Generally, disability insurance companies do not try to deny an insured’s claim for short term disability benefits as the amount of benefits paid out is usually not substantial. Nevertheless, this does not mean that disability insurance companies always approve a claim for short term disability benefits. The recent case of Desiree C. Stasen Vs The Prudential Insurance Companies Of America (Prudential), filed by a Pennsylvania disability attorney at the District Court for the Eastern District Of Pennsylvania, goes to show that even applications for short term disability benefits are not immune to denial of claims by disability insurance companies. Let us have a closer look at this case.

The Alleged Facts Of The Case Against Prudential

According to the lawsuit, the plaintiff Desiree C. Stasen is employed as a Senior Travel Counselor for the Carlson Companies. As an employee of the Carlson Companies, the plaintiff is covered under a group disability income plan which specifically provides short and long term disability income for its participating members. Prudential is said to be the Administrator for this Plan and the Plan falls under the ambit of the Employees Retirement Income and Security Act (ERISA).

Under the above mentioned plan, the insured is provided with short term disability benefits when the insured is unable to perform the substantial and material duties of the occupation for which insured was qualified for with regards to age, education, training, experience, station in life, physical and mental capacity.

On November 3rd 2009, the plaintiff suffered from severe abdominal pain. She subsequently informed her employer that she was unable to perform the duties of her job as a Senior Travel Counselor. As a result of her medical condition, the plaintiff was deemed to be disabled under the Plan and is entitled to a weekly disability benefit payment of $450.00. She applied and received short term disability benefits until April 26th 2010. The plaintiff stated in the lawsuit that she was not able to return to work until November 10th 2010.

Denial of Short Term Disability Benefits

Between the period from April 26th 2010 to November 10th 2010, the plaintiff did not receive any disability benefit payments from Prudential as she was informed on May 9th 2010 that Prudential was denying her claim for short term disability benefits.

Subsequently, the plaintiff made efforts to appeal Prudential’s decision to deny her short term disability benefits until she exhausted all her administrative remedies. To date, none of the plaintiff’s requests for review and appeals were successful. According to the lawsuit, the plaintiff alleged that she has complied with all terms and conditions precedent of the policy contracts and all reasonable requests made by Prudential.

The plaintiff argued stated that Prudential had continued to refuse paying the disability benefits without proper justification and is acting in violation of its duties under the insurance contract and the law. The plaintiff also claimed that the justification put forward by Prudential for the termination and denial of short term disability benefits were arbitrary, capricious, improper, insufficient and invalid. As a result of Prudential’s action in denying payment of short term disability benefits, the plaintiff alleged that she suffered great economic distress and hardship.

Claim for Relief from the Court

The plaintiff is specifically requesting from the Court:

  • A declaration that she is entitled to the Short Term Disability benefits and/or Long Term Disability benefits which she seeks from April 26th 2010 to November 10th 2010 under the terms of the plan.
  • The plaintiff is also seeking an award for attorneys’ fees and costs for pursuing this civil action against Prudential.