The Plaintiff, with the help of a California disability attorney, filed this lawsuit in the United States District Court against Standard Insurance Company (Standard) and the Oscient Pharmaceuticals Corporation Employee Benefit Plan (Oscient). The lawsuit claims that the Plaintiff did not continue to receive the disability benefits that she was entitled to under the Plan that she was eligible for due to her employment with Oscient.
In Christine W. Vs Standard Insurance Company, Plaintiff has filed this lawsuit to gain the rightful disability benefits owed to her under the Plan that were not paid by Standard.
How Plaintiff Was Covered Under The Plan
Plaintiff worked for Oscient as a sales representative, which entitled her to be a participant in Group Insurance Policy Number 139943-B. This Plan would entitle Plaintiff to long term disability benefits equivalent to 67% of Plaintiff’s monthly earnings minus any other income benefits beginning 90 days after the approval of a claim until Plaintiff’s 65th birthday.
Plaintiff began suffering significant neck pain over several years. She also endured several treatments in an attempt to alleviate this pain, which continued to worsen over time. These treatments began on or about May 29, 2007 and continued until September 11, 2007. These treatments included two right sacroiliac joint block injections, a right L4, L5, S1 and medial branch nerve blocks, an MRI of her lumbar spine, a lumbar epidural steroid injection, and right S1 selective nerve root block.
Plaintiff continued to receive more treatments and have more visits with her physicians, but the pain continued to worsen. It was advised that she stay out of work until at least November 25, 2007 so that she could collect short term disability payments.
Plaintiff filed for long term disability payments, which was approved by Standard on or about March 12, 2008. Plaintiff was also granted life insurance waiver of premium on or about September 2, 2008. Treatments and more appointments occurred between May 21, 2009 and April 6, 2010.
Standard Decides To Cut Off Plaintiff’s Long Term Disability Benefits
On or about August 16, 2010, Standard denied Plaintiff’s claim for ongoing disability benefits beyond August 18, 2010. Plaintiff still continued to suffer from symptoms of severe neck pain, as evidenced by a follow-up examination by Tina L., MD on or about November 29, 2010.
On or about December 28, 2010, Plaintiff filed an appeal of Standard’s denial. Plaintiff consulted with Regina N., MD regarding her increasing difficulties with fine motor movements, speech, and word-finding. This prompted Plaintiff to supplement her denial with a follow-up letter on or about February 11, 2011.
Despite two more follow-up examinations with two other physicians in February and April 2011, Standard denied Plaintiff’s appeal on or about May 5, 2011. This has forced Plaintiff to file this lawsuit against Standard.
Merits of the Case Against Standard
This lawsuit was filed because Standard ignored the opinions of Plaintiff’s treating physicians. Standard also did not give proper consideration of Plaintiff’s medical records and her overall condition. Standard’s denial of benefits was wrongful, capricious, arbitrary, and irrational.
The Relief Sought Against Standard
Due to the hardship experienced by the Plaintiff, Plaintiff requests following relief against Standard:
- An award of unpaid benefits due to the Plaintiff from August 19, 2010 to the date of the judgment of this case
- An award of all future payments so long as Plaintiff remains eligible under the terms of the Plan
- An award of reasonable attorney fees
- An award of all other relief that the Court deems appropriate
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.