Disabled woman got 15.4 Mil in landmark insurance suit

Discussion in 'Fibromyalgia Main Forum' started by ephemera, Mar 15, 2007.

  1. ephemera

    ephemera New Member

    FYI, from today's internet news.

    Disabled woman awarded $15.4 million dollars in landmark healthcare suit against Prudential Insurance Company of America.

    San Diego, CA (PRWeb) March 14, 2007 -- Darla Johnson, represented by Charles Moore and Sean Simpson of Simpson & Moore, LLP was awarded $15.4 million dollars in damages by a jury after a five-week trial in the San Diego Superior Court . (Case #GIE018815). Darla Johnson filed suit against Prudential Insurance for the unlawful termination of benefits under Ms. Johnson's disability insurance policy.

    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, 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.

    With no benefits and a life changing disability, Mrs. Johnson took Prudential Insurance to court on the basis that they had wrongly terminated her policy. Prudential maintained that Mrs. Johnson's benefits were properly terminate because Ms. Johnson was unable to provide sufficient objective evidence to substantiate her disability.

    The jury in the San Diego Superior Court found Prudential Insurance guilty in wrong fully terminating Mrs. Johnson's policy. The jury awarded Ms. Johnson back benefits and future benefits totaling $982,082.00, plus general damages of $500,000.00 for the grief, humiliation and inconvenience caused by the improper termination of benefits and $14,000,000 in punitive damages.

    "We feel our client has been vindicated by this verdict. This case is a landmark victory for anyone with Lupus, Fibromyalia Syndrome, Chronic Fatigure Syndrome, or other illness or syndrome for which there is limited objective medical evidence," Charles Moore of Simpson & Moore, LLP explained.

    Other syndromes with similar uncertainty of diagnosis include Carpal Tunnel Syndrome, Gulf War Syndrome, and Auto-Immune Deficiency Syndrome.

    "It's my sincere hope that this verdict will be a stepping stone for others to come forward who have had their insurance benefits wrongfully terminated. Hopefully, now people will know they can fight back, and don't have to bow down to the powers of the big insurance companies." Sean Simpson of Simpson & Moore, LLP noted.

    The defense attorney for Prudential Insurance plans to appeal the verdict.

  2. ephemera

    ephemera New Member

  3. dononagin

    dononagin New Member

    That's wonderful! One more step for the little guy!
  4. roge

    roge Member

    That is awesome!!

    I am printing that off and safe keeping so I can give to my lawyer and so he can give to my insurer if they ever even think of terminating me.

    With all the crap and stress they have put me thropugh over the last 2 years and draining my energy so I cant recover as well as their bad faith moves over the years , there are times when I want to sue their asses right now for damages and suffering even though I am still on LTD.

    anyway , that is great news.

  5. roge

    roge Member

    I missed that the first time, they are going to appeal??

    doesnt surpirse me but unbelievable, all the crap they put that person through and so many others now they are going to appeal like on what grounds ?? these insurers gotta be the lowest scum of the earth


  6. ayhatch

    ayhatch New Member

    By Crikey this is great news!
  7. mezombie

    mezombie Member

    The "no objective evidence" argument is widely used by insurance companies. That Prudential lost on this ground is great news for us and everyone with diagnoses that are based as much if not more on clinical findings as on "objective findings".

    Thanks, Ephemera, for bringing this to our attention!
  8. Cinderbug

    Cinderbug New Member

    I will send a copy of this to the attorney who is appealng my LTD case. My case does happen to be Non-ERISA.
    Every little bit of leverage helps/

  9. suzetal

    suzetal New Member

    My insurance Co. Last year told me they were terminating my benefits cause FM was not a physical problem it is mental and under my policy I am only covered for 2 years.

    Well I received a letter this week from them telling me they were going to continue paying me until they finish a new investigation into my case.

    My law firm had already contacted them about my civil suit against them.I wonder if this case has anything to do with it????

    I can only file a civil suit for what is owed me I can not sue for damages I wish I could cause they put me through hell.

    Thank you so much for posting this.I am sure it is helping my case.

  10. 2shasta

    2shasta New Member

    I am so glad to hear about this case and congrats to this woman. I have long contended that the biggest obstacle we endure is the basic right to an objective finding. And my question should go to all doctor's that if in fact you run all these OBJECTVE tests on us as patient's and still have not found the smoking gun per say and your finding is an illness that AFTER all has been ruled out, WHY THEN IS THIS NOT CONSIDERED AN OBJECTIVE DIAGNOSIS? Why also is a patient's history not considered a pattern for objectivity? Just becasue the medical community does not have the ability to prove beyond a shadow of doubt what we are enduring this should have no bearing on the FACTS THAT WE EACH HAVE PHYSICAL HISTORICAL HISTORY OF SYMPTOMS THAT ADD UP TO OUR ILLNESSES.
  11. rockgor

    rockgor Well-Known Member

    is not the end of the case.

    The judge could reduce it because the punitives are excessive. More likely, to settle the case, the parties will agree on a lesser figure.

    Thus the plaintiff will get some money now instead of waiting more years, and the carrier won't have to pay the full amount.
  12. Shalala

    Shalala New Member

  13. monkeykat

    monkeykat Member

    Wonderful! Thanks for sharing!
  14. ephemera

    ephemera New Member

    bumping for Fri night crowd
  15. mollystwin

    mollystwin New Member

    I thought all insurance companies were protected by erisa and could be sued for what should have been paid, but not for damages?????

    It's great that she got this, but I don't understand it.

  16. Cinderbug

    Cinderbug New Member

    My attorney told me that my LTD company is not protected by ERISA because the company I worked for is a non profit organization. I worked for a hospital that was owned by a large church affiliated chain.
  17. Lichu3

    Lichu3 New Member

    I have my LTD through my work, a huge private company, so it is under ERISA guidelines but if you buy individual LTD or small group LTD, it is NOT covered by ERISA and you can sue for damages. However, it sounds like this woman worked for UCSF which is a big company but is non-profit since it is a state entity. Interesting.
  18. mezombie

    mezombie Member

    ERISA is the law that governs claims brought against most employer provided group disability (and other) plans, including those adminstered by insurance companies.

    However, church plans, government plans, and plans organized by fraternal or similar organizations are exempt from ERISA.

    In this case, the group policy the plaintiff "bought into" was from the Univerity of California at San Francisco. I believe any state university plan would be considered a state (government) plan for puposes of ERISA.

    Individuals who buy their own policies through an insurance company are also not hampered by ERISA.

    Someone who has a disability policy not governed by ERISA can bring a suit against the insurance company that will pretty much be treated like a contract violation. No deference is given to the insurer, and actual and punitive damagages can be awarded.

    [This Message was Edited on 03/16/2007]
  19. mollystwin

    mollystwin New Member

    For the clarification! I am happy this person won her suit.

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