Prudential Insurance Company sued for denying claim for disability benefits to disabled individual suffering from chronic back and leg pain

A lawsuit seeking to recover monetary damages from Prudential Insurance Company (Prudential) was recently filed at the Supreme Court of the state of New York. In the lawsuit, the plaintiff Robert Hamil, through his New York disability attorney, alleged that Prudential’s termination of his long term disability claim was in violation of his benefit rights that were protected under the Employee Retirement Income Security act of 1974 (ERISA).

Background of the Case Against Prudential

The plaintiff Robert Hamil was a General Manager employed by Modell’s II Inc. While employed at Modell’s II Inc, the plaintiff Robert Hamil participated in a Group disability insurance policy (DBA Modell’s Sporting Goods Group Contract G-46597-NY) issued and maintained by Prudential.

As a result of chronic back and leg pain caused by herniated and bulging disc, despite two attempts at corrective operative procedures, the plaintiff Robert Hamil was forced to stop work on January 8th 2009. The plaintiff then filed a notice and statement of claim notifying Prudential of his disability. As required under the plan maintained by Prudential, the plaintiff provided all the necessary medical documentations regarding his disability. In addition, several statements of claims and disability forms which verified and confirmed the disability suffered by the plaintiff, apart from the verification from his attending physician, were also submitted to Prudential.

However, despite the legitimacy of Robert Hamil’s claim for long term disability benefits, Prudential refused to pay and denied Mr Hamil the benefits that he was entitled to under the plan maintained by Prudential. Robert Hamil then appealed to Prudential regarding their denial to pay him any long term disability benefits but was unsuccessful in his appeal. As a result the plaintiff was forced to sue Prudential for his entitlement.

First cause of Action

Through the lawsuit, the plaintiff alleged that Prudential had acted in bad faith and was in violation of the provisions under ERISA. Because of these violations by Prudential, the plaintiff is now seeking through his lawsuit for judgment to compel Prudential to pay him all long terms benefits plus interest that he is lawfully entitled to from August 2009.

In addition, the plaintiff is seeking further relief in the form of the award of attorney fees which the court may deem proper and equitable due to the bad faith actions by Prudential. The lawsuit by the plaintiff also requested a jury trial on all triable matters.

Removal of the lawsuit to Federal Court

In response to the lawsuit, Prudential removed the lawsuit to be the heard from the Supreme Court of the State of New York to the Federal district court of New York. Prudential argued that because the lawsuit involved claims for long term disability benefits under a group employee benefit plan, this is governed by the provisions under ERISA. This is because ERISA preempts any state law claims and provided the exclusive federal remedies for the resolution of claims of disability benefit plans that comes under the domain of ERISA. Hence, Prudential argued that the Federal court has original jurisdiction over this civil lawsuit and may remove the case from the Supreme Court of the State of New York to be heard in the district court of New York.

The New York disability lawyer that filed this Prudential disability claim denial in state court should have been aware that Prudential was going to move the case to Federal Court. The removal of the case from state to Federal court will delay the action by 30-60 days.

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There are 3 comments

  • Shea,

    We certainly share your sentiments. If more people speak out there stands a chance that Congress may one day take a close look at how insurance companies handle disability claims and possibly look to make adjustments to ERISA.

    Stephen JessupFeb 4, 2015  #3

  • I am in the same exact boat as Mr. Hamil, but since being on Long Term with Prudential, I have found a surgeon that can possibly fix my mid back herniation. If I can’t get my disability insurance back I will loose my job and my health insurance for me and my family. I will also not be able to afford the surgery or live on my little income. I feel that Prudential needs a class action lawsuit against them as does every other insurance company in this country to send a message that the people won’t take this lying down. The only way to stop this is to make them pay a ridiculous sum of money that it is noticed by the national news and causes these companies a huge black eye. I am appalled that they get away with destroying peoples lives with no consequences.

    Shea M.Feb 3, 2015  #2

  • MetLife long term disability insurance has done the same to me. I have been left with nothing. I wish someone would get a class action suite going. I would be the first in line. I have nowhere to turn.

    Theresa PettyApr 19, 2011  #1

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