In Alec L Vs Standard Insurance Company, Plaintiff seeks the long term disability benefit payments that were wrongfully denied to him under the terms of the Plan.

The Plaintiff has filed this lawsuit against Standard Insurance Company (Standard), who issued a long term disability plan for Wellbridge Company, who employed the Plaintiff as a Senior Sales Representative. The Plan met the requirements of the Employee Retirement Income Security Act (ERISA) of 1974. Oregon.

How Plaintiff Came To File Disability Lawsuit

Plaintiff was employed by Wellbridge Company as a Senior Sales Representative, which involved the duties of a sales manager, sales representative and floor manager. These tasks involved a great deal of energy, concentration, and ability to converse with the public.

On or about May 20, 2010, Plaintiff was a victim of a violent assault in Denver, Colorado. Plaintiff suffered multiple blows to the head and was rendered unconscious. Plaintiff was diagnosed with injuries to his neck and back in addition to a closed head injury and/or post-concussive syndrome, and post-traumatic stress disorder.

These injuries and resulting symptoms prohibited Plaintiff from performing the requirements of his job at the Wellbridge Company, including but not limited to severe cognitive difficulties (including with memory and concentration), severe headaches, loss of balance, anxiety, depression, fatigue and neck/back pain, and the effects of post-concussive syndrome and/or post traumatic stress disorder.

Due to the fact that the Plaintiff could not fulfill his job duties on a full-time basis, Plaintiff applied for and received short-term disability benefits from his employer (which was approved by Defendant, the Standard). He then filed an application for long term disability benefits to the Plan on or about August, 2010.

Standard Denies Plaintiff’s Long Term Disability Benefits Claim

On or around October 7, 2010, Standard denied Plaintiff’s claim for long-term disability (LTD) benefits. The Plan provides, in pertinent part, that an employee is disabled if that employee is unable to engage in the material duties of his or her regular occupation due to sickness or injury for the first 24 months of disability benefits. After 24 months of disability benefits, the plan will then only provide benefits if the person is unable to work any other reasonable occupation.

Plaintiff has been suffering from the following conditions through and beyond the 90-day elimination period:

  • Suffering due to illness or sickness
  • Unable to perform the essential duties of his occupation or any other reasonable occupation
  • Unable to perform the essential functions of his occupation or any other reasonable occupation

Plaintiff filed an appeal of the denial and submitted additional medical documentation to substantiate his condition. Still, Standard denied Plaintiff’s appeal. Standard submitted its final decision via letter dated September 16, 2011. Due to this, Plaintiff has filed a lawsuit against Standard to gain the long term disability benefits owed to him as defined under the Plan.

Filed Lawsuit Against Standard

Plaintiff claims in lawsuit that Standard has unreasonably refused to pay LTD benefits to Plaintiff, despite additional documents and other evidence submitted by Plaintiff, subsequent to Defendant’s denial of benefits.

Plaintiff was fully covered under the Plan at all times according to the terms of the Plan. Standard has improperly, erroneously, arbitrarily and/or capriciously denied Plaintiff benefits due and owing under the Plan.

Requested Relief

Plaintiff seeks the following relief against Standard:

  • Judgment against Standard for violating Plaintiff’s rights under ERISA
  • All benefits that have not been paid to this point in time
  • Retroactive reinstatement of LTD benefits
  • Continued payment so long as Plaintiff remains eligible under terms of the Plan
  • Reasonable attorneys’ fees and costs
  • Interest on any awards at the highest allowable rate
  • All other relief ordered by the Court