Life Insurance Company of North America sued under ERISA in three different cases for denial to pay disability benefits
Three different lawsuits were recently filed by disability lawyers under the Employee Retirement Income Security Act (ERISA) against the Life Insurance Company of North America (LINA) in the Federal Courts of Illinois and Minnesota for improper denial of claims for disability benefits.
The First Case
In the first complaint, the plaintiff through a disability attorney filed a lawsuit in the District Court for the Northern District of Illinois. The plaintiff was employed as a general manager for SCI Funeral and Cemetery Purchasing (SCI). While working for SCI, the plaintiff participated in both a short-term and a long-term disability plan that was sponsored by SCI and underwritten and administered by LINA.
The plaintiff stopped working at his position on December 10, 2009 due to symptoms associated with a major depressive disorder, acute stress reaction, generalized anxiety disorder, personality disorder, hypertension, agoraphobia, and insomnia, along with side effects from his prescribed medications. Plaintiff claimed short-term disability (STD) benefits on December 11, 2009.
Despite multiple requests from Plaintiff, LINA failed to provide a copy of the STD disability plan, even though LINA used parts of the Plan’s language to deny benefits. Initially, LINA did pay for benefits after acknowledging Plaintiff’s disabilities in a May 14, 2010 letter, but only through April 10, 2010.
STD benefits were stopped on May 27, 2010; LINA claimed that Plaintiff no longer met the Plan’s definition of disability. Plaintiff appealed the denial letter and submitted extensive medical evidence to prove his disability, but LINA again denied Plaintiff LTD benefits on October 27, 2010. As all administrative appeals have been exhausted, Plaintiff filed this lawsuit.
The Second Case
This lawsuit was filed at the District Court for the District of Minnesota Fourth Division by a disability attorney. The plaintiff was an employee for Aldi. She was provided with a LTD coverage plan that was fully insured and administered by LINA. Due to her salary, Plaintiff was a Class 1 employee under the Plan.
During her time working as a full time store manager for Aldi, in or about October 2005, Plaintiff unloaded a grocery truck at Aldi and sustained an injury that caused pain in her back and lower-right extremity. This same incident occurred again in or about May 2006 and on or around July 12, 2006. After the July incident, Plaintiff was no longer able to work as a Store Manager.
Despite several treatment methods, including facet joint blocks, right transforaminal epidural steroid injection, a three-level lumbar discography, and a spinal rehabilitation program, from November 2, 2006 to May 30, 2007, little to no improvement was made in her condition. On or around April 22, 2007, Plaintiff filed a claim for LTD benefits with LINA. LINA granted LTD benefits on September 5, 2007, with the period beginning January 11, 2007 after a benefit waiting period of 180 days.
Plaintiff underwent recommended intradiscal injection on October 4, 2007. On or around November 21, 2007, LINA informed the Plaintiff that LTD benefits would be terminated and that her claim would be denied beyond October 19, 2007. LINA’s claim was that there was no longer continuing documentation to support Plaintiff’s inability to perform her own occupation.
Plaintiff appealed denial. On or around February 6, 2008, LINA reversed its denial and reinstated Plaintiff’s LTD benefits. Plaintiff underwent more procedures to reduce her lower back pain between April 2008 and August 2009. LINA again informed Plaintiff that it was terminating her LTD benefits in October 2009 because the medical information on file no longer supported that she could not do her occupation.
On or around November 10, 2009, LINA stopped paying Plaintiff’s LTD benefits. Plaintiff immediately appealed this denial, supplying medical evidence and undergoing tests to prove she was so disabled that she could not continue her occupation. On or around December 18, 2009, LINA again denied the Plaintiff of LTD benefits. Plaintiff again appealed on June 16, 2010 after undergoing more procedures and supplying more evidence to LINA. After continuous dialogue and submittal of evidence from the Plaintiff to LINA, LINA again denied Plaintiff LTD benefits on November 23, 2010, stating that the Plaintiff can do sedentary work based on observance of videos provided to LINA. Since all administrative levels of appeal were exhausted, Plaintiff filed this lawsuit.
The Third Case
The third case was filed by a disability attorney at the District Court for the District of Minnesota Fourth Division. The suit alleged that LINA denied LTD benefits beyond Dec. 16, 2009 despite the Plaintiff undergoing numerous operations and procedures for a fall that occurred in her cabin on August 10, 2009. It was very difficult for the Plaintiff to comply with LINA’s requests for updated medical records since both LINA and Lakeview Clinic, where Plaintiff received continuous treatment for her injuries, would not cooperate on providing updated medical records in a timely fashion.
LINA claims that the records did not indicate a continuation of benefits was needed beyond December 16, 2009, despite numerous submissions by the Plaintiff toward her injuries and treatments. On August 20, 2010, LINA again denied the Plaintiff’s continuation of LTD benefits. Plaintiff appealed this denial on November 2, 2010, including additional medical evidence to support her disability claim. LINA again denied her claim on January 18, 2011, citing no “consistent functional impairment.”
Relief Sought in the Lawsuits
In the three mentioned cases, the relief sought by the plaintiffs from LINA in their lawsuits comprises of:
- A judgment that the plaintiffs are entitled to LTD benefits under their respective plans
- Benefits that have not been paid to be paid with interest
- An award of attorney’s fees and costs
- Any other relief that the court deems just and appropriate