ERISA Long Term Disability Case Citations and references

DISCLAIMER: Please note that every case is different and these verdicts and settlements, while accurate, do not represent what we may obtain for you in your case.

Court Finds for RSD Patient when Prudential Ignores Treating Physician

Elms had developed Reflex Sympathetic Dystrophy (RSD) as a result of a car crash in 2001 and was initially denied benefits by Prudential.  However, on further review, Prudential agreed to pay his benefits for a short period of time if Elms would undergo an IME.  The examiner found evidence of brachial plexus traction – but not RSD.  Nonetheless, he concluded that the degree of pain and spasm would preclude Elms from working.

Prudential later terminated Elms’ benefits because she failed to return some paperwork.  When she appealed this decision, she was referred for another IME, where the doctor found that his condition should improve within a year.  Prudential once again denied coverage.

On review, the a Pennsylvania federal court found that the plan did not vest discretionary authority in Prudential, so they applied a de novo standard of review.  De novo means that the court is reviewing the policy as if for the first time, without any deference to Prudential’s findings.  Under that standard, the court found that Prudential had incorrectly terminated benefits because every single doctor who had reviewed Elms file had found that her movements and ability to perform basic work tasks were impaired.