Prudential Insurance Company Settles Breach of Contract Lawsuit Arising From Allegations That It Terminated the Claim of CPA Disabled Under AICPA Long-term Disability Insurance Policy
Author: Attorney Cesar Gavidia
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.