Eric Wilson has brought a lawsuit in the United States District Court of the Eastern District of Louisiana against Reliance Standard Insurance Company and Lincoln National Life Insurance Company because the companies have refused to reply either pro or con to his petition for disability benefits in compliance with his insurance policy contract.
Background of Wilson’s Disability Benefits Claim
Reliance and Lincoln National issued an insurance policy to Eric Wilson when Wilson was employed at Centaur LLC and/or Associated Terminals in the Parish of Orleans, State of Louisiana. At the time of his disability application, Wilson was in possession of a valid short and long term disability insurance policy provided to him through his employer. On September 29, 2009, Wilson was injured at his job. He sustained injuries to his neck and back. Having met the requirements to be classified as medically disabled, Wilson applied for his disability benefits on March 15, 2010. Wilson was not awarded benefits nor did he receive a response about his application from either Reliance or Lincoln National.
He filed an appeal of his disability claim with the insurance providers on May 17, 2010 and included documentation and verifying medical records to corroborate his disability. Again, his request to have his claim evaluated was ignored. In his lawsuit, Wilson states that his treatment by Reliance and Lincoln National was both arbitrary and capricious. After filing his second appeal, which again resulted in no response from the insurance providers, Wilson filed a third appeal on June 30, 2010 as well as a fourth appeal on January 20, 2010.
Again and again, Reliance and Lincoln National failed to deny, approve, or acknowledge either Wilson’s original claim or his appeals. Consequently, Wilson has resorted to hiring a disability attorney and filing a lawsuit in the United District Court of the Eastern District of Louisiana in an attempt to force Reliance and Lincoln Nation to, at the very least, respond to his application. As of the filing of the lawsuit, neither Reliance nor Lincoln National have paid any retroactive benefits or any disability benefits, and in fact, have not acknowledged Wilson’s claim at all.
Wilson has asked for damages as provided by ERISA and Louisiana contract law because of the insurance provider’s actions and lack of actions in excess of $ 600,000.00 and asks for damages for his emotional and psychological damage. Specifically Wilson and his disability lawyer enumerate Wilson’s damages to include:
- Penalty/double damages
- Interest on amount owed
- Attorney fees
- Loss of past, present and future benefits
- Loss of reputation
- Loss of credit standing and self esteem
- Other miscellaneous damages
Legal Merits of Wilson’s Disability Claims
As stated in his claim, Wilson relies on Louisiana Civil Code, Article 2315, which would support that Reliance and Lincoln National are liable “for acts causing damages” that entitle Wilson to recover from “every act whatever of man that causes damage to another obliges him by whose fault it happened to repair it.” In addition, Wilson’s claim is made under Louisiana Civil Code, Article 2316, entitled “Negligence, imprudence or want of skill,” which states that “every person is responsible for the damage he occasions not merely by his act, but by his negligence, his imprudence, or his want of skill.”
Finally, and probably most importantly, Wilson bases his claim on Reliance and Lincoln National’s breach of their contract with him to provide Wilson with disability benefits when he qualifies for disability benefits under his contract with the insurers. A breach of contract means that a party has failed to adhere to the promises that party made in a contract and thus allows the damaged party to seek legal remedies for the breaking of those promises.
In his complaint, Wilson petitions the Court to force Reliance and Lincoln National to appear and answer his complaint. He also requests that a judgment be granted in favor of Wilson and that Reliance and Lincoln National be penalized for their actions; or in this case, their inaction.