After receiving disability benefits for 5 years from Sun Life insurance Company, Connie never expected her disability insurance benefits would be denied. Connie Hepburn was a "participant" in a Sun Life Disability benefit plan ("the Plan,") due to her employment with Toyoda-Koki Automotive North America, Inc. ("Toyoda") as a Shipping Supervisor in the Production Control Department. Sun Life acted as the plaintiff’s group disability insurer during the period for which her claim for benefits accrued, in addition to being the claims administrator for these benefits. The abovementioned plan was initially underwritten and administered by Genworth Financial prior to its employee benefits business being sold to Sun Life in 2007.

Sun Life Disability Application History

In April 2004, the plaintiff had developed a pituitary tumor known as a "pituitary adenoma." As a result of a decline in her health, the plaintiff stopped working on May 26th 2004. The plaintiff also stated that she underwent surgery to remove the tumor on the following day, May 27th 2004.

Claim For Sun Life Disability Benefits

On August 3rd 2004, the plaintiff filed a claim for long-term disability benefits with Genworth Financial on the ground that the surgical treatments the plaintiff underwent to remove the tumor had left her impaired both cognitively and functionally. The plaintiff’s claim was approved by Genworth Financial and her disability benefits was continuously recertified for a period of five (5) years based on her substantial medical proof of disability.

The plaintiff stated in the lawsuit that her condition had progressively worsened, and her memory problems have correspondingly worsened as well. She also developed a series of immunodeficiency ailments, including Gullian-Barre disease, a rare and very serious disorder which leads to paralysis of the limbs and restricts gait and movement. In addition, she has also been diagnosed with a number of intestinal and bladder infections which cause her great personal discomfort throughout the day and have permanently altered her ability to lead a normal life.

Termination of Long Term Disability Benefits After Receiving Payments for 5 Years

On October 20th 2009, Sun Life terminated Plaintiff’s long term disability benefits. Sun Life’s purported "reason" for terminating the plaintiff’s benefits was that "the medical on record does not support an inability to perform any gainful occupation at a sedentary level of activity."

The plaintiff submitted an ERISA appeal to the decision to terminate her disability benefits by Sun Life. Sun Life, however, upheld its denial on March 4th 2010. Subsequently, the plaintiff made another appeal to Sun Life’s denial and was again denied on November 2nd 2010 on the ground that the plaintiff did not provide "satisfactory proof’ that she remained disabled under the contract. This was despite the fact that in all of her appeals, the plaintiff provided substantial, credible, and overwhelming medical evidence of her continuing disability.

On November 2, 2010, Sun Life, again, upheld the termination of the claim stating, that, in its discretionary review of her claim, Plaintiff had not provided "satisfactory proof’ that she remained disabled under the contract. The plaintiff claimed that her medical condition has been in a period of steady deterioration of both her mental and physical abilities. Specifically, the Plaintiff stated that she suffered a loss of:

• Her cognitive abilities to think and process information correctly.
• Her ability to react and respond appropriately to stimuli.
• Her gait and ability to move, stand, and sit properly.
• Her ability to speak, concentrate and communicate effectively.

The plaintiff also stated that she suffered a series of debilitating physical ailments which have permanently altered her mobility and she had been rendered totally and permanently disabled within the definition of the Plan. The plaintiff also informed Sun Life that the Social Security Administration had determined the plaintiff to be totally and permanently disabled.

In the lawsuit filed by her Tennessee disability lawyer, the plaintiff alleged that after losing the above mentioned argument, Sun Life purported to review Plaintiff’s medical evidence and concluded that she suffers from "no disability" in the face of multiple different medical experts and the Social Security Disability Administration, all of whom found her to be totally disabled.

Legal Grounds For Lawsuit Filed by Tennessee Disability Insurance Attorney

Accordingly, under ERISA, the Plaintiff’s claim has been improperly denied as:

• Sun Life has failed to properly interpret its own group disability insurance contract such that Plaintiff’s long-term disability benefits were terminated, despite her meeting the policy’s basic eligibility requirements.
• The plaintiff and her employer fully paid all premiums and was entitled to coverage under the subject disability insurance policy.
• She has been adjudicated totally and permanently disabled by the Social Security Administration.
• The Plaintiff provided evidence of total and permanent medical disability to Sun Life from multiple physicians.
• Sun Life’s selective evaluation of the plaintiff’s medical evidence precludes Sun Life from claiming that Plaintiff is not totally disabled.

Relief Requested by the Plaintiff

The plaintiff seeks the following relief from the Court:

• An order compelling Sun Life to pay the plaintiff forthwith the full amount of benefits due to her and to continue such payments for the period set forth in the Plan, including interest on all unpaid benefits.
• Disgorgement of any profits or gain Sun Life has obtained as a result of the wrongful action alleged in her Complaint and distribution of any profits or gain to the plaintiff.
• Any and all such other relief as may be just and appropriate.
• Reasonable attorneys fees and costs pursuant to ERISA

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.