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CA Jury Awards FM/CFS Patient $15.4 Million in Disability Suit

  [ 1775 votes ]   [ 4 Comments ]
By Editor • www.ProHealth.com • March 19, 2007


On Thursday March 8, 2007 a jury in the Superior Court of San Diego County, California ordered Prudential Insurance Company of America to pay FM and CFS patient Darla Johnson $14 million in punitive damages.

This was in addition to an award of $982,082 in compensatory damages the jury had awarded her the previous week to cover back and future disability benefits the company had fully terminated – plus general damages of $500,000 “for the grief, humiliation, and inconvenience caused by the improper termination of benefits,” according to the San Diego-based legal firm of Simpson & Moore, LLP, which represented Ms. Johnson.

Prudential charged that the plaintiff - Ms. Johnson, age 49 - had not submitted enough evidence to prove she is disabled. But the jury decided otherwise, after a six-week trial during which Ms. Johnson spent much of the time with her head down on the table or resting on the floor.

Formerly a University Construction Manager
By way of background, the attorneys reported, “As a project manager in the University of California-San Francisco's construction department, Ms. Johnson bought into a group plan providing coverage for income replacement if she became unable to work. In May 1995, Ms. Johnson was diagnosed with Lupus, Fibromyalgia Syndrome, Chronic Fatigue Syndrome, and Antiphospholipid Antibody Syndrome, and had to stop working.

"After approximately five years of paying benefits [at half her income before she stopped working], Prudential terminated Ms. Johnson's benefits. Two internal appeals were denied, and Ms. Johnson had to file suit to correct the wrongful termination of her policy benefits.”

Prudential maintained that the termination decision was proper, because Ms. Johnson was not able to provide sufficient objective evidence to substantiate her disability.

Landmark Victory for Victims of Such Illnesses
Before the decision to halt payments, Prudential sent Ms. Johnson to a physician for “an independent medical exam,” which resulted in a report indicating she was not disabled, according to coverage of the case in the March 10, 2007 issue of the San Diego Union-Tribune. An expert for the defense testified that the insurer had begun to require “more stringent objective evidence to support disability claims, such as X-rays and blood tests,” the Union-Tribune article stated. But Ms. Johnson’s case involved “a perfunctory exam” and “a perfunctory report,” Charles Moore, one of her attorneys, reportedly charged. “He was paid to find she wasn’t disabled.”

“This case is a landmark victory for anyone with Lupus, Fibromyalgia Syndrome, Chronic Fatigue Syndrome, or other illness or syndrome for which there is limited objective medical evidence,” Moore stated.

Admittedly, the award for punitive damages that the jury called for is huge, and there’s some debate as to whether it is within legal limits. Prudential plans to appeal. But the bigger questions are whether Ms. Johnson will actually receive some of this compensation – and if so, when? It could take three years for her to receive any money, comments her lead attorney, Sean Simpson.




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Article Comments Post a Comment

typical
Posted by: fiorini
Mar 28, 2007
insurance companies will always look to screw you. I have had to go thru my state's insurance and banking dept. multiple times to collect monies properly due me, once for as little as $200 ! I have never appealed to the insurnace dept and lost my case. Surprise, surprise ?
Reply Reply

 
Insurance companies and CFS
Posted by: Luette
Sep 9, 2007
I jumped through hoops taking tests just to lose my disability with insurance company. I was told S.S. was the tough one to get, but I was granted S.S. My insurance company wouldn't keep paying even after I saw several drs (two of whom didn't really believe in CFS, one flat out told me to my face he didn't believe in it), with three drs supporting the CFS claim and even having an overnight sleep study done (came out no sleep apnea, no insomnia, but don't go into deep REM) and even the new ciguatera test (which while doesn't confirm CFS or ME, confirms something wrong as only people with cancer, hepatitis, ciguatera poisoning and CFS have high levels)which came back resembles CFS, was turned down on my appeal. They didn't tell me which tests I needed or what they needed to confirm, so had every test my doctors could think of. In the end, I know the insurance co. doctor didn't even go over thoroughly (the final paperwork my dr. faxed was very thorough and yet the denial letter was dated the SAME DAY the paperwork was faxed to insurance co.!). How does one prove what even many doctors won't confirm exists? One doctor told me just to go back to work (he said it was fibro, even tho have almost every symptom of CFS). Gee, why didn't I think of that?

 


Prudential is ...
Posted by: slevah
Oct 3, 2007
listed as one of the top 20 in the US for "BAD FAITH" insurance companies... I am in the appeal process with them right now.. Same S--t, Different Person!
Reply Reply
 
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