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:
- Has violated and continues to violate ERISA.
- Has been damaged to the amount of $30,000 per month from September 15, 2008 (when benefits were due and not paid) to November 4, 2009 (Plaintiff turned 60-years old and reached the maximum period of benefits).
- Has incurred attorney fees and costs.
Relief Sought By Plaintiff In The Prudential Lawsuit
As a result of Prudential’s actions, Plaintiff seeks the following from the Court:
- $30,000 per month for each month during the period of September 15, 2008 to November 4, 2009.
- Attorney fees and costs.
- All pre-judgment and post-judgment interest.
- All other relief that the Court finds to be just and proper.
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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?
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