The plaintiff Bradley Erickson was employed as an engineering manager for BorgWarner. By virtue of his employment, he was entitled to coverage under an employee welfare benefits plan issued by LINA and administered by CIGNA. At the District Court for the Eastern District of Michigan recently, a disability attorney filed a lawsuit on behalf of a client against the Life Insurance Company of North America (LINA) and CIGNA for denial of disability insurance benefits and ERISA violations.
The plaintiff in the case of Bradley Erickson vs Borgwarner Insurance Plan, Borgwarner, Life Insurance Company Of North America, And CIGNA alleged that CIGNA as the claims administrator for the BorgWarner’s employee welfare benefits plan had acted arbitrarily and capriciously in denying his claim for disability benefits.
The CIGNA Disability Insurance Policy Language
Under the plan, the plaintiff was entitled to long term disability benefits if he became disabled as defined below:
The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is either:
- Unable to perform all the material duties of his or her Regular Occupation or a Qualified Alternative; and
- Unable to earn 80% or more of his or her Indexed Covered Earnings.
After Disability Benefits have been payable for 30 months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is either:
Unable to perform all the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience; and
Unable to earn 60% or more of his or her Indexed Covered Earnings.
The plaintiff suffered from Stage IV adrenocortical cancer. As a result of his medications, he experienced symptoms like fatigue, diarrhoea, decreased appetite, weight loss, shortness of breath, depression, anxiety, headaches, dizziness, tremors, memory loss, loss of concentration. The plaintiff also required assistance with all activities of daily living.
Approval And Termination Of Disability Benefits BY LINA / CIGNA
On October 8th 2008, CIGNA approved the plaintiff for long term disability benefits at a rate of $4308. However, after 26 months, from December 16th 2010, CIGNA terminated the plaintiff’s long term disability benefit. The plaintiff stated in the lawsuit that an appeal was made to CIGNA on February 8th 2011 regarding the decision by CIGNA to terminate his disability benefits. Under ERISA, CIGNA was required to make a determination regarding the appeal with 45 days of the plaintiff appealing. Despite numerous promises, CIGNA failed to render a decision on the appeal in a timely manner. A lawsuit was subsequently filed by a Michigan Disability Lawyer seeking payment of disability benefits owed, attorney fees and cost.
Alleged Legal Cause For Action Against CIGNA
The plaintiff argued that as there had been no determination by CIGNA within the period stipulated under ERISA to render its decision regarding the appeal, the appeal is deemed to be denied. The plaintiff also alleged that the termination of his long term disability benefits was wrongful and breached the terms of the plan. In addition, the denial of benefits was arbitrary, capricious, and unsupported by reasoned explanation because:
- There was no conflicting medical evidence as to the plaintiff’s diagnoses and medical condition.
- CIGNA terminated the plaintiff’s long term disability benefits notwithstanding the uncontradicted evidence that his medical condition had not improved.
- CIGNA had a conflict of interest or self-interest to deny plaintiff’s claim because it was both the decision maker and the payer of the plaintiff’s disability benefits.
- CIGNA adopted the opinion of a consulting physician who was its employee and who did not examine the plaintiff instead of giving consideration and weight to the medical evidence from the plaintiff’s treating physicians.
- CIGNA failed to weigh and give a reasoned basis for rejecting the plaintiff’s Social Security Disability award.
- CIGNA gave no reasoned explanation or any reasons for denying the plaintiff’s administrative appeal.
- The denial of benefits damaged the plaintiff by loss of past and future disability benefits.
Relief Sought by the Plaintiff
Due to the actions of CIGNA, the plaintiff is requesting from the Court the following relief:
- A declaration that the plaintiff was and is entitled to past and future long term disability.
- Enter judgment for the plaintiff and against CIGNA for past due disability benefits.
- An order for CIGNA to pay the future disability benefits as they accrue.
- An order for CIGNA to pay reasonable attorney fees, costs, and legal interest.