Nestle Waters employee sues Assurant for denial of disability benefits under ERISA

A disability attorney recently filed a Federal lawsuit in Pennsylvania against Assurant, Inc. (Assurant), Assurant Employee Benefits (AEB), and Union Security Insurance Company (Union).

The plaintiff was employed by Nestle Waters North America Holdings, Inc. (Nestle), who contracted with Assurant, AEB, and Union to provide long-term disability benefits to its employees. By virtue of his employment, the plaintiff was covered by Nestle’s Group Long-Term Disability Plan (The Plan).

The plaintiff filed a disability lawsuit under the Employment Retirement Income and Security Act (ERISA) to recover long-term disability benefits that were wrongfully withheld by the aforementioned Defendants.

The Facts of the Case Against Assurant, AEB, and Union

The disability policy issued by Assurant, AEB, and Union to the Plaintiff defines “disability” according to the following terms:

Plaintiff has suffered from severe residual affects secondary to displacement of cervical, thoracic, and lumbar discs, resulting in bilateral lower extremity pain and numbness, neck pain, back pain, decreased range of motion, radiculopathy, and myofascial pain syndrome since August 6, 2008.

Defendants approved Plaintiff’s claim on September 3, 2009 for benefits through June 26, 2009.
Payments were made to the Plaintiff from February 3, 2009 to June 26, 2009.

Plaintiff’s medical history is well documented via Dr. Robert Sing’s (Dr. Sing) December 15, 2009 correspondence. He has treated the Plaintiff since March 2009, diagnosing fibromyositis of the cervical, dorsal, and lumbosacral spine that has resulted from the musculo-ligamentus sprain and strain of the cervical, dorsal, and lumbosacral spine, the cervical disc herination at C6-7, post-traumatic myofascial pain syndrome, exacerbation and aggravation of degenerative disc and joint disease of the cervical, dorsal, and lumbosacral spine. Dr. Sing concluded that Plaintiff will continue to have significant pain and muscle spasms on a permanent basis.

On June 25, 2009, Plaintiff underwent a functional capacity evaluation (FCE) under the supervision of Jim Schickling, P.T., at the direction of the insurer. The FCE showed that the Plaintiff could exert up to 50 pounds of force occasionally, up to 25 pounds of force frequently, and up to 10 pounds of force constantly.

Denial of Nestle’s Group Long-Term Disability Plan

After Defendants concluded Plaintiff could still work for Nestle as a Bakery Driver, Defendants denied Plaintiff long-term disability benefits via a letter on September 3, 2009.

Dr. Sing addressed the results of the June 25, 2009 FCE and stated that “the patient is suffering from pain and this would limit his ability to function in the work place.” Dr. Sing also mentioned that the patient could only lift 10 pounds on occasion, rarely 20 pounds, and never 50 pounds. Dr. Sing also mentioned that Plaintiff’s pain and other symptoms would prevent from concentrating to perform simple tasks.

Plaintiff responded to defendants’ decision to terminate his benefits via a letter sent on or around January 4, 2010, stating that the defendants’ Labor Market Survey was for a driver, not for a Route Salesperson, as he was prior to his injury and present condition, and the opinion of Dr. Sing that the Plaintiff could no longer work effectively due to his present condition.

Defendants upheld their decision to deny long-term benefits via letter to Plaintiff on April 7, 2010, claiming that Plaintiff could handle the occupations of a driver based on the definition of a driver under “Dictionary of Common Occupations.”

Plaintiff submitted final appeal via letter to Defendants on or about April 15, 2010, again stating that the Plaintiff’s former occupation was that of a “Route Salesperson” and not that of a “Driver.” Defendants denied Plaintiff’s final appeal on June 1, 2010.

Disability Lawyer Files Lawsuit Against Assurant, Assurant Employee Benefits, and Union

According to the lawsuit filed, the plaintiff alleged that Assurant, AEB, and Union failed to provide the following to the plaintiff:

Relief Sought By The Plaintiff In The Assurant, Assurant Employee Benefits, and Union Lawsuit

Due to the actions of Assurant, AEB, and Union, Plaintiff seeks the following relief from the Court:

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There is one comment so far

  • My husband is off-work at this time for an approved medical illness. As a teacher there is a clause in the Assurant long term disability plan to convert the calculation for benefits from a 10 month contract to a 12 month division that ultimately results in a reduction of his 75% payment. Contrarily the calculation they are using for his sub offset differential is the daily rate $66,000 divided by approx 200 days. His cost to pay his sub is $212 a day and the insurance company states he is receiving the difference which is not true. Ultimately he ends up receiving approximately 48% of his salary. The lady who is working with us is speaking to us like we are stupid and just don’t understand the way its calculated. We understand very well that the adjusters are reducing his monthly salary by calculating it at 12 months not 10 and then using the 10 month calculation to factor back in his sub differential. Crooks. I am contacting the State Insurance inspector. This is fraud.

    Terri MitchellNov 21, 2012  #1

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We represent Assurant clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Assurant disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Assurant. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Assurant.

How do you help Assurant claimants?

Our lawyers help individuals that have either purchased a Assurant long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Assurant:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
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Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

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Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

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Eloisa V.

I am a 62 year old woman that got ill and was unable to work. I had long term insurance that was paid by my job. One day I received a letter from the Hartford insurance company saying that I would not get paid any more since they thought I could perform any job.

I did not know what I was going to do since I could no longer work and my social security was not enough to pay my bills. I called a lot of attorneys in California and was not able to get a lawyer to take my case. I went on line and found Attorneys Dell & Schaefer. The reception took my name and in less than an hour I got a call from attorney Stephen Jessup. I told him what was happening and he listen to me and started the paper work. Now I’m a very happy person because Attorneys Dell & Schaefer won my appeal and got my long term insurance payment started again. They are always on top of things.

I have been very pleased with them and their office staff because when I call their office I always talk to a real person, they are very fast at calling me back and answer all my questions. I would highly recommend their service to anyone in need of an attorney.

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