Ricky C. Hampton, an insurance sales agent with Alfa Mutual Insurance Company (Alfa) has filed a lawsuit against his own disability insurance company, Liberty Life Assurance Company of Boston. A position described as light, Hampton was required to work forty hours per week, five days a week and was frequently asked to perform the following duties, all of which were documented in his job description.
- Perform physically in an office for at least 40 hours per week and meet with clients, accurately complete paperwork make prospect calls and perform other chores in the course of business selling and servicing insurance needs.
- Drive to clients and prospective clients’ homes to sell policies.
- Walk and perform other physical tasks to inspect, measure, and photograph insurance properties, which may require walking up and down stairs and navigating uneven terrain.
- Effectively communicate with clients and company employees.
- Think clearly and solve problems.
Hampton’s typical day consisted of paperwork and calls in the morning and field work in the afternoon. He sat for prolonged periods and also frequently walked, climbed, squatted, bended, stooped, and reached to accomplish his job requirements. Covered under a Liberty Life Assurance Disability plan, Hampton filed his disability claim with Alfa after succumbing to “intractable back and leg pain” in January of 2009. In February 2009, Hampton underwent lumbar spinal fusion surgery. He also underwent rehabilitation and follow-up treatment, and even though Hampton was conscientious to fulfill his therapy treatments, Hampton’s leg pain persisted and continues to disable him from performing his work duties.
Alfa Initially Paid Hampton His Long-Term Disability Benefits
As expected, Alfa paid Hampton his long-term disability benefits from April 9, 2009 until April 16, 2010, at which time, Alfa terminated Hampton’s benefits. This termination was in response to Hampton’s Social Security Disability application; and even though Hampton didn’t qualify for Social Security disability benefits, the insurance provider first offset Hampton’s benefits by the amount they determined Social Security would pay and later terminated Bennett’s disability benefits. Alfa’s decision to terminate Hampton’s benefits was made when Alfa reviewers, who had never actually seen Hampton, determined that Hampton was not disabled by relying on erroneous medical file and failed to check with Hampton’s regular physician to verify their findings.
The reviewer of Hampton’s records determined that Hampton should be okay as a result of his surgery and simply decided that Hampton had to be able to perform his duties as an insurance sales agent. Relying on this reviewer’s report, Alfa terminated Hampton’s disability benefits and closed his file on April 17, 2010.
Unfortunately, Hampton still suffered and continues to suffer from “unrelenting back and left leg pain and numbness.” Hampton describes his pain as being constant, sharp and burning, causing him concentration problems. To battle his pain, Hampton takes a narcotic pain medication which gives minimal relief and interrupts his sleep.
Hampton’s Job History
Hampton performed his duties as an insurance sales agent for eight and a half years prior to his disability, and was required to walk, climb, squat bend, stoop and reach while performing inspections of properties. In his lawsuit, Hampton and his disability attorney allege that the Insurance provider in this lawsuit erroneously concluded that Hampton’s job duties did not require these physical actions and that his chronic back and leg pain would not restrict Hampton from performing his duties as an insurance sales agent. Upon the denial of his claim, Hampton provided Alfa with complete documentation of his disability and requested that the insurer provide an appropriate, in person, evaluation of his condition by an independent doctor and vocational rehabilitation specialist. In response, Alfa, while it acknowledged Hampton’s request, again denied Hampton’s request for reinstatement of his disability benefits and upheld its previous position to terminate Hampton’s benefits.
After obtaining Social Security Disability benefits and providing more medical documentation of his condition, Hampton appealed Liberty Life’s decision on July 19, 2010. Again Alfa reconsidered Hampton’s claim and again denied Hampton his disability benefits. At that time Hampton had exhausted all his claim appeals and was forced to file this subject lawsuit.
Armed with Hampton’s physician’s medical records that Hampton’s medical condition is debilitating, Hampton’s disability attorney filed Hampton’s complaint in the United States District Court for the Northern District of Alabama Middle Division to let a Court decide if Hampton was entitled to his disability benefits as provided in his plan with Alfa.
Hampton’S Complaint Against Alpa
In the complaint Hampton’s disability lawyer notes that:
- Alfa denied Hampton his disability benefits in error in conflict with the insurer’s previous decision to pay those benefits.
- Alfa acted unfairly by ignoring substantial evidence that substantiated Hampton’s disability.
- Alfa acted unfairly by selectively reviewing evidence in a manner that supported their decision to terminate Hampton’s long-term disability.
- Alfa acted unfairly and with a conflict of interest by using the services of a physician and vocational consultant without having them conduct a face to face evaluation of Hampton.
In his lawsuit against Alfa, Hampton asks for all past due long-term disability benefits, current long-term disability benefits, attorney’s fees, interest, and any other relief the Northern District of Alabama Middle Division Court determines to be reasonable.