An employee of Delta Air Lines and his disability attorney recently sued Sedgwick to recover disability benefits under the Delta Family-Care Disability and Survivorship Plan. The employee charged the insurer of illegally denying him his short term and long term disability benefits as provided for in his insurance plan and thus, neglecting to uphold its duties in approving his claim.
As a covered member of the Delta plan since January 1, 2008, Mr. A and his California disability lawyer assert that Sedgwick has an inherent conflict of interest in that the insurer is both the funder and the granter of claims per the Delta Air Line insurance plan.
Background of this Disability Lawsuit
A 48-year-old Customer Service employee at Delta Air Lines, Mr. A’s position is “classified under the Dictionary of Occupational titles as Heavy with an SVP of 2 and considered to be unskilled work.” As a result of “degenerative and traumatic injuries,” Mr. A ceased working on August 13, 2008. Mr. A suffers from major depression as a result of high blood pressure and sleep apnea. At the time of his work stoppage, Mr. A filed a claim with Sedgwick for short term disability, but was denied. Then, on April 1, 2009, he filed for long term disability benefits and was again denied. On appeal, Mr. A’s claim was again denied and Sedgwick reminded Mr. A that in order to qualify for disability benefits, he must be disabled from his “Own Occupation.”
On December 9, 2009, Mr. A pursued his administrative remedies, supplied additional information to Sedgwick that included medical records to demonstrate his totally disabled condition. Unfortunately, for Mr. A, Sedgwick again denied his claim for long term disability benefits. After continuing to file appeal after appeal, Mr. A exhausted his administrative remedies and engaged the services of a California disability lawyer to help file his lawsuit in the United States District Court of the Central District of California.
Mr. A’s Disability
Mr. A’s medical conditions include multiple exertional and nonexertional impairments. He suffers from “occulusive coronary heart disease, sleep apnea, insomnia, headaches, nervousness, high cholesterol, acid reflux disease, severe hypertension, poor concentration, major depression, anxiety and stress.” Mr. A’s treating physicians have documented his continued pain, polyneuropathy and depression. With his various conditions having severely limited Mr. A’s activities, Mr. A cannot “engage in any form of exertional activity.” Prescribed multiple medications that include narcotic pain relievers to address his multiple symptoms, Mr. A still suffers break through “pain discomfort, and limitations in functioning.”
Mr. A and His Disability Lawyer File the Subject Lawsuit against Sedgwick
According to the subject complaint, Mr. A and his California disability lawyer allege that Sedgwick wrongfully denied Mr. A his disability benefits in violation of ERISA because:
- Mr. A is totally disabled;
- Sedgwick has failed to afford proper weight to Mr. A’s evidence of disability;
- Sedgwick’s interpretation of the definition of disability in the case of Mr. A is “unreasonable, arbitrary, and capricious”;
- Sedgwick has violated its contractual obligation to provide Mr. A with his disability benefits.
In the conclusion of their complaint against Sedgwick, Mr. A and his California disability attorney, ask the court for:
- Payment of benefits to Mr. A together with interest;
- Attorney’s fees;
- Costs of filing suit; and
- Further relief as the Court deems “just and proper.”