John Smith, a 60 yr old attorney, stopped working on April 8, 2004 due to major depression and chronic pain. Mr. Smith was covered for short-term disability benefits under a Prudential Group Policy provided by his employer. Between April 8, 2004 and August 30, 2004 Mr. Smith filed for disability benefits on three separate occasions as during this time period he tried to return to work on two separate occasions.
The first two applications for short-term benefits were approved and the third and final application was denied. Mr. Smith submitted two administrative appeals to Prudential and both were denied. Approximately January 2006 Smith filed a lawsuit in federal court seeking short-term and long-term disability benefits.
On October 3, 2007, the United States District Court for the Eastern District of Pennsylvania held that Prudential arbitrarily denied Mr. Smith’s short-term benefits and that the denial must be reversed. The court further stated that they did not see any medical evidence submitted by Mr. Smith to support an award of long-term disability. Specifically, Mr. Smith did not have his doctors submit any documentation which would support a long-term disability claim.
While reviewing the short-term claim, the court stated that Prudential provided no explanation as to why they relied on Mr. Smith’s doctor’s opinion during the first two approvals for disability benefits, but refused to do so for Mr. Smith’s third application for disability benefits. The court further noted that “Prudential’s focus on Smith’s future ability to return to work is illogical in the context of short-term benefits.”
See Smith v. Prudential Ins. Co. of Am., 2007 US District Lexis 74492 (E.D. Pa. Oct. 3, 2007).