In her lawsuit, filed against Prudential Insurance Company of America, US Airways, Inc. and US Airways Inc. Employee Disability Plan to recover disability benefits, Ashley LeClair alleges that as fiduciary of her insurance benefits plan, Prudential operates under a “conflict of interest in evaluating her claim due to the fact it operated in dual roles as the decision maker . . . as well as the payor of benefits.” In essence, Prudential’s conflict of interest exists because should the insurer decide that Ashley R. LeClair is disabled the insurance provider is also the party obligated to pay her benefits.

History Leading Up To LeClair’s Disability Lawsuit Against Prudential

As a Technical Training Coordinator for US Airways, LeClair became disabled in February 2010 as a result of serious medical conditions and was “unable to work in her designated occupation.” LeClair remains disabled and has been designated as totally disabled by her physicians. LeClair applied to Prudential for her short term disability benefits as stipulated in her US Airways insurance plan and provided confirming medical records, but was denied short term disability benefits on March 23, 2010. According to LeClair and her disability attorney, Prudential “failed to provide a full and fair review [of LeClair’s application] pursuant to ERISA because it completely failed to reference, consider, and/or selectively reviewed and de-emphasized most, if not all of [LeClair’s] evidence.”

LeClair then appealed the March 23, 2010 decision and submitted additional medical information as well as affidavits confirming that LeClair was not able to perform in her own occupation or any occupation relevant to her Prudential disability policy terms. In addition, LeClair provided Prudential with a narrative letter from her treating physician, a board certified physical medicine and rehabilitation, and pain management professional, stating that LeClair had been unable to work since February 2010 because she cannot “sit, stand, walk or do any lifting or carrying involving the left upper extremity for a prolonged period of time.” Her physician continued to write that she was unable to sustain gainful employment as a result of her chronic pain. LeClair also presented Prudential with similar assertions from her treating physical therapist as well as a Functional Capacity Evaluation from another qualified independent physical therapist, a report from her treating chiropractor, an affidavit from a qualified vocational expert, and written affidavits from four lay witnesses.

Exhausting All Other Resources For Receiving Her Disability Benefits, LeClair Must File Her Lawsuit

And, even when presented with unquestionable evidence of her disabling condition, Prudential sent LeClair a letter, dated January 6, 2011 stating that the insurer was sticking with its earlier decision to deny LeClair’s appeal. In the meantime while Prudential reviewed LeClair’s appeals, the time frame for receiving short term disability expired, leaving LeClair with only the option to file for long term disability benefits. But, Prudential denied all benefits to LeClair, long and short term ones, having relied on an opinion of only one review by one of the insurer’s reviewing physicians.

Having exhausted all administrative appeals pursuant to ERISA, LeClair filed her lawsuit against Prudential on May 30, 2011 in the United States District Court of Arizona. In the lawsuit LeClair and her disability attorney allege that Prudential did not apply the ERISA standard for a full and fair review of LeClair’s claim and allege that Prudential’s review was not an unbiased decision as the insurer has an interest in seeing that disability benefits not be paid out which created a conflict of interest.

LeClair and her disability attorney ask for compensation for damages suffered by LeClair “in the form of lost short and long disability benefits in addition to other potential employee benefits” she is entitled to under her US Airway’s sponsored Prudential plan. She also asks the Court for interest, compensation for losses, attorney’s fees and costs associated with having to file a lawsuit to receive her rightful disability benefits.