Suit Against Sun Life Assurance-Disability Insurance Denial

Published on: November 11, 2011 by

Long Term Disability Lawyer Sues Sun Life Assurance on Behalf of Disabled Worker

Disability Lawyer, Marc Whitehead represents a 38 years old disabled worker and a resident of Texas, who is became severely disabled while covered under a long term disability insurance policy issued and administered by Sun Life.

Plaintiff

Plaintiff is a 38 years old worker that was formerly employed by M-I L.L.C. as a chemist. Plaintiff is a resident of Nevada and is currently disabled due to pain in her lower back, hip, leg, left shoulder, and neck; Pinched nerve in her neck, bulging disc in her back, swelling in the brain, vision problems, light headedness and vertigo. The aforementioned impairments and their symptoms preclude Plaintiff’s performance of any work activities on a consistent basis.

Defendant

Sun Life Assurance Company of Texas, commonly referred to as Sun Life, is an insurance company based in Dallas, Texas.

Venue and Jurisdiction of Long Term Disability Lawsuit

Suit was filed in federal court in the Southern District of Texas pursuant to 28 U.S.C. § 1331.  Specifically, Plaintiff brings this action to enforce plaintiff’s rights under the Employee Retirement Income Security Act (ERISA), as allowed by 29 U.S.C. §§ 1132, 1133, & 1140

Allegations of Wrongful Denial of Disability Benefits Under ERISA:

Plaintiff brings this action to secure all long term disability insurance benefits, to which Plaintiff is entitled under a disability insurance policy underwritten and administered by Sun Life.  Plaintiff is covered under the policy by virtue of plaintiff’s employment with M-I L.L.C.

The Social Security Administration issued a fully favorable decision on Plaintiff’s claim for social security disability benefits under Title II and Title XVI of the Social Security Act, finding that Plaintiff is “disabled” during the relevant time period, a fact that Sun Life was aware of.

On October 6, 2010, Sun Life notified Plaintiff that Defendant affirmed its original decision to deny Plaintiff’s claim for long term disability benefits, totally ignoring the findings of the Social Security Administration.

Sun Life also notified Plaintiff on October 6, 2010, that Plaintiff had exhausted all administrative remedies and they would consider no further claims or evidence. Sun Life, in its final denial, discounted the opinions of Plaintiff’s treating physicians, among others, and the documented limitations from which Plaintiff suffers including the effects of Plaintiff’s impairments on plaintiff’s ability to engage in work activities.  Plaintiff has now exhausted all available administrative remedies, and plaintiff is forced to file a lawsuit to obtain plaintiff’s rightfully owed disability benefits.

The Law - The Employee Retirement Income Securities Act (ERISA)

This claim is governed under federal ERISA law.  All state law claims that may have been considered are preempted by federal ERISA law because the plaintiff is covered under an insurance policy issued through his employee benefits plan.  ERISA stands for the Employee Retirement Income Security Act of 1974.  ERISA is a federal law that regulates the handling of Employee Benefit Plans and the remedies of the beneficiaries of these Plans.  ERISA applies to all employees benefit plans established or maintained by an employer engaged in commerce or by an employee organization representing employees engaged in commerce.  Practically all long term disability plans offered by a private employer are governed by ERISA.  A claimant challenging a disability denial under an ERISA governed plan or policy must bring the claim pursuant to ERISA regulations and procedures.  All state law remedies are preempted, meaning they do not apply to an ERISA claim.

Marc Whitehead’s Comments:

Disability Insurance claims are governed by a complex set of laws and procedures.  These laws are full of traps for the unwary, even attorneys not experienced in ERISA law.  Most people make the mistake of thinking they can handle the administrative appeal themselves and then hire a lawyer if they lose and have to file a lawsuit.  This is totally backwards thinking.

Recently I had a client come to me with such a claim.  He said, “don’t worry about the administrative appeal, I filed it myself.  I just need you to file my lawsuit.”  It turns out he filed a one page letter asking the insurance company to reconsider because he “really was disabled.”  He was astonished to learn that this one page letter was the only evidence the judge could consider in his case other than what the insurance company chose to include when they denied him.  In other words, he had blown any chance to present his case in court.  Don’t let this happen to you.  If you don’t call us, call someone.  For more information, visit www.DisabilityDenials.com.