Prudential Settles Breach of Contract Lawsuit Arising From Allegations That It Terminated the Claim of CPA Disabled Under AICPA Long-term Disability Insurance Policy

Mr. S was working as a certified public accountant (CPA) when he purchased his long-term disability insurance policy through the American Institute of Certified Public Accountants (AICPA). The AICPA had contracted with Prudential Insurance Company of America (Prudential) to provide long-term disability insurance to any actively working CPA members.

At the age of 45 Mr. S began experiencing a sudden onset of memory loss, as well as slurred speech and visual movements. Although he already suffered from a mild case of Tourette’s his tics suddenly increased. Mr. S, his family and several of his physicians were confident that Mr. S had suffered a stroke, however, TIA was inconclusive. However, one thing was for certain, Mr. S could no longer continue functioning as a consultant and CPA. With the assistance of his wife, Mr. S submitted a disability claim to Prudential informing them of his medical complications and that he was no longer capable of effectively performing his job duties as a CPA.

Prudential Approves Disability Benefits But Later Terminates The Claim After Failing to Receive Updated Medical Records

Shortly after submitting his disability claim, Prudential approved Mr. S’s benefits and accepted that he was disabled from his own occupation as a CPA. Mr. S’s long-term disability policy with Prudential limited disability claims submitted for mental illness to 60 months, but otherwise paid benefits to age 65 for all other disabilities. The Prudential AICPA long-term disability policy defined disability as, “you are unable to perform, for wage or profit, the material and substantial duties of your own occupation; you are under the regular care of a doctor; and you are not working at any job for wage or profit.”

Approximately 17 months after approving his claim, Mr. S received a letter from Prudential notifying him that his claim had been terminated, citing that it had been unsuccessful in obtaining updated medical records from his treating physicians. Mr. S and his wife compiled the requested medical records and promptly delivered them to Prudential hoping that they would promptly reinstate his claim. Despite receiving the updated medical records, Prudential informed Mr. S that it was not overturning its decision and that his claim would remain denied.

Lawsuit filed Against Prudential in Florida State Court

After being referred by a family friend, Mr. S and his wife met with Attorney Cesar Gavidia. Mr. S had never been involved in a lawsuit before and was anxious and nervous about the process. Despite his anxiety and apprehension, Mr. S knew that in order to recover the benefits that he was rightfully due under an insurance policy that he had worked hard to pay for he had to fight even if that meant going to court. Soon after hiring Attorney Gavidia, Mr. S’s lawsuit was prepared and filed in Florida state court alleging that Prudential had breached the terms of the disability insurance contract. After months of litigation, discovery and negotiations, the parties reached a mutually agreeable confidential settlement and Mr. S voluntarily dismissed his case against Prudential.


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Prudential

Denied but Not Denied but I am Denied

Reviewed by KDDK on July 5th 2024   Verified Policyholder | August 2022 date of disability
I went out in Aug. 2022 for neck pain. After seeing a neurologist I had to get an ACDF C5-7, it was also determined I had carpal tunnel in my right hand and bulging disk i... read more >
Prudential

California State Disabilty "OFFSET" never mentioned or outlined when enrolling for STD coverage.

Reviewed by MartyG on June 29th 2023   Verified Policyholder | May 2023 date of disability
All terms and conditions of receiving a claim benefit not made available when enrolling. Hidden elements of eligibility... not fully transparent with issues that might eff... read more >
Prudential

Prudential terminated my LTD, so now I have no income

Reviewed by Carlos M on June 10th 2022   Verified Policyholder
I was working at a shipyard at San Diego and hurt my back again while working. Hurt my back in the US Navy in 98 and had issues since then so I decided to get the surgery ... read more >
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Sent on June 11th 2022 by Attorney Rachel Alters

Carlos, yes we may be able to help. Please email your denial letter to Rachel@diattorney.com and cc Amanda@diattorney.com. Thank you.

Prudential

Prudential cancelled my policy amid COVID crisis

Reviewed by Patricia M. on September 15th 2020   Verified Policyholder
In the mist of the covid crisis Prudential decided I needed to prove my disability, yet again. I have been physically disabled since 10/31/1989. I now know that I have bee... read more >
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Sent on September 15th 2020 by Attorney Jay Symonds

Patricia: This is a terrible situation. You likely have a right to appeal the decision. I suggest you contact our office and speak with one of the attorneys to discuss ... read more >

Prudential

I was sold a policy that I cannot use and no one will show me the policy

Reviewed by Jacqueline G. on August 18th 2020   Verified Policyholder
I had Prudential STD and LTD through my employer. I received my STD with no problem. Started receiving LTD for a while, then Prudential said I owed them because I receive ... read more >
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Sent on August 18th 2020 by Attorney Stephen Jessup

Jacqueline, in many cases a disability carrier cannot offset for SSDI benefits that were in place prior to the date of disability under the applicable policy. Your empl... read more >

Prudential

Prudential verbally approved my claim and then sent me a denial letter

Reviewed by Jacquieline C. on April 3rd 2020   Verified Policyholder
I have been denied twice from Prudential for my LTD case. Back injury 2009 – knee injury 2011. Back doctor took me out of work (July 2018) due to me working 35 hrs per w... read more >
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Sent on April 3rd 2020 by Attorney Jay Symonds

Jacqueline: Sounds like you have a pretty complex medical situation. And the fact that they verbally approved your claim over the phone then sent a denial letter is unu... read more >

Prudential

It would cost me more to fight Prudential than to let them get away with their games

Reviewed by Tim W. on December 9th 2017   Verified Policyholder
I’ve been thru all the same things everyone complains about here. I’ve always been one step ahead of their game due to research. I just got notice they are stopping my... read more >
Prudential

Prudential told me I would have a decision today, and now the need another week. Guess what, I'm still broke

Reviewed by Cancer Patient on June 22nd 2017   Verified Policyholder
Just called them and now they need another week and a half so they can do an occupational review on my job description or something like that. Even though the case manager... read more >
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Sent on June 22nd 2017 by Attorney Stephen Jessup

DL, many state insurance commissioners will not get involved in ERISA governed disability insurance policies as these polices are governed under federal law. Please fee... read more >

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