Opinion ID: 1381305
Heading Depth: 2
Heading Rank: 1

Heading: Prudential Discontinues Brown's LTD Benefits

Text: Brown worked for Hunt as a truck driver and enrolled in the Plan. Hunt sponsored the Plan and served as plan administrator. Pursuant to a group insurance contract with Hunt, Prudential insured the Plan and served as claims administrator. Prudential, not Hunt, was responsible for processing claims, determining eligibility, and paying benefits under the Plan. In August 2005, Brown stopped working for Hunt due to neck, back, and left knee pain. She made a claim for LTD benefits under the Plan. In September 2005, Prudential awarded Brown LTD benefits based upon her left knee condition. Prudential found Brown met the Plan's definition of disabled, i.e., unable to perform the material and substantial duties of [one's] regular occupation due to . . . injury. Brown was a lifelong trucker, and her knee pain made it impossible for her to continue driving a truck. In June 2007, Prudential discontinued Brown's LTD benefits. The Plan's definition of disabled changes after the first year of payments. The Plan states: After 12 months of payments, you are disabled when Prudential determines that due to the same . . . injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. Prudential determined that, even though Brown's knee pain prevented her from returning to work as a truck driver, there were other jobs she could perform. Prudential informed Brown it had obtain[ed] and review[ed] information about her medical condition, daily activities, and education, experience, and other occupations [she] would be qualified to perform. Prudential explained that, [b]ased on [its] clinical reviews, the medical documentation supports that [Brown had] sedentary work capacity and [was] limited to lifting up to ten pounds, stooping and bending [was] generally to be avoided, and sitting and standing [could] be alternated as needed. Prudential indicated one of its vocational rehabilitation specialists had determined Brown was employable as a semiconductor bonder, a surveillance system monitor, a food checker, or an assembler. Prudential notified Brown of her right to an internal administrative appeal of its decision in writing . . . within 180 days. Prudential required any appeal to state the reasons for disagreeing with its decision and to contain supporting evidence, including: [c]opies of therapy treatment notes, [a]ny additional treatment records from physicians, [a]ctual test results, and any other written comments, documents, records, or information related to [her] claim. Prudential informed Brown of her concomitant right to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to [her] claim.