Court Takes Sun Life To Task For Denial Of Disability And Life Insurance Benefits Of Man With Brain Tumor

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.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

View videos, articles, resolved cases and claimant reviews about your specific disability insurance company.

Leave a comment or ask us a question

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us