A recent Sun Life disability claim by a gunshot victim ended up as a lawsuit in the Orange County Superior Court because of the reluctance of the disability insurance company to pay out any long term benefits to its plan’s participants. In Marilyn Ellis v Sun Life Assurance Company of Canada, the plaintiff Marilyn Ellis with her disability attorney contended that she was at all times a participant to a group long term disability plan with the policy number 63311 that was provided by the Sun Life Assurance Company (Sun Life). As such, she argued that she was a beneficiary of the plan and is entitled to the long term disability benefits that were offered in the plan.
The Background of the case
According to the lawsuit, the plaintiff while working was seriously wounded as a result of being struck by a stray bullet on October 27th 2006. Since then, the plaintiff had become disabled. Due to the injury, the plaintiff filed a civil suit as well as a claim for worker’s compensation benefits. These matters were later settled through provisions made for the plaintiff to seek long term disability benefits under the long term disability plan issued by Sun Life. At the same time, the plaintiff was also terminated from her employment with the settlement of this matter.
Claim for long term disability benefits
Subsequently, with the settlement of the civil suit and claim for worker’s compensation benefits, the plaintiff made a disability benefits claim with Sun Life under the Claim No.161208-00384-00. The plaintiff contended that as a result of her gunshot injury, she suffered from “weakness of the right elbow, continuous trembling and numbness in her fingertips to the right hand with low grip strength, stiffness in the upper thoracic spine resulting in shortness of breath, inability to walk even short distances, constant aching and sharp pain in the low back with increased pain after prolonged standing, sitting, walking and laying down”. In addition to these symptoms suffered by the plaintiff, she also complained of having a low tolerance to stress, tiring easily, limited intimacy ability, weight gain, depression and moods spells. A consequential result of her disability, the plaintiff suffered from financial difficulties and inability to find employment that can take into account of her trauma and injuries.
Denial of claim for long term disability benefits
On May 12th 2009, Sun Life informed the plaintiff that her claim for long term disability benefits was denied on the grounds that:
- The plaintiff has the functional ability to perform the job of a receptionist with supported medical restrictions and limitations.
- The plaintiff did not satisfy the required 365 elimination period of disability.
- There were no evidences that the plaintiff was suffering from psychological trauma after March 12th 2007.
- The continuing back injuries that the plaintiff suffered from were from a prior condition.
The plaintiff argued that as a direct result of Sun Life’s conduct, she had suffered monetary losses which will be established with proof during the trial process. It was also argued that Sun Life lack of empathy and failure to pay long term disability benefits to the plaintiff while she was seriously disabled had caused her severe financial hardships.
Hence, the plaintiff through her California disability attorney is seeking a judgment from the court to compel Sun Life to:
- To award all benefits due to her pursuant to the plan and clarification of rights to any available future benefits;
- To award attorney fees and cost based on proof;
- Interest and any other relief which the court may deem equitable.