Mr. Paquin became disabled in 2003 after contracting encephalitis from a mosquito infected with the West Nile virus. The infection resulted in brain damage and cognitive impairment rendering Mr. Paquin unable to continue working as a business development director for his employer, Transistor Devices. He qualified for short term and long term disability benefits under his employer sponsored disability plans and received benefits until January 2015.
After nearly 12 years on January 7, 2015, his disability company, Prudential, terminated Mr. Paquin’s benefits based on a neuropsychological evaluation. His subsequent administrative appeals were unsuccessful forcing Mr. Paquin to file an ERISA lawsuit in a Colorado federal district court.
The Court’s review of Mr. Paquin’s claim
After reviewing all the medical evidence available in the file the court ruled in Mr. Paquin’s favor finding the evidence overwhelmingly supported a conclusion that Mr. Paquin was permanently disabled. The court was impressed by the length of time Mr. Paquin was considered disabled by Prudential and pointed out that Prudential had documented in the claim file as recently as 2014 – months before the termination of benefits – that Mr. Paquin’s cognitive issues were not likely to improve and that there were no gainful employment options for him.
While Prudential had relied on the report of a neuropsychologist who felt Mr. Paquin was not as impaired as he claimed the court observed that none of the other doctors or treating professionals who had evaluated and treated Mr. Paquin during the previous 11 years had thought or suggested that Mr. Paquin was malingering in any way.
Three of Mr. Paquin’s doctors had also rebutted the neuropsychologist’s findings and found her conclusions were “flawed if not outright incorrect.”
Ultimately, the court found Prudential’s decision was unsupported by substantial evidence and was an abuse of discretion.
This case is not unlike many cases denied by Prudential. It is important to remember that no matter how long you’ve been on claim you are not safe from Prudential cutting off your benefits. Prudential is notorious for referring claimants for neuropsychological examinations which often yield reports that the claimant is malingering despite the absence of any reports of malingering by any treating physician.
This case was not handled by our office but Attorneys Dell & Schaefer have extensive experience dealing with Prudential and we are very familiar with their tactics used to deny claims. If you have a Prudential disability claim at any stage feel free to contact one of our attorneys to discuss your options.