Sandra Cotton-Lyons filed a lawsuit against Liberty Life Assurance Company of Boston (Liberty Mutual), Administrator of the Bridgestone Americas, Inc. Long Term Disability Plan in the United States District Court for the Eastern District of North Carolina. As an employee of Bridgestone Americas, Inc. (Bridgestone Firestone), Cotton-Lyons, a resident of Rocky Mount, North Carolina, is a qualified, vested member in her employer’s disability insurance plan with Liberty Life.
The policy was effective for Cotton-Lyons on January 2, 2006. And, as the “sole authority to grant or deny benefits to applicants” under Cotton-Lyon’s plan, Liberty Life has a fiduciary responsibility to make decisions concerning Cotton-Lyons’s benefits claims. Consequently, when Liberty Life denies a claim, it risks being accused of having a conflict of interest in that decision. In addition, Liberty Life risks being accused of being “arbitrary and capricious” in such decisions when they it resorts to using its own discretion in making those decisions. Under these fiduciary obligations to its insured members, Liberty Life must administer its disability insurance plans “fairly and… furnish disability benefits according to the terms of” the subject Plan.
Tire-Builder Is Injured On the Job at Bridgestone
A 52-year-old tire-builder at Bridgestone Americas, Inc., Sandra Cotton-Lyons suffered an on-the -job injury on July 27, 2006, which resulted in several surgeries to her shoulder. When these surgeries resulted in Cotton-Lyons becoming totally disabled from performing her job, she ceased work and applied for her long term disability benefits and was initially granted those disability benefits.
Cotton-Lyons Appeals Liberty Life’s Denial of Disability Benefits
Then, Cotton-Lyons received a letter from Liberty Life, dated April 3, 2009 denying further disability benefits. Cotton-Lyons immediately appealed the insurer’s decision, submitted addition information, supported by medical records that proclaimed Cotton-Lyons totally disabled to perform her own employment or any other employment for that matter. In addition, the Social Security Administration declared Cotton-Lyons disabled and provided her with disability benefits under Title II and Title XVI.
On January 19, 2010, Cotton-Lyons was notified that Liberty Life was choosing to uphold its denial and notifying Cotton-Lyons that she had exhausted her administrative appeals with the insurer. This letter resulted in Cotton-Lyons being forced to file a lawsuit against the insurer in an attempt to receive her duly deserved disability benefits. Discounting Cotton-Lyon’s physician’s opinion, Liberty Life set itself up to be sued by Cotton-Lyons pursuant to 29 U.S.C. § 1132.
Suffering from “axial neck and bilateral arm pain, spondylosis, disc disease and bilateral neuroforaminal stenosis,” Cotton-Lyons takes multiple pain medications, but continues to suffer from pain and prescription drug side effects in the form of “sedation and cognitive difficulties.” Consequently, Cotton-Lyons alleges that Liberty Life of Boston is wrongfully denying her disability benefits in violation of ERISA because she is totally disabled, cannot function at work, and the insurer refuses to “afford proper weight to the evidence” in evaluating Cotton-Lyon’s disability claim.
Cotton-Lyons Asks the District Court for Her Disability Benefits
Cotton-Lyons and her disability attorney asks the United States District Court for the Eastern District of North Carolina for “declaratory and injunctive relief” so as to provide her with all past-due short term and long term disability benefits under her plan for the duration of her disability or until she reaches the termination age of her plan. In addition, Cotton-Lyons and her disability attorney request that the Court award her “reasonable attorney fees,” expenses, and any other relief that the Court sees as “just and appropriate.”