Recently, a lawsuit was filed against the Prudential Insurance Company of America (Prudential) by a Georgia disability attorney at the District Court for the Northern District of Georgia. In Robert Lucas v The Prudential Insurance Company of America, the plaintiff Robert Lucas claimed that Prudential had acted unreasonably, arbitrarily and without any justification in denying his claim for long term disability benefits.

The Statement of Facts in the Lawsuit

Robert Lucas, the plaintiff, was a former forklift driver working for the Wm. Wrigley Jr. Company. As an employee of Wm. Wrigley Jr. Company, he participated in a welfare benefit plan that was maintained and administered by Prudential. Under the Policy, “Disabled” is termed as:

“You are unable to perform the material and substantial duties of your regular occupation due to your sickness or injury; and

You have a 20% or more loss in your indexed weekly earnings due to that sickness or injury.”

In December 2009, the plaintiff had a heart attack resulting in him having to undergo an open heart surgery. Due to the circumstances that prevailed, the plaintiff did not return to work until March 15th 2010. However by March 26th 2010, the plaintiff stopped work as he was suffering from depression, dizziness, palpitations, panic attacks, shortness of breath and spells of anxiety. During this time, the plaintiff was paid short term disability benefits by Prudential which was later terminated on May 16th 2010. Because of psychiatric issues and the side effects of the medications which the plaintiff was taking to alleviate the symptoms that he was suffering from, the plaintiff remained disabled as defined under the welfare benefit plan since May 16th 2010.

Subsequently, the plaintiff appealed to Prudential its decision to terminate his disability benefits and provided medical documentations from his attending physician to support his appeal. Despite the extensive medical evidence that the plaintiff submitted to support his claim, Prudential continued to deny each of Plaintiff’s appeals and informed the plaintiff that its decision was final. According to the lawsuit filed, it was alleged that prior to the termination of the plaintiff’s benefits and denial of appeals, Prudential had never conducted an independent examination of the plaintiff’s medical condition.

As a consequence of Prudential’s decision to terminate the plaintiff’s claim for disability benefits and denial of appeals, on November 29th 2010, the plaintiff’s employer informed the plaintiff that:

“As a result of [Defendant’s] decision, you have two options (1) return to work … without restrictions or with restrictions that the Company can accommodate or (2) terminate your employment. Please contact us … to tell us whether you will be returning to work. Failure to do so will indicate to us that you are resigning … .”

Due to the fact that the plaintiff was unable to return to work, he was terminated from his employment on February 15th 2011 on the grounds of:

“involuntary separation – unable to perform job – health.”

Having exhausted all his administrative remedies, the plaintiff filed a lawsuit against Prudential alleging that Prudential’s decision to terminate the plaintiff’s long term disability benefits was unreasonable, arbitrary and without substantial justification.

The Claim for Relief

In the lawsuit, the plaintiff claimed that he is entitled to short term disability benefits under the policy for the reasons stated below:

1. The benefits were permitted under the plan

2. The plaintiff had satisfied all conditions for eligibility for receipt of these disability benefits

3. The plaintiff had not waived or relinquished his entitlement to these benefits.

Because of Prudential’s failure to pay the disability benefits claimed, the plaintiff alleged that he is entitled to the following relief stated below:

  • Short term disability benefits since from May 17th 2010 and continuing until paid in full inclusive of all interest on all back benefits.
  • Entitled to apply for Long Term disability benefits when the short term disability benefits have been paid in full.
  • Entitled to all other collateral benefits under the plan
  • An award of attorney fees and costs
  • All other relief considered just and proper by the Court