Denied Prudential Disability Claims: Abuse of Discretion
Was your claim for disability benefits denied because Prudential suppressed, ignored, overlooked or disputed the medical evidence that supported your disability claim? Marc Whitehead & Associates are here to help.
Marc Whitehead & Associates is a nationally recognized disability insurance benefits law firm dedicated to protecting the rights of sick and injured workers who have had their disability claims unfairly denied by the insurance giant. We’ve assisted hundreds of clients in obtaining the benefits they deserve from big insurance companies like Prudential.
We’ve been noticing an alarming trend among Prudential Insurance Company of America and other disability insurers in which policyholders are being unjustly denied their disability benefits because the insurer chooses not consider all the evidence that supports their claim.
In most Prudential disability claims, there’s usually evidence that supports either “side” of a case: some of the evidence may provide the insurance company with grounds for denying a claim, while other evidence (such as an approval of disability benefits from the Social Security Administration) support the claimant’s qualification for total disability benefits.
Cherry Picking Evidence
Because of this, the courts require that Prudential and other insurance companies take into consideration all of the medical and vocational evidence submitted by the claimant. “Cherry picking” which evidence they will consider, or ignoring or dismissing records that might tilt the case in favor of the claimant, when making their decision to award benefits is what the courts consider to be an “abuse of discretion” by the insurance companies.
One example of this abuse of discretion is the case of David Givens, who applied for long term disability benefits under his group employer policy insured by Prudential.
Abuse of Discretion: Givens v. Prudential Ins. Co. of America
In Givens v. Prudential Ins. Co. of America, David Givens, a pharmacy technician, filed for disability after a car accident left him disabled with chronic back pain. In 2004, he was awarded short term disability by Prudential, which expired after 24 months. Givens tried to return to work, but was unable to perform his previous occupation.
When Givens’ short term disability benefits expired, he then applied for long term disability (LTD) benefits. Prudential denied his claim. He appealed the denial, and Prudential again denied benefits.
In 2007, Givens filed a second appeal, at which time Prudential approved his claim for LTD benefits. The approval was based on the policy terms that Givens was “currently disabled from his regular occupation.” However, Givens’ was told by Prudential that after 24 months of payments, Prudential’s definition of disability would change to “unable to perform the duties of any gainful occupation” for which Givens was reasonably qualified.
In 2008, Prudential terminated Givens’ LTD benefits. Prudential plan administrators found that Givens’ medical evidence did not support a finding that he was unable to “perform the material and substantial duties of any gainful occupation for which he was reasonably qualified.”
In 2009, Givens once again appealed Prudential’s decision to terminate his benefits. His appeal was fully documented with volumes of continuing and supporting medical records, rehabilitation records, and doctors’ and chiropractors’ notes.
“An Incomplete and Inaccurate Representation”
The basis of Prudential’s decision to deny benefits was a vocational expert’s report of Givens’ capacity to work. The problem, as it turned out, was that Prudential sent the vocational expert only one report out of all of the physicians’ medical files. None of the others reached her desk.
The critical fact in this case is the manner in which Prudential reached its decision to deny Givens’ appeal. Because Prudential did not provide the vocational expert with all of the records relevant to Givens’ capacity to work, the report was an “incomplete and inaccurate representation of Givens’ ability to work.”
The Court ruled that Prudential abused its discretion by sending a “cherry-picked” file to vocational expert.
The court concluded that Prudential abused its discretion in denying Givens’ appeal for LTD benefits by sending a “cherry-picked” file to vocational expert. The court ruled in Givens’ favor, ordering Prudential to pay back benefits owed to Givens.
Solid Help with Prudential Disability Claims
The key take away in the case of Givens v. Prudential Ins. Co. of America is: If the insurance company denies your claim, don’t give up.
As one of the nation’s leading disability benefits law firms, Marc Whitehead & Associates have helped many clients who have found themselves in the same position as Mr. Givens after their disability claims were denied because an insurance company failed to consider all the evidence that was submitted.
Gathering and submitting all the evidence required to build a valid claim for benefits is difficult enough. Ensuring that all the evidence is considered can present even more of a challenge.
Marc Whitehead & Associates is here to help you through every step of the process, from the meticulous preparation of your appeal to our closing arguments to the court. Our highly experienced disability denial attorneys are here to ensure that Prudential and other disability insurers give your claim the full and fair review for long term disability benefits that you are legally owed.
If you have any questions about a Prudential disability claim denial for LTD benefits, please contact Marc Whitehead & Associates without delay. We serve clients all over the United States. Wherever you live, whatever your disabling condition is, you can count on us for support.