Walter Jajuga was thinking of his three children when he opted into a Prudential group life insurance policy at his company back in the 1980’s. When he became disabled in 1997, he applied for a number of disability benefits, including a waiver of the premium on that group policy, which would allow his children to collect on the policy even though he stopped working. He was found to be disabled by his employer, by the social security administration, and twice by Prudential itself (in connection with other benefits he had with them). What he did not learn until years later, just before his death, is that Prudential had denied the waiver application on the group life insurance policy, and failed to give him notice of its decision. When he died, Prudential refused to pay out the life insurance benefit to Mr. Jajuga’s children. After fourteen years, three administrative proceedings, a lawsuit in federal district court and an appeal to the First Circuit in Boston, Mr. Jajuga’s children will receive their inheritance, with interest, thanks to a team of local lawyers who took on the insurance giant and won.
When attorneys Terrence Low, Anthony Canata, Andy Kralios and Susan Sachs teamed up last fall to take the case to the First Circuit, the odds of winning – and getting paid – were slim. But they believed in the case and relished the idea of taking on Prudential and its team of lawyers from all over the country. So they began meeting every week in the wood-paneled conference room at Attorney Low’s office, researching, writing and editing a brief that would make their case to the lofty Justices of the First Circuit in Boston.
Attorney Low explained, “I put together a team of lawyers that I thought were smart, dedicated and willing to take on a case because it was the right thing to do even if we didn’t have much chance of success. Judge Ponser is very well respected, and with good reason. Getting the Circuit Court to overturn his decision was a long shot.”
The team met every week to discuss their progress over sandwiches from the Cornerstone Café, editing the brief, discussing the best ways to make their argument and grappling with the details that go into a complex legal brief for submission to one of the highest courts in the land. “It was practicing law the way you hope to practice it when you decide to go to law school,” Attorney Canata said. “You have a case you believe in where the odds are against you and the issues are complex, but you get to work with some dedicated people and try to make a difference.”
Their teamwork paid off in January, when the First Circuit overturned Judge Ponser’s decision and ordered Prudential to pay out the $300,000 life insurance policy at issue. In announcing the decision, the Circuit Court cited Prudential’s violations of ERISA regulations, chastised it for ‘conjuring’ up new defenses in litigation, and found for Attorney Low’s client in part based on the ‘unexplained inconsistency’ in the company’s disability determinations – all arguments put forth by the team of lawyers from Springfield. “It was a great decision from our perspective,” said Attorney Kralios. “We felt vindicated when the Court said that we were right about the law, and went on to make the findings of fact that we thought were there from the beginning. These kinds of cases are extremely difficult to overturn on appeal.”
With their first circuit win in hand, the attorneys returned to the local, Springfield District Court, this time to ask Judge Ponsor to award attorney fees and interest on the $300,000 policy benefit. Judge Ponsor granted their motion in its entirety, allowing the Jajugas to collect the entire benefit, with interest, and ordering Prudential to pay the attorney fees that otherwise would have come out of the benefit.
For the Jajugas and their attorneys, the win set right an injustice fourteen years in the making. But it also may help other, similarly situated plaintiffs to prevail. In reaching its decision, the court rejected Prudential’s argument that the insurance policy at issue had a different definition of the term ‘disabled’ than the policies in which it awarded benefits. Attorney Sachs, a lawyer who takes on these kinds of cases frequently, believes that the decision may put insurance giants on notice that they cannot blithely dismiss their own, or another agency’s, findings of disability when making disability determinations. Attorney Sachs summed it up best: “We were right, and we prevailed in a way that left nothing to interpretation. And that is a really gratifying feeling for a lawyer, one of the best a lawyer can have in the practice of law.”