Denied Prudential Disability Claims: Abuse of Discretion
Did Prudential suppress, ignore, overlook or otherwise dispute the medical evidence that supports your disability claim?
There is a trend with Prudential Insurance Company of America and other disability insurers where claimants are being denied disability benefits because the insurer does not consider all the evidence.
In a disability claim, often there is evidence that supports either “side” of a case: some evidence may lean in favor of the insurance company’s denial, while other evidence might support the claimant’s justification for total disability.
The courts require that the insurance company takes into consideration all of the medical and vocational evidence submitted by the claimant. No matter what, the insurer must not “cherry pick” submitted evidence, or leave out records that might tilt the case in favor of the claimant, in their efforts to approve or deny benefits. When they do, that is abuse of discretion.
Such is the case of David Givens, who applied for long term disability benefits under his group policy insured by Prudential.
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.
Givens then applied for long term disability (LTD) benefits, which Prudential denied. 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 found that the medical evidence did not support a finding that Givens could not “perform the material and substantial duties of any gainful occupation for which he was reasonably qualified.”
In 2009, Givens 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. Many of the reports showed a range of medical opinions which varied in their consistency of findings for and against his total disability to work at any job.
Court says Prudential abused its discretion by sending a “cherry-picked” file to vocational expert.
- The basis of Prudential’s decision to deny benefits was a vocational expert’s report of Givens’ capacity to work; however,
- 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 concluded that Prudential abused its discretion in denying Givens’ appeal for LTD benefits. The court ruled in Givens’ favor, ordering Prudential to pay back benefits owed to Givens.
The key take away here is: Don’t give up.
The reality is that many factors build a valid claim for benefits, as in the case of Robert Givens. Disability claims can be full of traps and mistakes and must be managed through competent, well-planned legal strategies.
Solid Help with Prudential Disability Claims
From the moment we take your case, we plan a winning strategy from the meticulous preparation of the appeal, to our closing argument to the court. Our attorneys will help to ensure that Prudential and other disability insurers give your claim a full and fair review of claims for long-term disability benefits.
If you have questions, please ask our lawyers about your Prudential disability claim denial without delay. Wherever you live, whatever your disabling condition is, you can count on us for answers.
Source: Givens v. Prudential Ins. Co. of America, 778 F. Supp. 2d 1011 (W.D. Mo. 2011) District Court, W.D. Missouri