Renaker Hasselman Scott LLP represents a member of the American Institute of Certified Public Accountants in a court challenge to the termination of his benefits under the AICPA Insurance Trust Long Term Disability Income Plan, which is insured by The Prudential Insurance Company of America. The AICPA Plan provides a lifetime benefit for participants who become disabled before the contract anniversary following the participant’s 50th birthday, while benefits for members who become disabled after this contract anniversary end when the participant reaches age 65. In the pending litigation, the certificate of insurance issued to the participant showed an effective date of coverage, which the participant understood to be the contract anniversary, and his disability began before the anniversary of that date following his 50th birthday. However, Prudential terminated his benefits at age 65, contending that the contract anniversary was actually an earlier date: the anniversary date of the current group policy, established in the contract between AICPA and Prudential, which was not disclosed to the participant. The suit seeks to enforce California law holding that insurers are bound by the terms set forth in the certificate of insurance provided to the insured, and that benefits limitations must be conspicuous, plain, and clear.
Read the complaint here.