Sun Life Insurance Sued by West Virginia Man for Denying Long-Term Disability Claim

The declining state of Charles Smoot’s health came to the point at which it became necessary for him to file a Sun Life disability insurance claim through his employer provided disability plan. Mr. Smoot’s claim was denied and his West Virginia disability lawyer filed an ERISA lawsuit against Sun Life in the United States District Court for the Southern District of West Virginia at Huntington.

By November 17, 2007, Mr. Smoot was no longer able to work with any continuity and became completely and totally disabled from performing the material functions of his occupation at Flint Ink Corporation – whose long-term disability plan is named as the co-defendant in this suit – or at any occupation due to disabling conditions not listed in his lawsuit.

Mr. Smoot met the definition of being “totally disabled” according to the long-term disability plan since he had met the elimination period of being totally disabled and has met the definition for 24 months following the elimination period. However, Sun Life chose to deny Mr. Smoot’s claim for long-term disability benefits in a letter dated July 28, 2008. Consequently, Mr. Smoot retained a West Virginia disability attorney to assist him with the appeals process.

As part of his appeal, Mr. Smoot requested 60 day extension on his appeal. That request was subsequently denied by Sun Life in a letter dated March 10, 2009 that also stated Mr. Smoot had exhausted all of his administrative remedies regarding his claim. In response to Sun Life’s failure to pay him disability insurance benefits, Mr. Smoot then exercised his right under ERISA to file a civil complaint against Sun Life.

Mr. Smoot alleges that Sun Life’s determination in the review of his long-term disability benefit claim stands at odds with what his treating physician reported and against the occupational assessment performed by Dr. Joe Woolwine that states he is completely and totally disabled. Furthermore, Mr. Smoot alleges that Sun Life’s decision to deny him long-term disability benefit payments was “arbitrary, illegal, capricious, unreasonable, discriminatory and not made in good faith.”

By such allegations, Mr. Smoot is claiming Sun Life did not take into account the supporting documentation from his treating physician stating Mr. Smoot met the definition of “disabled” as it is written in the long-term disability plan provided by Sun Life to Mr. Smoot’s employer, Flint Ink Corporation.

Mr. Smoot will have to demonstrate to the court how Sun Life acted in an arbitrary and capricious manner when they denied his long-term disability benefit claim. Mr. Smoot will have to present the court with supporting documentation from his treating physician and/or other medical professionals who have diagnosed him as completely and totally disabled and unable to work with reasonable continuity. Likewise, Mr. Smoot must demonstrate to the court how Sun Life either failed to of knowledge or refused to acknowledge the nature of Mr. Smoot’s disabling condition that would preclude him from working at his own occupation or at any occupation.

Mr. Smoot is seeking summary judgment against Sun Life to pay him long-term disability benefit payments he is due from the time he became completely and totally disabled on November 17, 2007. Mr. Smoot is also requesting the court award costs and attorney fees.