A Texas disability attorney recently filed a federal ERISA lawsuit against the Guardian Life Insurance Company of America after Guardian incorrectly denied long term disability benefits.

The Facts of the Case Against Guardian Life Insurance Company Of America

Plaintiff worked at Integra and was a participant of its Long-Term Employee Welfare Plan.

Plaintiff suffers from a medical condition, "organic brain syndrome" or "organic delusional or hallucinogenic syndrome," which is an exception to the limitation of coverage for "medical conditions."

This condition will not allow the Plaintiff to perform the duties of any occupation as defined in the Plan.

Denial of Guardian Disability Benefits Claim

On August 6, 2010, Guardian stopped paying LTD benefits to the Plaintiff.

Guardian also denied Plaintiff’s appeal.

Plaintiff has complied with all of the requirements to exhaust every administrative appeal.

Plaintiff was and continues to be disabled as defined by the terms of the Plan.

Guardian was both the determiner of claims and the payer of claims, indicating a conflict of interest.

Texas Disability Lawyer Files Lawsuit Against Guardian

According to the lawsuit, Plaintiff claims the following:

  • Plaintiff is entitled to LTD benefits as defined in the Plan, as Plaintiff has met the definition of "disability" described in the Plan.
  • Plaintiff has met the obligations to make a proof of claim in accordance with the terms of the Plan.
  • Guardian’s decision to deny benefits to the Plaintiff was capricious and arbitrary.
  • Plaintiff seeks benefits from Guardian that have not yet been paid.

Relief Sought By The Plaintiff In The Guardian Lawsuit

Due to Guardian’s actions, Plaintiff seeks the following from the Court:

  • An award that encompasses reasonable and necessary court costs to the Plaintiff, as well as attorney’s fees due to the filing of this lawsuit.
  • Guardian pays Plaintiff full employee benefits that have incurred and that have not been paid yet.
  • Guardian reinstates Plaintiff on the Plan for future payments in accordance with the terms of the Plan.
  • Guardian reinstates waiver of premium status for Plaintiff’s life insurance.
  • Guardian is to pay all reasonable attorney’s fees that have been incurred as a result of filing this lawsuit.
  • Guardian is to pay pre-judgment and post-judgment interest on benefits owed to the Plaintiff.
  • Guardian is to pay all costs that the Court finds to be just and proper. 

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.