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:
- 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.
- Prudential had failed to accord proper weight to the evidence in the administrative record that indicated the Plaintiff is totally disabled.
- 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.
- 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:
- A declaratory and injunctive relief, finding that she is entitled to all past due short term and long term disability benefits yet unpaid under the terms of the Plan;
- Prudential be ordered to pay all future short term and long term disability benefits according to the terms of the Plan until such time as Plaintiff is no longer disabled or reaches the benefit termination age of the Plan;
- An award of reasonable attorney fees and expenses;
- An award for such other relief as may be just and appropriate.