UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF FLORIDA

CASE NO.:

SAMUEL MONTALVO,

Plaintiff,

v.

THE PRUDENTIAL INSURANCE

COMPANY OF AMERICA,

Defendant.

____________________________________)

COMPLAINT

The Plaintiff, SAMUEL MONTALVO (“MONTALVO”), by and through his

undersigned counsel, hereby sues THE PRUDENTIAL INSURANCE COMPANY OF 

AMERICA (“PRUDENTIAL”), and alleges as follows:

JURISDICTION, VENUE AND PARTIES

1. This action arises under ERISA or the Employee Retirement Income Security Act of 1974, 

29 USC §§ 1001 et seq., and more particularly 29 USC §1132 (a) (1) (B) thereof. This 

Court has jurisdiction under 29 USC § 1132 (f), which grants to the federal court 

concurrent jurisdiction to determine claims under 29 USC §§ 1001 et seq. MONTALVO

brings this action to recover long-term disability (“LTD”) benefits due to him under the 

terms of an employee welfare benefit plan, to enforce his rights under the plan and to 

clarify his rights to benefits under the terms of the plan.

2. MONTALVO was, at all times relevant, a citizen of the United States of America and in 

all respects sui juris.

3. PRUDENTIAL is a corporation with its principal place of business in the State of New

Jersey that is authorized to transact and is transacting business in the Southern District of 

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Florida.

4. Venue is proper in this District under 29 USC 1132 (e)(2), in that the defendant, 

PRUDENTIAL, is authorized to and is doing business within the Southern District of 

Florida and “may be found” in the Southern District of Florida

FACTUAL ALLEGATIONS

5. This case arises out of the purposeful, unwarranted and unlawful denial of disability 

benefits to MONTALVO.

6. MONTALVO, at all times material, was an employee of or former employee of Royal 

Caribbean Cruises Ltd.

7. By way of his employment with Royal Caribbean Cruises Ltd., MONTALVO was at all 

times material a plan participant and a covered person under the Royal Caribbean Cruises 

Ltd. Long Term Disability Plan, Group Contract Number G-47450-FL (the “LTD Plan”), 

which is a long term disability insurance policy issued by PRUDENTIAL to Royal 

Caribbean Cruises Ltd., who is the Contract Holder and Plan Sponsor. It is pursuant to 

this LTD Plan that MONTALVO is entitled to benefits. A copy of the LTD Plan as 

provided by PRUDENTIAL has been attached hereto as Exhibit “A.”

8. The LTD Plan is an employee welfare benefit plan within the meaning of Title 29, USC § 

1002 and regulated by ERISA.

9. PRUDENTIAL is the insurer of benefits under the LTD Plan and is the named fiduciary 

for deciding claims for benefits under the LTD Plan and for deciding any appeals of 

denied claims.

10. As the decision maker and payer of plan benefits, PRUDENTIAL administered the claim 

with a conflict of interest and the bias this created affected the claim’s determination. As 

such, PRUDENTIAL is not entitled to a deferential standard of review.

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11. PRUDENTIAL is the fiduciary charged with making benefit determinations under the 

LTD Plan including the determinations made on MONTALVO’s claim at issue.

12. Pursuant to the terms and conditions of the LTD Plan, MONTALVO is entitled to LTD 

benefits for the duration of his disability, or until his normal retirement age, so long as he 

remains disabled as required under the terms of the LTD Plan. 

13. According to the LTD Plan, disability is defined as follows: 

14. At all relevant times, MONTALVO complied with all conditions precedent and exhausted 

all required administrative remedies under the LTD Plan.

15. Since approximately September 16, 2020, MONTALVO has been disabled under the 

terms of the LTD Plan.

16. Since on or about September 16, 2020, MONTALVO has been unable to perform the 

material and substantial duties of his regular occupation due to sickness or injury. 

17. Since on or about September 16, 2020, MONTALVO has been under the regular care of a 

doctor. 

18. Since on or about September 16, 2020, MONTALVO has had a 20% or more loss in his 

monthly earnings due to his sickness or injury.

19. Since on or about September 16, 2020, due to sickness or injury, MONTALVO has been 

unable to perform the duties of any gainful occupation for which he is reasonably fitted by 

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education, training or experience. 

20. At all relevant times, MONTALVO has been under the regular care of a doctor.

21. At all relevant times, MONTALVO was a Covered Person under the LTD Plan.

22. By letter dated June 9, 2021, PRUDENTIAL informed MONTALVO that it was denying 

his claim for LTD benefits, contending that he failed to meet the definition of disability of 

the LTD Plan. 

23. MONTALVO timely and properly submitted an appeal of PRUDENTIAL’s June 9, 2021

denial. 

24. By letter dated May 9, 2022, PRUDENTIAL informed MONTALVO that it was affirming 

its previous decision to deny MONTALVO’s claim for LTD benefits and advised 

MONTALVO that all required administrative remedies had been exhausted. 

25. From September 16, 2020 to the present date, MONTALVO has not received benefits 

owed to him under the LTD Plan despite MONTALVO’s right to these benefits.

26. At all relevant times, PRUDENTIAL was the payer of benefits.

27. At all relevant times, PRUDENTIAL was the “Insurance Company” identified throughout 

the LTD Plan.

28. At all relevant times, PRUDENTIAL was the named fiduciary for deciding claims for 

benefits under the LTD Plan and for deciding any appeals of denied claims.

29. At all relevant times, MONTALVO has been and remains Disabled and entitled to LTD 

benefits from PRUDENTIAL under the terms of the LTD Plan.

30. MONTALVO has been forced to retain the services of the undersigned counsel in order to 

prosecute this action and is obligated to pay a reasonable attorney’s fee.

CLAIM FOR BENEFITS, ENFORCEMENT AND CLARIFICATION OF RIGHTS, 

PREJUDGMENT AND POSTJUDGMENT INTEREST AND ATTORNEYS’ FEES AND 

COSTS PURSUANT TO 29U.S.C. § 1132(a)(1)(B)

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31. MONTALVO incorporates Paragraphs 1 through 30 as if fully set forth herein.

32. This is a claim to recover benefits, enforce rights, and clarify rights to future benefits 

under 29 U.S.C. §1132(a)(1)(B).

33. Pursuant to 29 U.S.C. §1132(a)(1)(B), MONTALVO, as a participant under the LTD Plan, 

is entitled to sue for judicial determination and enforcement of benefits. 

34. MONTALVO has no other adequate remedy at law to address the injuries he has suffered 

and will continue to suffer as a result of PRUDENTIAL’s failure to pay his continued 

claim for disability benefits. 

35. MONTALVO has exhausted all required administrative remedies under the LTD Plan.

36. Defendant breached the LTD Plan and violated ERISA in the following respects: 

(a) Failing to pay LTD benefit payments to MONTALVO at a 

time when PRUDENTIAL knew, or should have known, that MONTALVO was 

entitled to those benefits under the terms of the LTD Plan, as MONTALVO was 

disabled and unable to work and therefore entitled to benefits. 

(b) Failing to provide a prompt and reasonable explanation of 

the basis relied upon under the terms of the LTD Plan documents, in relation to 

the applicable facts and LTD Plan provisions, for the termination of 

MONTALVO’s claim for LTD benefits; 

(c) After MONTALVO’s claim was terminated in whole or in 

part, PRUDENTIAL failed to adequately describe to MONTALVO any additional 

material or information necessary for MONTALVO to perfect his claim along 

with an explanation of why such material is or was necessary.

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(d) PRUDENTIAL failed to properly and adequately 

investigate the merits of MONTALVO’s disability claim and failed to provide a 

full and fair review of MONTALVO’s claim. 

37. MONTALVO believes, and thereon alleges, that PRUDENTIAL wrongfully terminated 

his claim for disability benefits under the LTD Plan by other acts or omissions of which 

MONTALVO is presently unaware, but which may be discovered in this future litigation 

and which MONTALVO will immediately make PRUDENTIAL aware of once said acts 

or omissions are discovered by MONTALVO. 

38. Following the termination of benefits under the LTD Plan, MONTALVO exhausted all 

administrative remedies required under ERISA, and MONTALVO has performed all 

duties and obligations on his part to be performed under the LTD Plan.

39. As a proximate result of the aforementioned wrongful conduct of PRUDENTIAL, 

MONTALVO has damages for loss of disability benefits in a total sum to be shown at the 

time of trial.

40. As a further direct and proximate result of this improper determination regarding 

MONTALVO’s claim for benefits, MONTALVO, in pursuing this action, has been 

required to incur attorneys’ costs and fees. Pursuant to 29 U.S.C. § 1132(g)(1), 

MONTALVO is entitled to have such fees and costs paid by PRUDENTIAL. 

41. The wrongful conduct of PRUDENTIAL has created uncertainty where none should exist,

therefore, MONTALVO is entitled to enforce his rights under the terms of the LTD Plan 

and to clarify his right to future benefits under the terms of the LTD Plan. 

REQUEST FOR RELIEF

WHEREFORE, SAMUEL MONTALVO prays for relief against THE PRUDENTIAL 

INSURANCE COMPANY OF AMERICA as follows:

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1. Payment of disability benefits due Plaintiff; 

2. An order declaring that Plaintiff is entitled to immediate reinstatement to the LTD Plan, 

with all ancillary benefits to which he is entitled by virtue of his disability, and that 

benefits are to be paid and to continue to be paid under the LTD Plan for so long as 

Plaintiff remains disabled under the terms of the LTD Plan; 

3. In the alternative to the relief sought in paragraphs 1 and 2, an order remanding Plaintiff’s 

claim to the claims administrator to the extent any new facts or submissions are to be 

considered; 

4. Pursuant to 29 U.S.C. § 1132(g), payment of all costs and attorneys’ fees incurred in 

pursuing this action; 

5. Payment of pre-judgment and post-judgment interest as allowed for under ERISA; and 

6. Such other and further relief as this Court deems just and proper. 

DATED: October 27, 2022

ATTORNEYS DELL AND SCHAEFER, 

CHARTERED

Attorneys for Plaintiff

2625 Weston Road

Weston, FL 33331

Phone: (954) 620-8300

Fax: (954) 922-6864

S/ Rachel Alters

RACHEL ALTERS, ESQUIRE

Florida Bar No: 0106232

Email: Rachel@diattorney.com

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