Epileptic auto technician sues Lincoln National Life Insurance Company (formerly Jefferson Pilot Financial Insurance Company) for denial of disability benefits

A lawsuit was recently filed against Lincoln National Life Insurance Company (formerly Jefferson Pilot Financial Insurance Company) by a husband and wife couple, Dale and Georgina Eckman, through their disability attorney to seek the recovery of disability benefits rightfully due to Mr. Eckman under a long term disability insurance policy. The plaintiffs alleged that the Jefferson Pilot Financial Insurance Company (Jefferson Pilot) had acted in bad faith in denying the plaintiff his claim for disability benefits.

The Background of the Case

The plaintiff Dale Eckman was employed as an Auto technician by Lund Cadillac, LLC since April 1999. In January 2004 while employed at Lund Cadillac, LLC, the plaintiff enrolled in a Voluntary Long Term Disability Insurance Program offered by his employer through Jefferson Pilot. Consequently the plaintiff was issued a Certificate of Insurance by Jefferson Pilot on March 1st 2004. During the enrolment period, Mr. Eckman also disclosed to Jefferson Pilot that he had recently developed seizure issues but it was well controlled with medication. The seizure condition which Mr. Eckman was suffering from developed when he was an adult and it occurred at the part of the brain that manages memory. Although Mr. Eckman is able to function after he suffered a seizure attack, he would have no recollection of the activities that he was engaged in for about an hour after the seizure attack.

Certified as ASE Master Technician since 1979 and a GM Master Technician since 2001, Mr. Eckman’s job involved conducting test drives on customers’ cars to diagnose problems for repairs at the car dealership. His earnings from April 1999 to January 2007 ranged from $70,000 to $84,000. For the years 2000 to 2006, Mr. Eckman was earning approximately $84,000 annually.

Reassigned as a Service Adviser

On December 27th 2006, Mr. Eckman had a seizure attack while working. Because of the risk and possible liability associated with his condition, he was reassigned from being an Auto technician to be a Service Advisor at another Lund Cadillac, LLC dealership earning approximately 70% of his prior salary as an Auto technician.

1st Change of Employment

On May 2007, Mr. Eckman left his employment with Lund Cadillac, LLC for another company called Airpark Auto Service in order to work as an Auto Technician. Although Mr. Eckman was working as an Auto Technician with Airpark Auto Service, he was only earning approximately 50% of his prior salary at Lund Cadillac, LLC. Mr. Eckman also suffered another seizure attack during his tenure at Airpark Auto Service. At the same time, he was given 3 to 4 warning letters regarding faulty work which had never happened before and eventually led to his termination of his job in April 2008.

2nd Change of Employment

Mr. Eckman found alternative employment at another auto repair shop called Ultimate Auto Repair in May 2008 earning just 40% of his prior salary at Lund Cadillac, LLC. On December 4th 2008, while driving home from work, he suffered another seizure and had an accident involving two other vehicles. After the accident, Mr. Eckman left the employment of Ultimate Auto Repair.

When consulting his attending physician in January 2009, Mr. Eckman was advised to stop working because of the risk of serious injury to himself and others while driving or working on cars. Even then, Mr. Eckman attempted to look for a job as an Auto Technician with several potential employers but was unsuccessful.

Notice of Claim

As a result of his disability, Mr. Eckman filed a claim for long term disability benefits with Jefferson Pilot on August 4th 2009. All necessary medical documentations, the employer’s statement, employee’s statement and the physician’s statement was submitted by Mr. Eckman to Jefferson Pilot to enable Mr. Eckman’s claim be processed and approved.

On September 29th 2009, Jefferson Pilot informed Mr. Eckman by way of correspondence that his claim for long term disability benefits was denied due to the following reasons:

1st Appeal to Jefferson Pilot

Mr. Eckman appealed to Jefferson Pilot’s decision to deny his disability benefits on October 20th 2009. Jefferson Pilot on January 25th 2010 determined that Mr. Eckman’s date of disability for the “Own” occupation category was from March 10th 2007 to September 6th 2010. Jefferson Pilot further determined that although Mr. Eckman was totally disabled from the “Own” occupation category, he was not totally disabled as to exclude him from the “Any” occupation category. As such, Mr. Eckman was not entitled to any disability benefits beyond September 6th 2010.

2nd Appeal to Jefferson Pilot

On March 25th 2010, Mr. Eckman appealed again to Jefferson Pilot for its decision to deny him any long term disability benefits beyond September 6th 2010. on May 13th 2010, the Lincoln National Life Insurance Company (having taken over Jefferson Pilot) denied Mr. Eckman’s claim under both the Total disability and Partial disability provisions of the policy.

3rd and 4th Appeals by the plaintiff

On May 25th 2010, Mr. Eckman appealed to the Lincoln National their denial of coverage under the Total disability and Partial disability provisions of the policy. Lincoln National replied on 19th July 2010 again denying Mr. Eckman’s claim. Mr. Eckman then submitted another appeal to Lincoln National on August 23rd 2010 to which Lincoln National responded on January 31st 2011. In their reply to Mr. Eckman, Lincoln National made its final determination that Mr. Eckman was no longer totally or partial disabled under the terms of its policy. Lincoln National also indicated to Mr. Eckman that he had exhausted all rights of appeal.

Claims for Relief in the Lawsuit

In the lawsuit, the plaintiffs alleged that Jefferson Pilot/Lincoln National had breached its contract resulting in Mr. Eckman suffering substantial damages. The plaintiffs also argued that Jefferson Pilot/Lincoln National had acted in bad faith by intentionally withholding, delaying, underpaying and denying Mr. Eckman his disability benefits. As a result of Jefferson Pilot/Lincoln National’s conduct, Mr. Eckman had suffered and is still suffering from anxiety, worries, mental and emotional distress, physical distress and loss of time and expenses incurred. As such, the plaintiff is seeking from the Court:

The plaintiffs also pleaded in the event that the Court finds that the policy fall under ERISA, the plaintiffs are seeking, for Jefferson Pilot/Lincoln National acting arbitrarily and capriciously and abusing its discretion, the following remedies:

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There are 2 comments

  • Then we have the across the board medical experts/PHDs that regularly and routinely automaticaly state the causes as “congenital” thereby preculding a claiment from fair or simple littigation(s) in attempts to collect for damages that resulted in otherwise collectable instances!

    It is not just the Insurance Companies, it is also the medical profession turned “traitor” against a patient for the favor of the insurance companies that pay their extravagant billing practices. It is always advisable to be very careful/reserved in letting on about pre-existing conditions and especialy that any referal/examination/diagnosis is relative to any sort of claim against another party, as physicians see this as a red light to be completely honest regarding the diagnosable truth of the symptoms or damage. This is also why physicians do not want to comply with patients requests for posession of records, or allow recording devices or witnesses.

    J. B.Nov 12, 2011  #2

  • If the claimant was not able to drive due to his medical condition, how was he to commute to a job, IF he could get a job?

    Under the terms of the insurance contract, “any occupation” education, jobs available (it’s broad in scope) however GAINFUL OOCUPATION) is typically defined as an ability to earn 60% of pre-disability income. If he was covered up until JUNE 2008, the terms of the insurance contract should be upheld in favor of the claimant in this instance.

    Was the claimant ever able to earn 60% of his pre-disability income and in what time frame and what subsequent employment are they using to determine the % amount?

    Tactics as this upset me. The insurance company, again forking over Attorney fee’s and battling a disabled claimant for years for funds rightly owed and due to them as defined in the contract. The claimant is left to battle this for years, while the insurance company uses the funds they have set aside for not just him, but other claimants they are doing this to, making huge interest off those very funds in the interim.

    In the end, when they finally agree to provide the past owed funds, they will have made so much interest, paying Attorney fee’s, and small interest will have no impact because they have MADE MORE MONEY by withholding these very funds from claimants.

    The claimants however are ruined instantly, who will pay their mortgage, their food bill, electric or other. They had insurance that was supposed to protect a portion of their income if they became disabled, the contract is not being upheld, the claimant is not just instantly ruined, the rest of their life is negatively impacted on the instant acts of the insurance company.

    The laws MUST change in ERISA to allow for punitive damages in the instances. Until the insurance companies are hit in the pocket for their corruption they will continue to act in this manner and WHY NOT, these acts themselves allow them to increase their profit!

    Randy T.T.May 23, 2011  #1

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