Prudential's summary judgment ruling is reversed twice by the 7th Circuit US Court of Appeals
Hugo Diaz, a computer programmer for Bank One, stopped working on January 31, 2002 due to chronic back pain, and underwent a lumbar fusion surgery on February 4, 2002. Mr. Diaz’s job was classified as sedentary and required him to be sitting for 90% of the time. On July 22, 2002, Diaz filed his application for long-term disability and on August 27, 2002 Prudential denied Mr. Diaz’s claim on the basis that his inability to perform his job was not consistent with the medical evidence presented. After filing his initial application and submitting two Appeals of his denial to Prudential, Mr. Diaz received his final denial on April 16, 2003.
Mr. Diaz’s long-term disability policy defined disability during the first 24 months as: “You are disabled when Prudential determines that you are unable to perform the substantial and material duties of your regular occupation due to your sickness or injury; and you have a 20% or more loss in your indexed monthly earnings due to that sickness or injury.
Mr. Diaz filed a lawsuit in the district court on April 22, 2003 and on May 12, 2004 a summary judgment was granted in favor Prudential. The Appellate Court reversed the summary judgment because the district court applied the wrong standard of review. The district court reviewed the case again and granted another summary judgment in favor of Prudential. Finally on August 23, 2007, the Appellate court once again reversed the entry of Summary Judgment for Prudential and ruled that a summary judgment in favor of Prudential can not stand. In reversing Prudential’s summary judgment for the second time, the Appellate Court stated, “The district court failed to consider the difference between a person’s being able to engage in sporadic activities and her being able to work eight hours a day five consecutive days of the week. In doing so, it ignored the dispute of material fact about Mr. Diaz’s capacity to do the latter.” The court also noted that the district court failed to consider the opinions of Mr. Diaz’s personal physician, neurologist, and pain management specialist.
Practice note: This case is very interesting because the Appellate court acknowleged that district court judges can be confused about the manner in which they are suppose to review an insurance companies denial of long-term disability benefits. The court stated, “Some of the confusion in this area may be attributable to the common phrase “de novo review” used in connection with ERISA cases.
In fact, in these cases the district courts are not reviewing anything; they are making an independent decision about the employee’s entitlement to benefits. In the administrative arena, the court normally will be required to defer to the agency’s findings of fact; when de novo consideration is appropriate in an ERISA case, in contrast, the court can and must come to an independent decision on both the legal and factual issues that form the basis of the claim. What happened before the Plan administrator or ERISA fiduciary is irrelevant.”
Resources to Help You Win Disability Benefits
Submit a Strong Prudential Appeal Package
We work with you, your doctors, and other experts to submit a very strong Prudential appeal.
Sue Prudential
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Prudential.
Get Your Prudential Disability Application Approved
Prevent a Prudential Disability Benefit Denial
Negotiate a Prudential Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Denied but Not Denied but I am Denied
California State Disabilty "OFFSET" never mentioned or outlined when enrolling for STD coverage.
Prudential terminated my LTD, so now I have no income
Reply
Prudential cancelled my policy amid COVID crisis
Reply
I was sold a policy that I cannot use and no one will show me the policy
Reply
Prudential verbally approved my claim and then sent me a denial letter
Reply
It would cost me more to fight Prudential than to let them get away with their games
Prudential told me I would have a decision today, and now the need another week. Guess what, I'm still broke
Reply
Q: I made a Short term disability claim with Prudential but they right away went to consider long term disability
Q: Prudential denied me STD due to a doctor who wrote personal things about me, like I still drive.
Q: Prudential is sending me to an IME but refuses to allow recording. Should I refuse to go to the IME?
Q: What can I do about my long term benefits that’s ending after 2 years?
Q: My mother paid many years for a long-term care policy. When she had to be put in an assisted care facility, Prudential won't pay. Do you accept cases like this?
Q: Can Prudential deny me if SSDI approves me?
Q: How does Prudential calculate attorney fees?
Q: Can I sue my PRUDENTIAL LTD for the cost of hiring a disability attorney to get my benefits reinstated?
Prudential Lump Sum Disability Policy Buyout Options
Is Exhaustion of Remedies Required before filing an ERISA Lawsuit?
What Should I Expect When Suing Prudential for a Disability Insurance Benefit Denial?
Do I need to disclose my disability insurance claim if I filed for bankruptcy?
Can I submit a long-term disability claim if my employment has been terminated?
How Much Time Does Prudential Have to Make A Determination On an ERISA Disability Appeal?
If I File A Short Term Disability Claim With My Carrier And My Claim Is Denied, Do I Also Need To File A Separate Long Term Disability Claim?
Can the disability company limit my disability benefits to 24 months if I have been diagnosed with depression as a result of my physical disability?
Prudential reverses decision to terminate LTD benefits of MRI Tech with Primary Progressive Multiple Sclerosis and degenerative Disc Disease
Engineer With Depression Wins Prudential LTD Appeal
Dell Disability Lawyers Win Disability Insurance Appeal Against Prudential for KPMG Employee
Lawyer Wins 24 Month Mental Nervous Prudential Disability Denial
Research Epidemiologist with chronic fatigue / ME wins LTD appeal against Prudential
JP Morgan Chase Financial Advisor With Cancer Wins Prudential Long Term Disability Appeal
Prudential Fails to Pay Long Term Disability Benefits of Claimant Suffering from Addison’s Disease
Successful Appeal Against Prudential Gets Breast Cancer Survivor Back on Claim for LTD Benefits
Reviews from Our Clients






