The Plaintiff, with the help of her Massachusetts Disability Lawyer, has filed this lawsuit in the United States District Court against Standard Insurance Company (Standard) for the denial of long term disability benefits as defined by the Plan that the Plaintiff was eligible due to her employment as a nurse with UnitedHealth Group.
The Plaintiff is a 63-year-old resident of Wrentham, Norfolk County, Massachusetts, while Standard is engaged in the business of disability insurance, and is licensed and authorized to engage in the business of insurance within the Commonwealth of Massachusetts. In regards to this lawsuit, Standard engaged in the administration and, in pertinent part, insurance, of the UnitedHealth Group, Long Term Disability Plan.
In Kathleen F Vs Standard Insurance Company, Plaintiff seeks reinstatement of long term disability benefits as defined by the terms of the Plan.
Plaintiff's Background and Reasons For Submittal of Claim
Plaintiff worked as a healthcare utilization review coordinator for UnitedHealth Group, up to and including January 3, 2006. On or about January 3, 2006, Plaintiff was involved in a motor vehicle accident and suffered a right acetabular (hip) fracture. She could not perform the duties of her occupation, or any occupation, due to multiple complications of the healing of the fracture (non-union), as well as severe posttraumatic arthritis secondary to the injury and depression secondary to the injury.
Plaintiff filed for long term disability benefits under the LTD plan. She provided the necessary claim forms, physicians' statements, and supportive medical records. UnitedHealth Group, who funds the first 24 months of benefit payments, approved the claim. This would last through July 2, 2008. After this date, Standard was expected to take over the LTD payments.
Standard Decides To Not Fulfill LTD Payments To Plaintiff
Via letter dated March 31, 2008, Standard denied Plaintiff's claim for disability benefits when it was due to take over payments on July 3, 2008. Plaintiff filed an appeal of this denial, including additional medical support for her claim. However, Standard denied her appeal on July 28, 2008.
Plaintiff was offered, and through counsel, requested an additional level of review by letter dated September 22, 2008. Plaintiff thereafter submitted additional support for her claim, including a recorded video statement on DVD. Plaintiff requested a copy of the complete claim file from Standard on September 22, 2008. Standard did provide some of the requested records, but not provide any of the requested guidelines, policies, or procedures. Plaintiff again requested these relevant documents via letter dated November 27, 2008.
Standard denied Plaintiff's appeal via letter dated April 27, 2009. Standard informed Plaintiff that she has exhausted her administrative remedies. Because of this, Plaintiff has filed this lawsuit against Standard.
Merits of the Lawsuit Against Standard
Plaintiff asserts that Standard did not properly apply the provisions of the LTD plan to her claim. Plaintiff still has not received the requested documents she asked for from Standard. This has denied the Plaintiff her ERISA's statutory right to a "full and fair review" of her claim, as it has prevented her from mounting additional argument in favor of her claim and deprived her of the opportunity to submit evidence that may perfect her claim. This leads to the assertion that Standard breached its fiduciary duties as an ERISA administrator and shows a clear abuse of discretion.
Plaintiff's Relief Requests
Plaintiff wants the following relief from Standard:
- Plaintiff has been and continues to be eligible to receive LTD benefits as defined by the terms of the Plan
- Standard must pay all disability benefits to which the Plaintiff is entitled to and owed from July 3, 2008 to the present date
- All attorney's fees, interest, costs, and disbursements be paid
- All other relief that the Court determines to be necessary and just
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.