Prudential denies disability benefits to KPMG employee suffering from “sick sinus” syndrome

A disability attorney was forced to file a federal ERISA lawsuit against The Prudential Insurance Company of America after his client was wrongfully denied continued long-term disability benefits.

The Facts of the Case Against The Prudential Insurance Company Of America

Plaintiff was employed by KPMG and was covered under the Long-Term Disability Plan that was provided by Prudential.

Plaintiff became disabled on September 15, 2005 because of “sick sinus” syndrome, where the sinus node, the heart’s natural pacemaker, does not function properly. This syndrome caused the Plaintiff to experience several falls and a motor vehicle accident.

Plaintiff has a pacemaker installed on October 20, 2005 to regulate the rhythm of his heart.

On or about February 28, 2006, Plaintiff files a claim for LTD benefits under the Plan.

On or about September 14, 2006, Prudential approved the claim, beginning on September 15, 2006. Plaintiff receives LTD benefits based upon his psychiatric condition only.

Denial of Prudential’s Disability Benefits Claim

On or about September 4, 2008, Prudential terminated LTD benefits beginning on September 15, 2008, based on the Plan’s 24-month mental illness benefit limitation provision.

On or about July 13, 2009, Plaintiff appealed Prudential’s termination of LTD benefits.

On or about October 7,2009, Prudential denied Plaintiff’s appeal and upheld its decision to terminate Plaintiff’s LTD benefits.

On or about June 4, 2010, Plaintiff appealed original denial and Prudential’s subsequent denial from October 7, 2009.

On or about August 19, 2010, Prudential again denied Plaintiff’s appeal and upheld its decision to terminate Plaintiff’s LTD benefits.

Plaintiff has exhausted all administrative remedies, leading to him filing this lawsuit.

Disability Lawyer Files Lawsuit Against Prudential

According to this lawsuit, Plaintiff claims that Prudential did the following to him:

Relief Sought By Plaintiff In The Prudential Lawsuit

As a result of Prudential’s actions, Plaintiff seeks the following from the Court:

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Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

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I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

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I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

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