A New Jersey Federal Court finds Prudential Insurance Company of America (“Prudential”) Improperly Denied Short-Term and Long-Term Disability Benefits to a Newspaper Reporter with Chronic Fatigue Syndrome (“CFS”).
Background
Mr. Brian Vastag worked as an award-winning science reporter for the Washington Post. In July 2012, he became ill with flu-like symptoms and his blood work tested positive for several viruses including Epstein Barr Virus (“EBV”) and Coxsackie. By January 2014, Mr. Vastag was unable to keep up with the pace of work and was approved for short-term disability (“STD”) benefits.
However, shortly thereafter, Prudential terminated Mr. Vastag’s STD payments, denied his claim for long-term disability (“LTD”) benefits, and later denied all subsequent appeals despite his ongoing issues and continued support from his doctors. The evidence supporting disability included:
- a capacity questionnaire from a leading CFS expert (Dr. Susan Levine),
- a Cardiopulmonary Exercise Testing (“CPET”),
- a Quantitative Electroencephalogram (“qEEG”), and
- neurocognitive testing.
Mr. Vastag then filed a lawsuit in federal court against Prudential.
The Court’s Decision
The Court ruled in favor of Mr. Vastag, finding Prudential’s denial to be “particularly troubling” in light of all the documented impairments demonstrated by Mr. Vastag’s testing, as well as the conclusions made by Mr. Vastag’s “highly experienced” treating doctors. Specifically, the Court made the following findings:
- None of Prudential’s medical reviewers demonstrated any expertise in CFS.
- “Disability does not mean that a claimant must vegetate in a dark room excluded from all forms of human society” or “lose his special talent for communication in order to be found disabled.”
- Contrary to Prudential’s claims that Mr. Vastag’s symptoms and limitations were merely “self-reported,” the record contained objective medical evidence supporting Mr. Vastag’s disability, including the CPET, which is the “gold standard” for evaluating and measuring functional capacity in CFS patients.
- Prudential’s decision indicated a significant failure to understand the current state of medical knowledge about CFS and its devastating impact on Mr. Vastag.
The Court ultimately found that Prudential did not make the correct decision and ordered Prudential to pay Mr. Vastag the benefits it owed him.
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