Prudential Insurance sued by disabled HNI Corporation employee for denial of disability insurance benefits after 7 years

A 49 year old woman said to be suffering from degenerative disc disease and disabling pain recently filed a lawsuit at the District Court for the Southern District of Iowa against the Prudential Insurance Company of America (Prudential). In the case of Kimberly Maserang v The Prudential Insurance Company of America, the plaintiff’s disability lawyer alleged that Prudential has wrongly denied payments after paying her disability benefits for 7 years. Despite a worsening of the plaintiff’s medical condition, Prudential determined that the plaintiff is no longer disabled.

Disability Lawsuit Against Prudential and Claim History

The plaintiff was previously employed by Heatilator HNI Corporation as a “Flat Line Operator, Brake Press.” Under the Dictionary of Occupational Titles (DOT), this occupation is deemed as heavy with a Specific Vocational Preparation (SVP) of 7 and is considered skilled work. By virtue of the plaintiff employment with Heatilator HNI Corporation, she was covered under a group disability benefits policy issued by Prudential. Prudential was also the plan’s administrator and retained the sole authority to grant and deny benefits to claimants.

On December 21st 2000, due to the plaintiff’s degenerative disc disease and disabling pain, she ceased working with Heatilator HNI Corporation. It was alleged in the lawsuit that the plaintiff became disabled on December 21st 2000 as well. As such, due to her disability the plaintiff submitted a claim for short term disability benefits with Prudential. The plaintiff’s claim for the short term disability benefits was granted. Later, the plaintiff also filed a claim under the plan for long term disability (LTD) benefits. Prudential initially approved the plaintiff’s claim for LTD benefits on June 28th 2001. However in a letter to the plaintiff on April 3rd 2008, Prudential informed the plaintiff that it was denying her further LTD benefits. The disability standard that was in effect at the time of the denial was that the plaintiff had to be considered as being unable to perform “any occupation”. The letter also gave the plaintiff 180 days to appeal Prudential’s decision.

The ERISA Disability Denial Appeals

On July 1st 2008, the plaintiff asked Prudential for an administrative review of the denial of benefits. The plaintiff in support of her appeal submitted medical records that indicated she was totally disabled from the performance of both her own and any other occupation as defined by the Plan. She also submitted documentations from the Social Security Administration (SSA) that found the Plaintiff to be totally disabled under the Social Security Act.

The plaintiff was informed by Prudential on July 28th 2008 that her appeal was unsuccessful and Prudential was reaffirming its previous decision to deny the plaintiff’s claim for LTD benefits. A second appeal was filed by the plaintiff on March 19th 2009 with additional supporting medical documentations. Nevertheless, the plaintiff was issued by Prudential a final denial of her claim for LTD benefits on April 23rd 2009.

Relief sought in the Prudential Insurance lawsuit

The plaintiff had no options remaining other than to file a lawsuit through her Iowa disability attorney. The plaintiff contended that having exhausted all her administrative remedies, she is seeking relief from the court for the wrongful denial of benefits under the Employee Retirement Income Security Act (ERISA). The plaintiff alleged that Prudential had violated the provisions of ERISA due to the following reasons:

  1. Plaintiff is totally disabled and cannot perform the material duties of her own occupation and any other occupation which her medical condition, education, training, or experience would reasonably allow.
  2. Prudential had failed to accord proper weight to the evidence in the administrative record that indicated the Plaintiff is totally disabled.
  3. Prudential’s interpretation of the definition of disability contained in the policy is contrary to the plain language of the policy, as it is unreasonable, arbitrary, and capricious.
  4. Prudential had violated its contractual obligation to furnish disability benefits to the Plaintiff.

As such, the plaintiff requested the court to grant her the following relief:

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Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Prudential. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Prudential.

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Our lawyers help individuals that have either purchased a Prudential long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Prudential:

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Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

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When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

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I have been a client of Dell & Schaefer for the 6 months and they have already successfully taken my disability claim to approval. It is privilege to write this testimonial. I am a professional myself, a physician and to me these are some of the core strengths of Steve Jessup and his team.

Listening to the client: Attorneys at Dell & Schaefer really listen to you explain your special situation and undoubtedly every one of us has a special circumstance and specific wishes as to what we want. Most of the time attorneys and in general most professionals these days, will listen to you a couple of minutes and then file you away in a category or a bin and chalk out a plan for you in their mind and stop listening to you and start thinking about the next thing that they have to do. That is why these interactions are so often exasperating for the client.

As a physician I used to try and teach medical students that any well trained monkey can read a few books and do a particular thing in a particular situation, it is however extremely essential that you determine what the situation is and no one understands the situation better than your client or patient. I spoke to a couple of attorneys at D&S, initially with someone who took my call and then Steve who was assigned to me and it was impressive that they really tried to get what I was trying to convey, what my special and unique situation was (and whose isn’t?) and what I wanted.

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