Prudential Insurance Wrongful Denial of Disability Insurance ClaimThe Prudential Insurance Company of America ("Prudential") is a very large insurance company that is a frequent administrator of long-term disability benefits. Whenever a person has their disability insurance through work, it is usually governed under the federal law known as ERISA. Prudential is frequently the insurance company providing disability insurance benefits. If your claim for disability insurance benefits is denied, then you should consult with an ERISA disability attorney. Evan T. Engler is an ERISA disability attorney helping clients across Ohio and the 6th Circuit states of MIchigan, Kentucky, and Tennessee.
Prudential's Definition of "Disability" Changes Over TimePrudential usually has a definition of "disability" that changes after 24 months of insurance coverage. Every disability insurance plan could be slighly different, but in general, Prudential will consider a claimant to be "disabled" within the first 24 months of the claim if the claimant is unable to work at their current job. After 24 months, the definition of "disability" changes so that a claimant is only considered "disabled" if they are unable to work at any job. This has the effect of making it very hard to stay on disability insurance after 24 months. That definition change is usually when insurance companies kick individuals off of disability insurance.
In Adams v. Prudential Ins. Co of America, 280 F.Supp.2d 731 (N.D. Ohio 2003), Prudential informed the disability insurance claimant that after 24 months they no longer met the definition of disability. The claimant said that he couldn't work due to chronic pain, dependence on narcotic pain medication, and its impact on his ability to get to work. Prudential performed an employability assessment that identified 5 types of jobs that the claimant was allegedly qualified for and could perform. The claimant did multiple administrative appeals and was denied by Prudential each time.
The insurance claimant said they were unable to work largely because they couldn't drive. As part of their treatment plan they were prescribed a number of narcotic pain killers and the claimant was not able to operate heavy machinery on those pain killers. The Court ultimately agreed that the claimant's reliance on narcotic pain medications like oxycontin, zoloft, neurontin, and demerol could impair their ability to drive. The Court found that Prudential never properly evaluated the effect of the claimant's medications on their ability to drive to and from work. If they couldn't drive to work, then they couldn't work. The Court granted disability benefits to the claimant and awarded the claimant attorney fees plus their back owed benefits.