The widow of a claimant, who died from a malignant brain tumor, brought this lawsuit with the help of a Colorado Disability Lawyer after Sun Life refused to award cancer disability benefits. This case was not handled by our law firm and we have written this article to educate you about the conduct of Sun Life.
The case, as presented to the Court, convinced the Court that the claimant should have been awarded disability benefits, but the question remained, is his widow entitled to life insurance benefits? To be eligible for life insurance benefits under the provisions of ERISA (the Employee Retirement Insurance Security Act of 1974), the claimant’s widow had to prove that not only was the claimant unable to perform the duties of his own occupation, but that he was also disabled from performing the duties of “any occupation.”
In Cynthia B., as personal representative of the Estates of John B. v. Sun Life and Health Insurance Company, et. al., the Court determined that a decision by Sun Life to deny long term disability benefits to a Vice President of Advisory Services and subsequently deny his widow life insurance benefits after he died from his disabling condition did determine that the insurer’s denial of the claimant’s disability benefits was “arbitrary, capricious,” and “an abuse of discretion.”
History of the Claim against Sun Life
John B., recognized as an industry leader among his peers, took a position as Vice President of Advisory Services on January 1, 2005. Outperforming the other two divisions of the company for which he worked until late in 2006, John B.’s wife noted that he had a behavioral change about this time. She noticed that John B.was “increasingly angry, agitated,” and “sometimes confused.” And, even though John B.had a history of cycling through jobs (he went through approximately seven jobs in fourteen years) and many times leaving those jobs in rage, John B. was highly regarded in his work, asked to speak at engagements, was a published author in industry journals, and was quite successful overall. Thus, when John B.’s work started to suffer, his wife and he considered this to be a problem and John B. went to see his doctor. Diagnosed with complex psychological problems, John B. was prescribed an antidepressant, but was still terminated from his job for poor performance, and was retained as an independent consultant to finish some projects.
After attempting to unsuccessfully complete these projects, John B. again sought the consult of a doctor, underwent a CT scan, and was diagnosed with a malignant brain tumor. He underwent brain surgery in May of 2007 and ceased working on May 21, 2007. In June 2007, John B.’s family physician determined that John B.’s personality changes and his depression diagnosis were all secondary symptoms of his brain tumor and that the tumor had “been growing for an unknown amount of time” before it was diagnosed, thus, putting the date of his disability before the reporting of that disability to his insurer in 2007.
Regardless, Sun Life Insurance, John B.’s employee plan disability and life insurance provider, denied John B.’s disability benefits claims initially and throughout all his appeals. On July 14, 2007, John B.’s wife, on his behalf, filed his disability benefits claim, used the date of his diagnosis, January 1, 2007, as the date of disability as advised by a VP at her husband’s employer, submitted all medical information about her husband’s condition and included an Attending Physician’s Statement that stated that John B.’s symptoms began in September 2006. On September 13, 2007, Sun Life denied John B.’s claim for cancer disability benefits, stating that he did not qualify as totally disabled before his employment ended and proceeded to deny appeal after appeal. After the administrative remedies were exhausted, the widow brought this lawsuit
Claimant Dies as a Result of His Disabling Condition
Subsequently, John B. died as a result of the brain tumor, and his widow was left to fight for his long term disability benefits and life insurance benefits in the United States District Court of Colorado. Hiring a disability attorney, Ms. John B. filed a lawsuit, filed a Motion for Summary Judgment of her case, and at the conclusion of the briefing on the motion, her attorney and the defendants agreed to a Judgment on the Pleadings which was conducted on February 27, 2012. One of the major questions to be addressed was the meaning of the policy’s definition of disability as it applies to life insurance benefits.
Because of the misdiagnoses of the claimant’s disability and the fact that by the time he had applied for long term disability benefits, there was no time left in which to pursue some other occupation, as the claimant was well on his way to dying, the Court noted that the distinction in the claimant’s duties of his “regular occupation” and “any occupation” was immaterial. With medical evidence that showed that the claimant’s condition dated back as far as 2005, even though no claim of disability was filed until 2007, the Court admonished the insurer for relying only on previous medical records in denying the claimant’s application for long term disability benefits, stating that Sun Life “did not, so far as the record discloses, attempt to obtain any medical information or opinions of its own.” After being confronted with the misdiagnoses of John B.’s condition, Sun Life had a duty to investigate John B.’s widow’s appeal of his life insurance benefits case further and not simply rely on the records submitted concerning John B.’s misdiagnosis.
Sun Life Admonished for Not Further Investigating John B.’s Disability Claim
No evidence exists to indicate that the insurer attempted to investigate the new information in this case. It did not make efforts to find out if John B.’s work had suffered before his termination and did not investigate the date John B. supplied the Social Security Administration, May 21, 2007, to determine where that date came from. And, while Ms. John B.’s clarification of her comments and notes about her husband’s condition could be construed as self-serving, the testimonies of John B.’s co-workers who claimed they noticed a worsening of John B.’s temperament and behavior in 2006 was confirming of that date as being a turning point in John B.’s medical condition. The Court concluded that “from beginning to end, Sun life refused to acknowledge that the tumor might have been the cause of the deterioration of his work, or that [John B.] might in any sense have been unable to carry on his occupation, or any other occupation that could be seen as relevant to the situation.”
Relying on case law, particularly, the case of Woo v. Deluxe Corp., 144 F.3d 1157, 1161 (8th Cir. 1998), which determined that “retrospective opinions of doctors who determine that an undiagnosed condition exited and impacted the employee’s job performance before the employment must be seriously considered,” the Court granted John B.’s widow’s Summary Judgment Motion in respect to the long term disability claim, the life insurance claim, pre-judgment and post-judgment interest and costs. Summing up its decision by quoting Gaither v. Aetna Life Ins. Co., 394 F.3d 792, 809 (10th Cir. 2004) that concludes “Fiduciaries cannot shut their eyes to readily available information when the evidence in the record suggest that the information might confirm the beneficiary’s theory of entitle and when they have little or no evidence in the record to refute that theory,” the Court ruled in favor of John B.’s widow and against Sun Life Insurance.