Despite numerous disabling medical conditions, The Standard Insurance Company Denied disability benefits. The plaintiff was a medical secretary working at a private practice. By virtue of her employment, the plaintiff became eligible for coverage under the Standard Insurance’s Select Trust Group Policy, Long Term Disability Benefits, Group Policy. Under the terms of the Plan, Standard Insurance is the Plan fiduciary and insurer.
In 2004, due to two (2) motor vehicle accidents, the plaintiff was left with neck and back pain, upper and lower extremity numbness and tingling. As a result, the plaintiff underwent a series of lumbar injections, discogram and disc decompressors at the L4-L5 and L5-S1 and S1. According to the lawsuit, despite these treatments, as well as the prescription of a daily dosage of 50 mg oxycontin, the plaintiff continued to have chronic lower back pain for the next few years.
In May 2006, the plaintiff decided to have back surgery to relieve her of the chronic pain that she was suffering from. Despite several months of recuperation, the plaintiff still suffered from severe back pain. Nevertheless, the plaintiff tried to return to work in September 2006. Unfortunately, upon returning to work, the plaintiff’s medical condition only worsened. Finally in May 2007, the Plaintiff underwent a second back surgery. According to the lawsuit, despite the two surgeries, the Plaintiff’s back pain never resolved. Consequently, the plaintiff underwent treatment for pain management. Her attending physician diagnosed the plaintiff in the latter part of 2007 with “Failed Back Syndrome”.
Award of Long Term Disability Benefits
In January 2008 following a routine evaluation, the Plaintiff diagnosed with acute myeloid leukemia. The plaintiff stated in the lawsuit that irrespective of her diagnosis of leukemia, her severe pack pain continued and she became unable to work on January 28th 2008.
Shortly thereafter, the Plaintiff made an application to the Standard Insurance for long term disability benefits based on her disability. As result, the plaintiff was awarded long term disability benefits on April 28th 2008 after the ninety day elimination period. The plaintiff stated that on October 6th 2008, the Plaintiff was also awarded Social Security Disability Benefits as a result of her disability.
Termination of Disability Benefits
When the plaintiff’s leukemia went into remission, Standard Insurance terminated the plaintiff’s long term disability benefits on February 23rd 2010 on the ground that:
In summary, you ceased work due to a diagnosis and treatment for leukemia. The documentation supports you have not had a recurrence of leukemia. You have had some side effects that include peripheral neuropathy, lower extremity edema and depression. There is no satisfactory proof that these conditions are of a severity to preclude full time sedentary level work.
The plaintiff alleged that Standard Insurance had totally ignored her well documented back pain and “failed back syndrome” but choose to focus only on her leukemia.
On June 28th 2010, the plaintiff appealed the denial of benefits and submitted several reports to support her claim of total disability. Despite the overwhelming medical evidence of the plaintiff’s back problem, Standard Insurance on August 16, 2010, reaffirmed its prior decision to terminate the Plaintiff’s long term disability benefits. The focus was again on the fact that Plaintiffs leukemia was in remission and ignored all of her well documented back pain.
Legal Basis For Lawsuit Against Standard Insurance Filed By Disability Lawyer
In the case of Donna Lee Seitz vs. The Standard Insurance Company filed at the District Court for the District Of New Jersey by a disability attorney, the plaintiff alleged that The Standard Insurance Company (Standard Insurance) arbitrarily and capriciously terminated her long term disability by ignoring all of her well documented back pain.
The plaintiff argued that Standard Insurance’s final decision on August 16th 2010 denying her appeal was arbitrary and capricious because:
- Not based on any substantial evidence.
- Failed to properly investigate the Plaintiff’s claim and failed to consider her treating physicians’ opinions.
- Failed to consider the devastating effect of medication on the Plaintiff’s ability to function.
- Failed to consider the plaintiff’s own subjective complaints and ignoring the compelling evidence of the plaintiff’s back pain and her inability to sit for any length of time.
- Standard Insurance is acting under a clear conflict of interest
- Standard Insurance’s decision on August 16, 2010 constitutes a breach of the its fiduciary duty owed to the Plaintiff under ERISA.
Relief Sought by the Plaintiff
The plaintiff is seeking from the Court the following relief:
- Declaring that the plaintiff is totally disabled within the meaning of Standard Insurance’s group Policy.
- Ordering Standard Insurance to immediately place the Plaintiff back on claim for total disability under the terms of the policy, retroactive to February 23, 2010.
- Awarding to the plaintiff her costs of suit, including reasonable attorney’s fees.
- Awarding to the plaintiff interest on all unpaid benefits.
- Granting such other and further relief as the Court may deem just and proper.