Disabled IKA Works, Inc. employee sues the Prudential Insurance Company of America to compel payment of disability benefits under an ERISA plan
A disability attorney recently filed a lawsuit at the District Court for the Eastern District of North Carolina on behalf of a client against the Prudential Insurance Company of America (Prudential). In Cynthia Grimsley Vs the Prudential Insurance Company Of America, the plaintiff filed the complaint to seek the recovery of disability benefits under the Employee Retirement Security Act of 1974 (ERISA) from a Prudential issued Disability Plan.
The Alleged Facts of the Disability Case Against Prudential
The plaintiff was formerly an employee of IKA Works, Inc. while employed at IKA Works, Inc, the plaintiff participated in an ERISA welfare benefit plan called the “Short Term Disability and Long Term Disability Coverage for All Full-time Employees whose annual Earnings are $45,000 or more” which was funded by an insurance policy issued by Prudential.
According to the lawsuit, on October 1st 2007, the plaintiff ceased working due to being disabled within the definition of the Plan. She timely filed a claim for disability benefits under the long term disability plan and was approved for long term disability benefits payments until December 31st 2008.
Prudential Discontinued Long Term Disability Benefits
However, on January 6th 2009, the plaintiff was informed by Prudential that it was denying the plaintiff’s claim for long term disability benefits beyond December 31st 2008. The January 6th 2009 letter also stated that “After completion of the first level of appeal, you “¦ may file a lawsuit under the Employee Retirement Income Security Act (ERISA).” It is likely that benefits were denied due to a change in the definition of disability after 24 months of payments.
Appeals to Prudential’s Decision To Deny Long Term Disability Benefits
The plaintiff stated that she made an appeal to Prudential’s January 6th 2009 decision to deny her long term disability benefits but was informed by Prudential on March 17th 2009 that she was unsuccessful in her appeal. She made a second appeal through her North Carolina Disability Lawyer on September 3rd 2009. Prudential again denied the plaintiff’s second appeal on March 8th 2010. In the denial letter, the plaintiff was told that “This decision is final and cannot be appealed further to Prudential…” and she “may file a lawsuit under the Employee Retirement Income Security Act (ER1SA).”
Cause Of Action for Plan Benefits against Prudential
The plaintiff argued that under the terms of the ERISA Plan, she was entitled to receive long term disability benefits in the event she became disabled within the definition of the Plan. She alleged that even though she became disabled, Prudential had failed to provide payment of disability benefits under the terms of the Plan and hence breached the terms of the Plan. The plaintiff further alleged that Prudential’s decision to deny her claim for disability benefits was wrong and that Prudential’s decision making processes were arbitrary and capricious. Prudential had made its determination to deny the plaintiff’s claim for disability benefits without any evidence supporting the decision.
As a result of Prudential’s actions, the plaintiff claimed that she has suffered damages in the amount equal to the amount of benefits to which she would have been entitled under the Plan. The plaintiff also claimed that she will continue to suffer damages in the future, under the Plan in form of future benefits and interest payable to her by Prudential.
Relief Sought By the Plaintiff
As a result of exhausting all her administrative remedies, the plaintiff is seeking from the Court the following:
- A determination in favor of the plaintiff against Prudential.
- Damages in the amount equal to the disability benefits to which she was entitled through the date of judgment and for the unpaid disability benefits pursuant to the provisions under ERISA.
- An award of Prejudgment and postjudgment interest.
- An Order compelling Prudential or the appropriate Plan fiduciary to pay continuing benefits in the future so long as the plaintiff remains disabled under the terms of the Plan.
- An Order compelling Prudential to retroactively and prospectively provide other such benefits as are available to the Long Term Disability recipients under other employee benefit plans including, but not limited to, healthcare coverage, dental coverage, and life insurance.
- An award of reasonable attorney fees and costs.
- Other such relief as the court deems just and proper.
Resources to Help You Win Disability Benefits
Get Your Prudential Disability Application Approved
Prevent a Prudential Disability Benefit Denial
Negotiate a Prudential Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Prudential told me I would have a decision today, and now the need another week. Guess what, I'm still broke
Q: My mother paid many years for a long-term care policy. When she had to be put in an assisted care facility, Prudential won't pay. Do you accept cases like this?
Q: Can I sue my PRUDENTIAL LTD for the cost of hiring a disability attorney to get my benefits reinstated?
Q: Is it best to hire an attorney first and then file a complaint with Indiana Insurance License Board or do both? How long does it usually take to resolve a case like this?
If I File A Short Term Disability Claim With My Carrier And My Claim Is Denied, Do I Also Need To File A Separate Long Term Disability Claim?
Can the disability company limit my disability benefits to 24 months if I have been diagnosed with depression as a result of my physical disability?
Federal ERISA Lawsuit Filed Against Prudential After It Denies Long-term Disability Benefits to Insured With Parkinson's Disease
Reviews from Our Clients
Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.