In Maryland Federal Court, a four-year employee (working as a receiver) at Weis Markets, Inc. ceased working in October 2009 due to cervical surgery that she had to undergo for repair of injuries she sustained in a car accident in October 2008. After being denied long term disability benefits by Guardian, she was forced to hire a Maryland disability attorney and file suit.
Suffering from occipital headaches, neck pain, stiffness, and radiation in her arms, the claimant was diagnosed with cervical radiculopathy that required surgery for a "cervical fusion and decompression of C5-C6 with replacement o instrumentation," which left her with a "30% permanent partial impairment of her neck."
Denied Long Term Disability Benefits
Not eligible for short term disability benefits, the claimant applied to Guardian Life Insurance Company of America for her long term disability benefits as provided by her employee plan with Weis Markets, Inc. In a letter dated June 18, 2010, Guardian Life denied the claimant her long term disability benefits, after it concluded that the claimant was capable of performing her "prior job duties," which included the "ability to life a heavy garage door." The claimant appealed the insurer's decision, sent additional documents in support of her inability to work at her previous job, and was again denied her Guardian Life disability benefits. On June 21, 2011, the claimant received her final denial from Guardian Life, in which the insurer upheld its original decision, forcing the claimant to hire a disability lawyer to file a lawsuit to try to collect on the disability benefits she is entitled to through her employee disability plan.
Lawyer Appeals to Maryland District Court for Relief
Claiming that Guardian failed to "conduct a full and fair review and that the decision to deny disability benefits to the claimant was unreasonable and not supported by substantial evidence" for the denial of her benefits, the claimant and her lawyer filed suit in District Court on August 17, 2011. In the complaint, the claimant and her lawyer ask the Court for the following relief:
- Payment to the claimant of all long term disability benefits due under her Guardian plan from June 1, 2010 to the present and continuing;
- Judgment against Guardian for "all amounts due and owing" on the claimant's disability benefits;
- Attorney's fees pursuant to 29 U.S.C. § 1132; and
- "Any and all other relief to which the Plaintiff may be entitled or the nature of this cause of action may require."
Maryland District Court will Decide if The claimant is Disabled or Not
The issue in this suit revolves around the question as to whether or not she meets the definition of disabled per her employee insurance policy. The claimant and her attorney are confident that she does meet the criteria as she cannot lift the heavy garage door that is a duty under her employment requirements. Consequently, they claim that her lawsuit has substantial evidence that Guardian has not conducted a full and fair review of her claim and that the insurer unreasonably denied her claim as a result of that failure. The claimant and her disability attorney allege that Guardian has breached her contract with her by not providing her disability benefits as promised, and that the insurer's denial of her disability benefits is "arbitrary, illegal, capricious, unreasonable, discriminatory and not made in good faith."
About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-411-9085.