An employee at RAMM Metals, Inc., suffering from endometrial carcinoma, and her Pennsylvania disability attorney filed a Complaint against Fort Dearborn Life Insurance Company in Federal Court seeking disability benefits from the insurer that have wrongfully been denied. A Controller at RAMM, Patricia C. became disabled on October 24, 2007 when she was unable to perform her job at the company. Unfortunately, Fort Dearborn has decided that Patricia C. does not qualify for long term disability benefits and has refused to pay. After being denied benefits, this suit was filed.

According to the Fort Dearborn policy Patricia C. is supposed to receive 60% of her $5,600.00 salary minus Social Security Administration (SSA) disability benefits. Awarded Social Security Disability Insurance (SSDI) benefits on September 30, 2008, Patricia C. has consistently received $1,915.00 monthly from that provider and was supposed to be eligible for the rest of her disability benefits as provided in her employee insurance policy at RAMM. As calculated by Patricia C. and her lawyer, Patricia C. was entitled to disability benefits in the following amounts from Fort Dearborn, which has thus far gone unpaid.

  • $4,516.13 in January 2008;
  • $5,000.00 per month for the months of February 2008 and March 2008; and
  • $3,685.00 per month beginning April 2008 (when her SSDI began) until the present.

Fort Dearborn Claims Patricia C. Doesn’t Qualify for Disability Benefits

Since May 2008, Fort Dearborn has maintained that Patricia C. does not qualify for disability benefits because a Fort Dearborn consultant “interpreted the medical evidence as not showing that [Patricia C.] was totally disabled from performing the material and substantial duties of her job during the elimination period and thereafter.” Patricia C. and her attorney appealed this denial, offering the disability determination of the SSA and medical records as follow-up for the appeal, only to again be denied under the same terms as before.

Insurer Alleges that Controller Could Function at Work with Certain Accommodations

Armed with letters from her employer, additional medical records, a psychological evaluation from the SSA, and the service of her attorney, Patricia C. requested another appeal, but was again denied long term disability benefits from Fort Dearborn. The insurer continues to claim that Patricia C. was not totally disabled during the elimination period, and thus, not entitled to long term disability benefits. According to records supplied to the insurer, Patricia C., during the elimination period, suffered from “continuing diarrhea as a result of a total hysterectomy performed to address endometrial carcinoma. While acknowledging that Patricia C. did suffer from the aforementioned conditions, Fort Dearborn’s consultant continues to uphold the denial because, according to the consultant, Patricia C. “was not disabled during the complete period that she suffered from [the] debilitating condition.”

The consultant states that Patricia C. could have been accommodated at work while working during her elimination period (at which time she suffered from diarrhea due to a diabetic condition), and thus, the policy doesn’t cover her. Having failed to pay any benefits to Patricia C., Patricia C. and her attorney allege that the insurer’s denial is “clearly arbitrary and unsupported by the evidence.” And, since the insurer didn’t look at the combination of Patricia C. diabetic problems, the medication necessary for that condition, and the addition of surgery and its effects, Patricia C. also alleges that the insurer, “acted capriciously” and that the insurer’s denial was not supported by the evidence provided to it.

Pennsylvania Disability Attorney Accuses Fort Dearborn of Ignoring Evidence

Claiming that Fort Dearborn completely ignored the evidence, Patricia C. asks the District Court to demand that Fort Dearborn:

  • Pay Patricia C. all disability benefits due beginning January 4, 2008 until the present;
  • Declare that Patricia C. continues to be disabled and is entitled to continuing disability benefits from the insurer;
  • Pay any interest on the unpaid benefits;
  • Reimburse Patricia C. for Court costs and attorney’s fees; and
  • Be required to provide Patricia C. with any further relief as the Court finds appropriate.