Recently, a Colorado disability attorney filed a lawsuit against the Prudential Insurance Company of America Disability Management Service (Prudential) at the El Paso County’s District Court, Colorado. In Pamela J. Koehiler vs the Prudential Insurance Company of America Disability Management Service, the plaintiff is suing Prudential for failing to reinstate and pay her long term disability benefits.

The Nature of the Complaint

The plaintiff was formerly employed as a logistic manager at GAP lnc. While working with GAP lnc., the plaintiff was covered under a group long term disability policy issued by Prudential. Upon being disabled under the terms of the policy, the plaintiff filed a claim for disability benefits with Prudential and had received long term disability benefits under the policy.

The plaintiff claimed in the lawsuit that since July 11th 2006, she had been unable to perform the material duties of her prior occupation or any other gainful employment. The plaintiff alleged that Information was provided to Prudential from the plaintiff’s attending physicians to show that the plaintiff was and is disabled and is unable to return to work in her prior occupation or in any other gainful occupation which she may have had access prior to her disability by training, education or experience.

Denial of Disability Benefits

Nevertheless on June 8th 2007, the plaintiff was notified by Prudential that it was terminating the plaintiff’s disability benefits and that no further disability benefits were payable. In response, the plaintiff made an appeal to Prudential for a reconsideration of its June 8th 2007 decision to terminate her disability benefits.

A decision was rendered by Prudential regarding the plaintiff’s first appeal on November 14th 2007. The decision led to the plaintiff seeking a second appeal to Prudential’s decision to terminate her disability benefits.

The plaintiff stated that on August 25th 2008, Prudential issued its decision in response to the second request for reconsideration of its decision to terminate her long term disability benefits under the above mentioned policy. The plaintiff contended that despite all the medical reports from her attending physicians, Prudential has refused to reinstate her disability benefits.

Benefits Due Under The Policy Terms

The plaintiff argued that Prudential has breached the terms of the aforementioned policy and insurance contract by failing to reinstate and pay disability benefits to her. Under the terms of the insurance contract, the plaintiff entitled to disability benefits and is entitled to recover the past due benefits due to her under the provisions and terms of the insurance contract.

Bad Faith Breach Of Insurance Contract By Prudential

The plaintiff also argued that Prudential owed a duty of good faith and fair dealing to her in the handling, investigation of her claim for disability benefits. The plaintiff alleged that Prudential had breach this duty of good faith and fair dealing by the following unreasonable acts:

  • Failure to adopt and implement a reasonable standard for the investigation and handling of the plaintiff’s claims for disability benefits.
  • Failure and refusal to pay the plaintiff’s disability benefits without conducting a proper investigation based on all the available information.
  • Engaged in a course of conduct that is designed to undermine the payment of long term disability benefits to the plaintiff, including failure to properly review the plaintiff’s past and current medical evidence.

The plaintiff alleged that, through the above mentioned actions, Prudential had acted in a willful and wanton manner. As a result of these actions, Prudential has caused the plaintiff to suffer damages in the form of lost benefits and injuries in the form of emotional distress.

Relief Sought in the Lawsuit by the Plaintiff

Having exhausted all her administrative remedies, the plaintiff is seeking through the Court the following relief:

  • A determination that Prudential is obligated to pay the plaintiff ongoing disability benefits as a result of her inability to perform the material and substantial duties of his regular occupation.
  • Enter judgment against Prudential in the amount to be determined for all disability benefits due.
  • Award damages in an amount to be determined.
  • Award exemplary damages in an amount to be determined.
  • Award pre-judgment interest, costs.
  • Award any such other relief the plaintiff may be entitled under law and/or equity.