Long Term Disability carriers hide behind many defenses one of which is that you are not entitled to learn the basis of the denial or analyze the nature of the information the Long Term Disability carrier considered in making the decision.
In a recent case of Grams v. American Medical Industries under Prudential Insurance Company, my good friend and colleague, Claudeth Henry, fought the Prudential Insurance Company on these discovery issues and won!
The court has ruled that Ms. Grams is entitled to analyze how Prudential reached this decision to deny benefits and analyzed the nature of the information that Prudential considered.
If there is a conflict of interest, the administrator decision does not automatically prevail in the 11th Circuit, and instead the court has to continue its inquiry to determine the self-interest of the claim’s administrator.
While the court pointed out that the existence of a conflict of interest doesn’t necessarily permit fraud discovery, it doesn’t allow the discovery to focus on evidence related to Long Term Disability carrier Prudential Insurance Company self interest in denying claim’s benefits.
In Ms. Grams case, Prudential Insurance Company determined the eligibility for benefits and paid the benefits.
We will see if Prudential Insurance Company abides by the court’s decision and produces this material.
If your claim for Long Term Disability or ERISA benefits has been denied and you are filing an appeal you need to consult an experienced Long Term Disability attorney immediately. You only have 180 days to submit to the Long Term Disability carrier the evidence that supports your claim. Delay can even result in denial! You can contact Pinellas and Hillsborough County Long Term Disability attorney Nancy Cavey by phone at 727-894-3188 or Contact Us Now online.