Background of the Prudential LTD Claim Denial Case
At Berg Plummer Johnson & Raval, we often deal with long term disability claim denials. We are pleased to report the good news for our client, Kristy Midkiff, where we served as local counsel alongside Terry Coleman.
The case of Midkiff v. Prudential is a study in some of the twists and turns a long term disability claim can take. Ms. Midkiff was a manager of Stock Plan Services at SunPower Corporation. SunPower provided its employees group long-term disability benefits through Prudential Life Insurance Co. Ms. Midkiff became disabled after an automobile accident in June 2015. Already with a history of scoliosis, Ms. Midkiff’s pain was uncontrollable after the accident. She had constant pain in her neck and middle and low back, with numbness, paresthesia, and weakness in her arms and legs. A February 2016 MRI revealed scoliosis, loss of normal cervical lordosis, cervical spondylotic changes with ventral cord contact at C5/C6, degenerative disc disease of the thoracic and lumbar spines, diffuse disc bulges, facet hypertrophy, annular fissures, disc osteophyte complexes and central protrusions with ventral cord contact.
Prudential approved Ms. Midkiff’s disability claim for May-November 2016, then denied further benefits. She appealed the denial, including evidence of her August 2017 Social Security disability award. Prudential denied the appeal anyway.
Legal Battle: Fighting Against Prudential Long-Term Disability Denial
Ms. Midkiff filed suit against Prudential in the Northern District of California on March 19, 2019. Prudential then successfully moved to transfer this case out of California and into the Western District of Texas, where Ms. Midkiff lived. The parties submitted their trial briefs in the summer of 2020, and a bench trial was held by Zoom on November 6, 2020.
Court Ruling: A Victory for Long Term Disability Claimants
On March 19, 2021, the Court issued a detailed opinion in favor of Ms. Midkiff. In doing so, Judge Yeakel concluded that Prudential could not create new reasons why it denied the claim and appeal, even with its lawyers providing new rationales during the trial. It could not “cherry pick” the medical records in a desperate effort to support its decision. (“Prudential may not but, indeed, has selected “slivers of information” that arguably support its previous denial of benefits”). Prudential also improperly relied on its own nurse employee’s medical record review, failed to ask Ms. Midkiff to undergo an Insurance Medical Examination (IME), and failed to properly review the Social Security Disability award.
The Court’s assessment of Prudential’s conduct may have been reflected in its order that Prudential pay all past due benefits and future benefits until Ms. Midkiff turns 67. The Court further ruled:
“Midkiff shall recover long-term-disability benefits owed under the SunPower long-term-disability plan from May 3, 2017, until she is 67 years old; a reinstatement of her premium-waiver benefits owed under the SunPower life-insurance plan from May 2, 2016, until she is 65 years old; prejudgment interest payable at the rate of 5% per annum to be paid from October 25, 2017, until the date of Final Judgment herein; postjudgment interest payable from the day after Final Judgment until paid in full; and costs.”
The issue of attorneys’ fees has not yet been resolved.
What’s the Takeaway Lesson?
Insurance companies who deny disability claims are no longer getting the benefit of doubt, and courts are independently and carefully reviewing the basis of those decisions. This helps further the goal of ERISA, which is to protect the interest of employees.
Contact a Houston Disability Insurance Lawyer Today
If you have had your legitimate disability insurance claim wrongfully denied by an insurer, undervalued, or unreasonably delayed, then it’s important to get in touch with an experienced Texas disability insurance attorney here at Berg Plummer Johnson & Raval, LLP for assistance. With the aid of a qualified attorney, you can effectively and timely appeal the denial of benefits. If the internal appeal is unsuccessful, we are prepared to represent you in court.
FAQs
What Can I Do If Prudential Financial Denied My Claim?
If Prudential Financial denied your long-term disability claim, don’t lose hope—you still have options. First, carefully review the denial letter to understand the reasons. Then, gather strong medical evidence, including doctor’s reports, test results, and any supporting documentation that proves your disability. If you haven’t already, apply for Social Security Disability Insurance (SSDI), as an approval can strengthen your case.
Next, file an appeal within the deadline specified in your policy—usually 180 days. Be sure to address every reason Prudential gave for the denial and include new or missing evidence. Avoid handling the appeal alone; working with an experienced disability insurance attorney can significantly improve your chances.
Can an insurance company change the reason for denying my claim during the appeal or trial?
Generally, insurance companies are expected to provide specific reasons for denying a claim and should not introduce new reasons during an appeal or trial. Courts may view changing denial reasons unfavorably, as it can indicate arbitrary decision-making.
