for continuing disability benefits per the terms of her employee Prudential policy.
Prudential Terminates Claimant’s Disability Benefits
Unfortunately, Prudential did not come through for Tanaka, and her disability benefits were terminated on September 9, 2008, when the insurer took away Tanaka’s benefits, “claiming that her disability was based primarily on ‘self-reported symptoms’ and thus she was limited to 24 months of benefits.” Submitting medical evidence documenting her disability, Tanaka appealed the insurer’s decision and was again turned down by the insurer for the same reasons as given for the termination of her disability benefits. The denial letter also stated that Prudential attributed Tanaka’s condition to “mental illness,” a condition that precludes the receiving of disability benefits. And, in addition, Tanaka’s live insurance plan premium waiver was denied in that the insurer alleged that Tanaka was never disabled in the first place and did not qualify for the waiver.
Claimant and Her Disability Lawyer File a Complaint In California District Court
After exhausting all of her administrative appeals, Tanaka saw no other alternative but to hire a disability lawyer to bring her case to District Court. Tanaka and her lawyer allege that Prudential’s decision to terminate Tanaka’s benefits was “wrongful, unreasonable, contrary to the medical evidence, contrary to the provisions of the Plan, and contrary to law.” Tanaka and her attorney seek relief from the District Court, asking the Court for:
- A declaration that Tanaka is “entitled to continued disability benefits after September 13, 2008”;
- An award of disability benefits past, present and future, including interest;
- Reinstatement of her life insurance coverage
- Reasonable attorney fees; and
- Any “other and further relief as [the] court deems just and proper.”