Prudential and Reassure reconsider the occupation of insured at the time he claims disability

Michael Sullivan left the Knights of Columbus where he had worked as a financial consultant and began trading in the stock market for his own account at the end of 1999. He filed a claim for total disability benefits with Reassure in March 26, 2002, following an auto accident. On the application for disability benefits, Mr. Sullivan listed his occupation as “retired.” After filing his claim statement and other supporting documentation on June 5, 2002, Reassure denied his claim based on their evaluation that he was able to perform the daily functions of a retired person.

Mr. Sullivan filed an appeal and argued that his occupational duties prior to his disability were that of a day trader. Reassure again denied the claim, and Mr. Sullivan appealed this denial a second time on December 30, 2003.

Reassure then requested review of Mr. Sullivan’s file by an orthopedist and conducted an in-person vocational assessment with Mr. Sullivan. After considering these reports and the information submitted by Mr. Sullivan, Reassure concluded that Mr. Sullivan was not totally disabled as either a retired person or day trader, and therefore not entitled to long-term disability benefits under the policy.

At trial, the court held that Reassure’s actions in reviewing Mr. Sullivan’s claim was done promptly and appropriately, and therefore he is not entitled to benefits.

See Sullivan v. Prudential Ins. Co. of Am., No. 05-10030-GAO, 2007 U.S. Dist. LEXIS 68545 (D. Mass. September 17, 2007).

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