Forced to hire a disability lawyer to represent him in United States District Court to file an ERISA lawsuit against Prudential Insurance, a Software Design Test Engineer and his attorney allege that the insurer breached its contract, violated the consumer Protection Act, acted in bad faith, and was negligent in denying him ERISA long-term disability benefits.
Johnson succumbed to a disabling illness and ceased work at Microsoft in August 2009. Diagnosed with fibromyalgia, headaches, obstructive sleep apnea, and fatigue, Johnson became disabled in that he is “unable to competitively and predictably work because he is disabled due to his medical conditions.”
Claimant Was Initially Awarded Disability Benefits
Johnson was paid short term disability benefits by Prudential until November 2009, at which time, the insurer informed him in a letter that it was terminating his disability benefits. Prudential claims that after reviewing Johnson’s medical information, the insurer determined that Johnson was “able to perform the material and substantial duties of his regular occupation.” Consequently, in April 2010, Prudential denied Johnson’s long term disability benefits. Johnson appealed the insurer’s denial, and upon reconsideration, the insurer continued to refuse to award Johnson his disability benefits. Claiming that Prudential “conducts its claim review process in a manner that results in the denial of valid claims,” didn’t consider the opinions of Johnson’s “treating and examining physicians,” and did not examine Johnson personally, Johnson’s disability attorney states that Johnson “has sustained severe economic and emotional damages” as a direct result of Prudential’s actions.
What Claimant and His Disability Attorney Want from Prudential
In their complaint, Johnson and his disability attorney allege that Prudential has not fulfilled its obligation to appropriately consider Johnson’s claim and this breach of contract has resulted in damages to Johnson. In addition, according to the complaint, the insurer has violated other duties and the law, consequently, causing Johnson great hardship and emotional turmoil. Johnson and his disability lawyer ask the Washington United States District Court to pass judgment against Prudential and award Johnson:
- All damages incurred by Johnson as a result of Prudential’s breach of contract;
- All damages incurred by Johnson in violation of the Consumer Protection Act;
- All damages to Johnson as a result of the insurer’s bad faith dealings with Johnson;
- All damages to Johnson sustained as a result of negligence;
- Full benefits due under ERISA in addition to pre-judgment interest and attorney’s fees;
- Declaratory judgment that Prudential must continue its disability benefits obligation to Johnson; and
- Reimbursement of court costs from Prudential.