Assurant Disability Help

Nestle Waters employee sues Assurant for denial of disability benefits under ERISA

A disability attorney recently filed a Federal lawsuit in Pennsylvania against Assurant, Inc. (Assurant), Assurant Employee Benefits (AEB), and Union Security Insurance Company (Union).

The plaintiff was employed by Nestle Waters North America Holdings, Inc. (Nestle), who contracted with Assurant, AEB, and Union to provide long-term disability benefits to its employees. By virtue of his employment, the plaintiff was covered by Nestle’s Group Long-Term Disability Plan (The Plan).

The plaintiff filed a disability lawsuit under the Employment Retirement Income and Security Act (ERISA) to recover long-term disability benefits that were wrongfully withheld by the aforementioned Defendants.

The Facts of the Case Against Assurant, AEB, and Union

The disability policy issued by Assurant, AEB, and Union to the Plaintiff defines “disability” according to the following terms:

Disability means that in a specific month, a participant to the Plan satisfies either the Occupation Test or Earnings Test.
Occupation Test requires participant to have an injury, sickness, or pregnancy during the first 24 months of a period of disability (including qualifying period) that requires participant to be under the regular care and attendance of a doctor and prevents participant from performing at least one of the material duties of his/her original occupation.
Material duties include sets of skills or tasks that are generally required by his/her employers from those engaged in a particular occupation.
One material duty refers to the ability of the participant to work for an employer on a full-time basis as defined in the Plan.

Plaintiff has suffered from severe residual affects secondary to displacement of cervical, thoracic, and lumbar discs, resulting in bilateral lower extremity pain and numbness, neck pain, back pain, decreased range of motion, radiculopathy, and myofascial pain syndrome since August 6, 2008.

Defendants approved Plaintiff’s claim on September 3, 2009 for benefits through June 26, 2009.
Payments were made to the Plaintiff from February 3, 2009 to June 26, 2009.

Plaintiff’s medical history is well documented via Dr. Robert Sing’s (Dr. Sing) December 15, 2009 correspondence. He has treated the Plaintiff since March 2009, diagnosing fibromyositis of the cervical, dorsal, and lumbosacral spine that has resulted from the musculo-ligamentus sprain and strain of the cervical, dorsal, and lumbosacral spine, the cervical disc herination at C6-7, post-traumatic myofascial pain syndrome, exacerbation and aggravation of degenerative disc and joint disease of the cervical, dorsal, and lumbosacral spine. Dr. Sing concluded that Plaintiff will continue to have significant pain and muscle spasms on a permanent basis.

On June 25, 2009, Plaintiff underwent a functional capacity evaluation (FCE) under the supervision of Jim Schickling, P.T., at the direction of the insurer. The FCE showed that the Plaintiff could exert up to 50 pounds of force occasionally, up to 25 pounds of force frequently, and up to 10 pounds of force constantly.

Denial of Nestle’s Group Long-Term Disability Plan

After Defendants concluded Plaintiff could still work for Nestle as a Bakery Driver, Defendants denied Plaintiff long-term disability benefits via a letter on September 3, 2009.

Dr. Sing addressed the results of the June 25, 2009 FCE and stated that “the patient is suffering from pain and this would limit his ability to function in the work place.” Dr. Sing also mentioned that the patient could only lift 10 pounds on occasion, rarely 20 pounds, and never 50 pounds. Dr. Sing also mentioned that Plaintiff’s pain and other symptoms would prevent from concentrating to perform simple tasks.

Plaintiff responded to defendants’ decision to terminate his benefits via a letter sent on or around January 4, 2010, stating that the defendants’ Labor Market Survey was for a driver, not for a Route Salesperson, as he was prior to his injury and present condition, and the opinion of Dr. Sing that the Plaintiff could no longer work effectively due to his present condition.

Defendants upheld their decision to deny long-term benefits via letter to Plaintiff on April 7, 2010, claiming that Plaintiff could handle the occupations of a driver based on the definition of a driver under “Dictionary of Common Occupations.”

Plaintiff submitted final appeal via letter to Defendants on or about April 15, 2010, again stating that the Plaintiff’s former occupation was that of a “Route Salesperson” and not that of a “Driver.” Defendants denied Plaintiff’s final appeal on June 1, 2010.

Disability Lawyer Files Lawsuit Against Assurant, Assurant Employee Benefits, and Union

According to the lawsuit filed, the plaintiff alleged that Assurant, AEB, and Union failed to provide the following to the plaintiff:

Consideration of the requirements of employment in Plaintiff’s regular occupation as a Route Salesperson, including the “frequent lifting of 65 pounds.”
Ignored the material duties of Plaintiff’s employment and the nature of Nestle Waters, which included heavy lifting.
To consider all of the medical evidence submitted by the Plaintiff
To administer the Plan in accordance with E.R.I.S.A. Claim regulations

Relief Sought By The Plaintiff In The Assurant, Assurant Employee Benefits, and Union Lawsuit

Due to the actions of Assurant, AEB, and Union, Plaintiff seeks the following relief from the Court:

Render judgment against Defendants for 60% of Plaintiff’s gross monthly salary as per the terms of the Plan until the death of the Plaintiff or the cessation of the Plaintiff’s total disability, as well as accumulated interest associated with this monthly salary.
An award of attorney’s fees, including litigation expenses and the cost of this action.
Declaration that the Defendants breached fiduciary duties owed to plaintiff
Grant other just and proper relief as deemed by the Court

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S.S.

I am a physician in my 30s who was practicing in my hospital based medical specialty until my Multiple Sclerosis diagnosis began to severely limit my physical ability to work.

My husband and I were obviously in distress at these very unwanted life changes and frankly overwhelmed with the possibility of a long and traumatizing legal battle ahead of us. We knew we were legally entitled to benefits through the separate private individual and employer based ERISA disability insurance policies we had, but even cursory research and discussion with colleagues made it clear that insurance companies will strategize with their own legal teams to find ways to not pay out benefits. We found many before us who had fallen unwittingly into legal pitfalls that prevented them from ultimately obtaining benefits. We realized we needed to seek legal counseling.

We found Dell Disability Lawyers through their YouTube channel where their partners have videos discussing the legal intricacies and latest developments in private disability law. I was impressed by their dedication to the field and reached out through their website to request a free consultation.

We were delighted to hear that Mr. Steven Dell himself would be willing to take our case and felt assured that we would be represented by the best of the best.

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Merlin has demonstrated a very high capacity for organizing and handling the endless myriad of documents and communications between us and the insurance companies. She has also been very compassionate, accessible and forthcoming in dealing with our many anxiety fueled emails and telephone calls to her and we are very grateful for her involvement.

For over 7 months, we have been working closely with Steven Dell and Merlin Bryan from Dell Disability Lawyers as they have guided us through the process of review and initial application for benefits from our two insurance policies (Hartford and Ameritas).

We are happy to announce we just received approval of claim from the Hartford insurance company.

At this time we are still working with this firm as we await the final decisions from Ameritas policy that we are hopeful will have a similar outcome.

As anyone with a chronic and progressive illness can tell you, time becomes a very precious commodity. Through their representation, Dell Disability Lawyers has allowed us to focus the majority of our time enjoying the time and function I have left while resting assured that our disability case laid in competent and caring hands.

The truth is that no amount of money can make up for what we have lost, but it is a huge comfort to have a team like Dell Disability Lawyers at our sides to help us ensure we will be able to continue to care for ourselves and our families.

We highly recommend Dell Disability Lawyers, Mr. Steven Dell and Ms. Merlin Bryan to handle your disability insurance claim.

Thank you Steven, thank you Merlin!

We will certainly plan on leaving another review for completeness once we have our final decision from Ameritas.

Paula B.

I have been working with Dell Disability Lawyers for the past 5 years concerning my disability as it pertained to my employer. I have been more than pleased with them the entire time. They have always kept me informed of any paperwork needing completed or any changes coming ahead. Nothing has been a surprise. I would recommend them to you to help with your disability case if you’re trying to dip into the policy you’ve been paying for.

Michael M.

I am a physician who has been disabled for over 10 years. During this time I have been represented by Cesar Gavidia and his assistant, Danielle Lauria. Their representation on my behalf has allowed me to concentrate on dealing with my disability/disease process and all associated complications and not having to deal with all the things that are necessary in a disability insurance claim. Based on my personal experience from many years of practicing medicine I would consider their work product, insight and effort in the disability insurance claim procedures to be superior. I would recommnend them, which I have done, with my highest level of confidence. In short, you will be well served with this practice.

Dan P.

I had to retire from my career due to a bad back that restricted me from performing my duties. I had LTD insurance and after a few years of receiving monthly benefits from this insurance company, they notified me that my benefits were terminated stating that I don’t qualify due to my duties not fitting into some “national job description” and a nurse had deemed me eligible to go back to work. It’s a crushing feeling to have this told to you over the phone with hardly any information given. Luckily, I came across Dell Disability Lawyers and spoke with Attorney Palamara who calmed me down and stated they would take my case. Within a couple of months my benefits were restored, and I had piece of mind. I cannot thank Attorney Palamara and the staff at Dell Disability Lawyers enough for their professionalism, no nonsense approach, personal and timely communication and quick ability to litigate my case.

Jen S.

I wanted to thank Mr. Symonds and his legal assistant Sonia for their professionalism, guidance and dedication towards my LTD insurance claim. Going through the denial process on my own was going to get me sicker and I knew it was time for help right away. I reached out to Dell Disability Lawyers for assistance and not too long after my call, I was connected with Sonia. Soon after that, I was talking about my case with Mr. Symonds. After a long and tedious process with the LTD insurer, we won the case. The wait can absolutely be lengthy, but in the end, it was all very much worth the fight. Thank you both so much for all that you have done for me! I also want to thank those who assisted in keeping me updated, as needed. Highly recommended for anyone who is going through the brutal process of an LTD denial.

Carl G.

I would like to thank Dell Disability Lawyers for taking care of my case and help me get the insurance coverage that I was rightfully in need of. Specially, I would like to thank Attorney Alexander Palamara and right-hand legal assistant, Sonia Nogueira, who made this process less stressful. They answered all my questions and kept me informed every step of the way.

Don’t get me wrong. They never promised or told me that I was going to win my case, as no one can guarantee that for you. What they did do, was letting me know that they were working hard for me and to keep positive. Something that I recommend everyone to do is to subscribe to their YouTube channel. That will give you an idea on how they operate and why they (for most of their cases) win their cases.

Since I was awarded disability, I am still having surgeries and thanks to them, I’ve been able to cover all those expenses.

Warm regards to everyone at Dell Disability Lawyers!

Clarisa B.

I’m so very Grateful and Thankful for the team at Dell Disability Lawyers. They worked tirelessly to get the best outcome for me. I’m so glad that I found them!!

Carole S.

Exceptional, efficient and professional service from Jay Symonds and Sonia Nogueira. They were both so helpful and knowledgeable and navigated me through a very stressful and difficult situation with New York Life.

K. S.

Awesome team. Jay and his team, Sonia and Francesca, truly care. This team is very professional and quick to respond. Jay always provided answers in detail to my questions. I strongly recommend Jay Symonds.

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