Rose Mary Lee filed a lawsuit in the United States District Court of Nevada against Standard insurance Company, Woodside Group, Inc., and Woodside Group, Inc. Employee Disability Plan on May 30, 2011. In her Complaint, Lee alleges that the Standard Insurance Company and her employer violated their fiduciary duties under her disability insurance policy because of a conflict of interest because Standard is both the decision maker as to benefit awards and the payor of monies that satisfy benefit awards.

Lee worked for Woodside Group, Inc. as a real estate agent until she became disabled in December 2008, at which time she was “unable to work in her designated occupation.” Lee was paid her short term disability benefits through July 17, 2009, “the maximum short term disability provided under” Standard’s Plan. At the time of the termination of her short term disability benefits, Lee submitted a disability application for long term disability benefits with The Standard, and as a disabled employee was entitled to the waiving of disability premiums until such time as she was no longer disabled. She supported her long term disability application with the waiver by submitting medical records and statements from her attending and treating physicians cataloguing Lee’s disabling condition. Standard hired a medical consultant of its own to review Lee’s records who disagreed with her attending physician’s characterization of Lee’s disability. Consequently, Lee and her disability attorney question the consultant’s “independence, impartiality and bias” in the evaluation of Lee’s claim in her Complaint.

Lee And Her Nevada Disability Lawyer State That Standard’s Position In Lee’s Claim Is Inherently Adversarial

Claiming that the Standard consultant’s “opinion is adversarial because of the individual’s conflict of interest as an employee” of Standard, Lee accuses Standard of having a “financial conflict of interest” as “motivating factors” in why she was denied long term disability benefits by the insurer. The consultant didn’t examine Lee personally and merely read her medical documentation, and “unlawfully and erroneously ignored and/or de-emphasized” Lee’s complaints, abilities and the effect of her prescribed medications on her ability to perform her job, according to the Complaint.

On November 12, 2009, Standard notified Lee of the denial of her long term disability claim and the waiver of her life insurance premium. As a result Lee appealed the denial in a letter to Standard on April 29, 2010. Submitting additional medical records, Lee also provided Standard with a Functional Capacity Evaluation performed by a qualified physical therapist in which the therapist stated: “[it] remains quite clear . . . that [Lee] cannot return to any occupation as a result of her medical condition.” And, Lee’s treating physician stated that Lee suffers from” daily widespread pain” and “wakes up unrefreshed.” Lee also provided the insurer with affidavits of people who acknowledged that Lee suffers from “fatigue, cognitive problems, and is unable to perform her job.”

Long time friends and other family members testify to Lee’s inability to work, but Standard wasn’t swayed from its denial, and denied Lee’s appeal again, at which time Lee and her Nevada disability lawyer accused Standard of not performing a “lawful review which was . . . full nor fair . . . and violated ERISA, specifically, 29 U.S.C. 2560.503 . . . due to its dual roles as decision maker and payor of benefits which created an inherent conflict of interest,” causing her long term disability claim to be denied.

Lee Asks The United States District Court of Nevada To Rule In Her Favor

With no other options available for resolution of Lee’s situation, Lee and her disability lawyer filed a disability lawsuit alleging that Lee has been injured by Standard and has suffered damages in the form of lost disability benefits as well as other potential employee benefits.” Lee asks the United District Court of Nevada to:

  • Force Standard and the other defendants to pay her rightful disability benefits, both past due and current moving forward;
  • Make Standard provide a statement that Lee does meet the definition of disability under the “own” and “any” occupation definitions of her Standard policy;
  • Order that Standard pay Lee her disability benefits as well as her waiver of life insurance premium until she meets the requirements that would terminate those benefits under her employee benefits plan;
  • Award her attorneys’ fees and suit costs; and
  • Other relief the Court deems necessary.