Suit Filed Against Prudential-Long Term Disability Denial
Disability Lawyer, Marc Whitehead has filed suit on behalf of a disabled worker and a resident of Texas, who became severely disabled while covered under a long term disability insurance policy issued and administered by Prudential.
Plaintiff was employed as a truck driver and is a resident of Texas and is currently disabled to musculoskeletal problems. Prudential is an insurance company doing business in Texas.
Venue & Jurisdiction of Long Term Disability Lawsuit
Suit was filed in federal court in Texas pursuant to 28 U.S.C. § 1331. Specifically, Plaintiff brings this action to enforce plaintiff’s rights under the Employee Retirement Income Security Act (ERISA), as allowed by 29 U.S.C. §§ 1132, 1133, & 1140
Allegations of Wrongful Denial of Disability Benefits Under ERISA:
Plaintiff brings this action to secure all long term disability insurance benefits, to which Plaintiff is entitled under a disability insurance policy underwritten and administered by Prudential. Plaintiff is covered under the policy by virtue of plaintiff’s employment.
The Social Security Administration issued a fully favorable decision on Plaintiff’s claim for social security disability benefits under Title II and Title XVI of the Social Security Act, finding that Plaintiff is “disabled” during the relevant time period, a fact that Prudential was aware of.
Prudential notified Plaintiff that Defendant affirmed its original decision to deny Plaintiff’s claim for long term disability benefits, totally ignoring the findings of the Social Security Administration.
Prudential also notified Plaintiff that Plaintiff had exhausted all administrative remedies and they would consider no further claims or evidence. Prudential, in its final denial, discounted the opinions of Plaintiff’s treating physicians, among others, and the documented limitations from which Plaintiff suffers including the effects of Plaintiff’s impairments on plaintiff’s ability to engage in work activities. Plaintiff has now exhausted all available administrative remedies, and plaintiff is forced to file a lawsuit to obtain plaintiff’s rightfully owed disability benefits.
The Law – The Employee Retirement Income Securities Act (ERISA)
This claim is governed under federal ERISA law. All state law claims that may have been considered are preempted by federal ERISA law because the plaintiff is covered under an insurance policy issued through his employee benefits plan. ERISA stands for the Employee Retirement Income Security Act of 1974. ERISA is a federal law that regulates the handling of Employee Benefit Plans and the remedies of the beneficiaries of these Plans. ERISA applies to all employees benefit plans established or maintained by an employer engaged in commerce or by an employee organization representing employees engaged in commerce. Practically all long term disability plans offered by a private employer are governed by ERISA. A claimant challenging a disability denial under an ERISA governed plan or policy must bring the claim pursuant to ERISA regulations and procedures. All state law remedies are preempted, meaning they do not apply to an ERISA claim.
Marc Whitehead’s Comments:
Disability Insurance claims are governed by a complex set of laws and procedures. These laws are full of traps for the unwary, even attorneys not experienced in ERISA law. Most people make the mistake of thinking they can handle the administrative appeal themselves and then hire a lawyer if they lose and have to file a lawsuit. This is totally backwards thinking.
Recently I had a client come to me with such a claim. He said, “don’t worry about the administrative appeal, I filed it myself. I just need you to file my lawsuit.” It turns out he filed a one page letter asking the insurance company to reconsider because he “really was disabled.” He was astonished to learn that this one page letter was the only evidence the judge could consider in his case other than what the insurance company chose to include when they denied him. In other words, he had blown any chance to present his case in court. Don’t let this happen to you. If you don’t call us, call someone. For more information, visit www.DisabilityDenials.com.
Disability Insurance companies such as Unum, Cigna, Aetna and Prudential often write their policies so to take full advantage of ERISA rules and regulations to make it difficult for a disabled person to get receive benefits or to keep them for the entire length of the term of their insurance policy. Other insurance companies with a large share of the disability market include The Hartford, Standard Insurance, SunLife, MetLife and Liberty Mutual, Provident, CNA, John Hancock, Colonial, AXA Equitable, New York Life, Guardian, Penn Mutual.
If you have questions, ask disability attorney, Marc Whitehead by visiting www.DisabilityDenials.com or you can download Marc Whitehead’s free E-book, Disability Insurance Policies-How to Unravel the Mystery and Prove Your Claim.