Disabled Georgia man sues Boston Mutual for denial of disability benefits

A Georgia disability attorney recently filed a federal ERISA disability lawsuit against Boston Mutual Insurance Company of America and Disability Reinsurance Management Services (DRMS) to recover long-term disability benefits that were wrongfully withheld.

The plaintiff was employed by Green Island Country Club who contracted with Boston Mutual Insurance Company to provide disability benefits to its employees. By virtue of his employment, the plaintiff was covered by Green Island Country Club’s Overall Welfare Benefit Plan.

The Facts of the Case Against Boston Mutual Insurance Company

The disability policy terms issued by Boston Mutual to Plaintiff defines “disability” and Boston Mutual’s financial responsibilities to disabled Participants as follows:

Plaintiff went on disability October 4, 2007, was found to be disabled, and was paid up until January 2, 2010.

Denial of Boston Mutual Benefits Claim

By letter dated May 14, 2009, Boston Mutual terminated Plaintiff’s benefits due to not enough medical evidence supporting disability claim.

On July 19, 2010, Plaintiff hired services of a disability lawyer who ordered the claims file.

The attorney discovered on or about August 24, 2010 via the claims file that a denial letter was dated December 23, 2009. Plaintiff did not appeal this denial within the 180-day period.

Plaintiff, through the attorney, requested DRMS via certified letter on August 24, 2010 to reopen the file, as it appeared that the Plaintiff was very mentally slow. Plaintiff added updated medical records to the file.

On September 7, 2010, Plaintiff received letter from DRMS that returned all of Plaintiff’s information and that stated that since the Plaintiff missed the 180-day period to appeal by 2 months, DRMS would not reopen Plaintiff’s claim.

On September 13, 2010, Plaintiff, via letter through the attorney, informed DRMS that he was uncertain whether he even received the denial letter from December 23, 2009. Since DRMS did not send the letter by certified mail or via any other traceable method, DRMS could not prove that it was sent, so Plaintiff asks again for DRMS to reopen the file, reiterating again that Plaintiff is very mentally slow.

On September 15, 2010, Plaintiff sends additional information and asks DRMS to reopen the file.

Two more attempts to reopen the file were denied by DRMS, even with an inclusion of a Neuropsychological Evaluation that showed that the Plaintiff had a cognitive disorder that caused severe deficits in his attention, concentration, visual memory, and processing speed.

Disability Lawyer Files Lawsuit Against Boston Mutual And DRMS

According to the lawsuit, Plaintiff alleged that Boston Mutual and DRMS have failed to:

Relief Sought By The Plaintiff In The Boston Mutual And DRMS Lawsuit

As a result of Boston Mutual and DRMS’ actions, the Plaintiff seeks the following relief from the Court:

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