Sunlife denies disability benefits to Wise Foods employee disabled by cancer and shoulder surgeries

John McGinnis has filed a lawsuit against Sun Life Assurance Company of Canada because the insurer denied him his disability insurance benefits and life insurance coverage as dictated by ERISA 29 U.S.C. § 1001 et seq. According to the Complaint that McGinnis and his disability attorney filed in the United States District Court of New Jersey when the insurance company denied him his disability benefits and life insurance benefits the insurer was fully aware of McGinnis’s history of longstanding medical conditions that entitled him to disability benefits when it denied him disability benefits.

Disability Lawyer Files Mcginnis’ Complaint Against Sun Life And Wise Foods

The Complaint that McGinnis and his disability attorney filed alleges that Sun Life and Wise Foods, Inc. “unlawfully and unreasonably denied McGinnis’ benefits without justification and without granting him full and fair review of his claim of benefits… improperly rejected and ignored the opinion of McGinnis’ treating physicians in an attempt to deprive him of LTD benefits due… improperly introduced extra-contractual requirements beyond the proof of claim set forth in the Policy… failed to provide reasonable claims procedure that would yield a decision on the merits of McGinnis’ claim… [and] improperly conducted a biased review of the claim which led to the denial of benefits due.”

As a result of this Complaint, McGinnis and his disability attorney ask that the Court allow McGinnis to receive his past-due disability benefits, receive reinstatement of his benefits and receive his long-term disability benefits as long as he proves is disability is ongoing. In addition, McGinnis wants to receive all other benefits that he is entitled to which includes life insurance coverage of $90,000.00 as well as attorney’s fees and any other remedies the Court sees fit.

History Of The Case

A 58-year-old man, John McGinnis started working at Wise Foods in 1989. During his 19 years of employment at Wise Foods McGinnis held many positions beginning as the Sales Manager at the Snack Distributors Branch of Wise Foods, Inc. and was promoted time after time from the position of Sales Manager at the Snack Distributors Branch by moving through the ranks to the position of Director of Sales. In December 2005, McGinnis was diagnosed with cancer on the base of his tongue, at which time he underwent aggressive cancer treatment, including radiation and chemotherapy. As a result of these treatments, McGinnis was placed on a feeding tube for a ten month period. Being declared to be in remission in October 2006, McGinnis was still weak and was unable to work because of his extreme weakness, exhaustion, and difficulties eating and swallowing.

The Social Security Administration declared McGinnis disabled in September 2006 and retroactively awarded monthly disability benefits of $1,053.00 going back to June of 2006. Not working for two years, McGinnis received disability benefits from an insurance company that at that time provided long-term disability benefits to Wise Foods employees. Then, in July 2007, McGinnis attempted to return to work with accommodations, working three days per week at a Wise Foods facility and two days at home. His health deteriorated, and McGinnis developed other symptoms that included “peripheral neuropathy, constant fatigue and exhaustion, shoulder, back and neck pain, difficulty speaking due to tongue swelling, dry mouth, ongoing open sores in his mouth, as well as throat damage that caused him choking and pain.”

In January 2008, McGinnis’ condition got so bad that he ceased working and filed for short term disability benefits. In the meantime, on January 1, 2008, Wise Foods and Sun Life entered into a contract that provided employees of the company short term disability, long term disability, and life insurance. According to the Sun Life plan, McGinnis was entitled to disability benefits under the new policy.

Under the Sun Life plan, McGinnis filed a claim for his short term disability benefits and received those from January 11, 2008 until July 11, 2008. Then, on June 26, 2008, Sun Life Insurance approved McGinnis’ long-term disability benefits, concluding that McGinnis was disabled from performing his duties as a sales director. And, having previously qualified for Social Security disability benefits, McGinnis’ disability benefits from Sun Life were offset by the amount McGinnis received from his Social Security benefits.

In March 2008, McGinnis underwent surgery to repair his rotator cuff. However, McGinnis continued to suffer from migraine headaches, fatigue, exhaustion, shoulder, back, neck and peripheral pain, and had difficulty speaking and eating as well as sleeping problems, poor concentration and focus, and high blood pressure. With continued documentation of these medical problems, Sun Life continued to provide McGinnis with his disability benefits. McGinnis again underwent another rotator cuff surgery, continued to suffer from the symptoms of his previous mouth cancer, and received his disability benefits throughout 2009. All was going well until McGinnis’ status was reviewed in 2010.

Unfortunately for McGinnis, Sun Life determined that McGinnis was capable of working in a light to sedentary position in 2010 and consequently offered McGinnis a settlement for his long term disability claim in the amount of $27,864.00. After McGinnis denied this offer, Sun Life upped the amount to $35,000.00; and when McGinnis again denied the offer, Sun Life closed the claim and denied McGinnis further disability benefits.

McGinnis appealed Sun Life’s decision and Sun Life hired a medical evaluation service to conduct two separate IME’s on McGinnis. Both IME reports reported that McGinnis was only capable of light work and “too fatigued and weak to work at a higher demand level.” Sun Life used these evaluations to justify denial of McGinnis’s disability benefits. As a result of the two IME reports, Sun Life denied McGinnis both his disability benefits and his life insurance coverage.

Mcginnis And His Disability Attorney State Erisa Violations In Complaint

Listing a great number of ERISA violations in his complaint and refuting Sun Life’s evaluation of McGinnis’ condition, McGinnis and his disability attorney filed suit against Sun Life requesting that Sun Life be forced to reinstate McGinnis’ disability and insurance benefits under his Sun Life plan, require Sun Life to award McGinnis his total disability benefits due and owing under the plan from July 8, 2010 until the present, require Sun Life to reinstate McGinnis’ life insurance coverage, require Sun Life to cover McGinnis’s attorney’s fees and provide other equitable relief as the Court sees fit.

Comments (2)

  • Stephen,

    If you are unable to work as a result of your condition then you should absolutely appeal their denial. If they deny you, we will review your denial letter and make determination if we can assist you with your claim. Based upon the limited information you have provided I would anticipate that Sun Life will continue to pay your disability claim. Please contact us if your claim is denied.

    Gregory Dell Sep 5, 2011  #2

  • I have been receiving Long Term Disability Benefits from Sun Life Financial for two years. During this time the Social Security Administration also approved Long Term Disability Benefits, which reduced my Sun Life Benefits by half. I received a letter on August 24, 2011 from Sun Life Financial stating that they are processing my claim for continued benefits beyond the two year period. To date, Sun Life has not yet completed their review to determine my eligibility for continue benefits. The letter states that since they have not made a determination at this time, they will continue to pay benefits on a limited basis, but if declined, They will reserve the right to recoup any payments made after 10-03-11, which was the deadline of my initial two year period of LTD benefits. This is a group plan provided by my former employer. I called Sun Life and they informed me that their medical staff was in the process of reviewing my claim, that was on 08-29-11. I was originally placed on LTD for chronic myelogenus leukemia, coronary artery disease, hyperlipidermia, gastro-esophageal reflux disease, hypertension, and and list of side effects from graft vs. host diseases, joint deterioration, which has caused numerous surgeries, side effects from numerous prescription drugs, primarily the drug gleevec and this past may, I was diagnosed with stage 3 chronic kidney disease. I have provided all medical evidence of these conditions along with documentation from my doctors.

    My question: If I am denied, should I appeal, their decision and can you help? Please respond.


    (Age=54, B.S. Degree, former job: site acquistion in tower industry)

    Stephen Aug 31, 2011  #1

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