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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It was a great experience I had with the whole team. Whoever I worked with through out the whole process was very responsive, detail and time sensitive. The cost arrangement was discussed up front so I knew exactly what my cost would be. My case was discussed in person, all the documentation I had available, I provided. Some specific statements were requested of me, friends and family. It was reviewed by Dell & Schaefer and it was determined that I had a strong case.

The appeal was submitted before the deadline and I had a copy of it to review. I was very pleased of the whole content of the submission. I read all the strong points of the appeal and I knew at that point that it was a very strong appeal case and one way or another Dell & Schaefer would win the case. It was a matter of principal for me and I feel that I got my point across to my employer. I could’ve waited to go through a trial but I did not because I really did not want to have this issue hanging over me any longer so agreed to settle my case.

They are very detailed, responsive, up-front, they tell you if you have a strong case, tell you the angle that they’ll use to go after your case, get all the appropriate documentation so as to back-up everything they say, they are time sensitive and keep you updated as time goes by. They are a great team! I had my concerns at first because they are not local but they gave me all the time I needed to have any discussions and ask any questions.

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