Prudential denies disability benefits despite FCE Exam stating former Data Distributor Inc. employee with heart condition cannot perform sedentary occupation

A disability attorney recently filed a long term disability lawsuit due to Prudential Insurance Company’s wrongful denial of disability benefits to a former project manager. This case shows that despite strong objective evidence and a positive FCE exam in support of multiple disabling conditions, Prudential can still hire physicians that can review a file and determine that a claimant has no restrictions and limitations.

The Facts of the Prudential Disability Denial

The plaintiff as part of his employment benefits with Data Distributors Inc as a project manager, was a participant in a life insurance plan as well as a long term disability plan that was insured and administered by Prudential. The plans are said to be governed by the Employee Retirement Income Security Act (ERISA).

The plaintiff stated in the lawsuit that he stopped working for Data Distributors on or around August 4, 2009 as he was suffering from multiple heart problems and shortness of breath. His medical diagnosis consists of ischemic cardiomyopathy, diabetes, hypertension, systolic heart failure, hypercholeserolemia, hypertriglyceridemia, status post ICD, low back problems, left knee problems and left elbow problem.

Termination of Disability Insurance Benefits

After filing for a claim for long term disability benefits, Prudential initially approved the plaintiff’s claims for long term disability benefits as well as a life insurance premium waiver. Prudential, however, terminated the plaintiff’s disability benefits and waiver of premiums on June 30th 2010.

Prudential denies two ERISA Appeals submitted by Claimant

On July 28th 2010, the plaintiff submitted his first administrative appeal to Prudential. As part of the administrative review process, Prudential requested MES, a medical review company, to review the plaintiff’s medical records. The plaintiff contended that MES requested an internist to review the records and render an opinion. The internist, however, concluded that the plaintiff could handle the duties of up to a light duty occupation, which consisted of lifting up to twenty (20) pounds of force occasionally and negligible force frequently for lifting, carrying, pushing and pulling.

On September 1, 2010, Prudential denied the plaintiff’s administrative appeal resulting in the plaintiff submitting another appeal on February 21st 2011. To support his appeal, the plaintiff included a functional capacity evaluation (FCE) which indicated that the plaintiff did not meet the lifting and sitting requirements required of a sedentary occupation. The plaintiff’s treating physician, a cardiologist, also opined that the plaintiff was unable to perform the material and substantial duties of his regular occupation.

In its review process, Prudential assigned MLS, another medical review company to review the plaintiff’s records. The review concluded that the plaintiff would be able to handle a sedentary workload capacity but indicated a VO2 max stress test (done for standing and walking) should be done to better assess the plaintiff’s cardiovascular issues. The review also opined that the plaintiff did not give a true effort on the functional capacity evaluation and determined that many of the activities performed in a sedentary office occupation would not require repetitive lifting from floor to waist and waist to the level of the scalp. The plaintiff stated in the lawsuit that none of the plaintiff’s treating physician and therapist were consulted during the Appeal review process. Hence, on May 27th 2011, Prudential denied the plaintiff’s second administrative appeal.

Legal Basis for Lawsuit against Prudential

The plaintiff alleged that Prudential’s decision to deny his claim for long term disability benefits was unreasonable, arbitrary and capricious due to the following reasons:

Relief Sought by the Plaintiff

As a result of Prudential’s actions, the plaintiff is seeking from the Court the following relief:

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

Leave a comment or ask us a question

FAQ

Do you help Prudential claimants nationwide?

We represent Prudential clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Prudential disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Prudential. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Prudential.

How do you help Prudential claimants?

Our lawyers help individuals that have either purchased a Prudential long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Prudential:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Sonja P.

A very effective and professional law firm who believes in being dedicated to their clients. Dell & Schaefer are committed to getting the job done with a successful ending.

Read 424 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us