Washington Court Finds Man Disabled from Chronic Back Pain under Prudential LTD Policy

Andrew Cherry was an accomplished senior software engineer for Microsoft for nearly 10 years. His occupation required he be able to handle sustained sitting to solve coding issues and implement, or improve upon, various Microsoft products.

Mr. Cherry suffered from chronic back pain and lumbar radiculopathy which was confirmed through MRI imaging, 2-day physical assessment, and medical records detailing his pain and symptoms. Mr. Cherry’s treating providers unanimously agreed he is unable to sit for any length of time and thus unable to work in a sedentary position.

Despite the evidence supporting disability, Prudential denied the claim. It denied it on two bases: 1) he could work in a full-time position because he did part time work on and off and 2) he was disabled from a mental health condition and thus limited to 24 months of benefits which were already paid.

In denying the claim, it relied on the opinion of its reviewing provider who only did a paper review of the file. Prudential’s reviewer is the only doctor to opine that Mr. Cherry could sit for 1 hour but no provider said he could sit for more than 4 hours per day. In other words, Prudential’s own doctor did not agree he could sit for more than 4 hours which is required for sedentary work.

Mr. Cherry filed a lawsuit in the Washington United States District Court, where he lived and worked. Washington state law requires the court review his case de novo versus the higher standard of review—arbitrary and capricious— which is applied in most ERISA disability insurance cases. That means, the court reviewed his case with a fresh set of eyes, giving no deference to Prudential’s decision.

The court found that Mr. Cherry was disabled from working in any capacity. Specifically, the court held that he could not sit for any sustained period of time and was unable to work in a full-time position. The court also noted that there was no evidence his disability was due to a mental health condition.

This case is just one example of a common theme we see in disability insurance claim denials. Insurance companies ignore credible and objective evidence of disability in favor of their own reviewing doctor’s opinions.

As experienced disability insurance attorneys, we have successfully handled chronic back pain cases against every major disability insurance company around the country. We have a winning strategy for building up chronic back pain claims to help prove disability.

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