In Jacqueline J. Vs Sun Life Insurance Company, the Plaintiff seeks reinstatement of short term disability benefit payments and payment of long term disability benefit payments that she is entitled to. This lawsuit, filed with the help of her Texas Disability Attorney, was filed in the United States District Court for the Southern District of Texas Houston Division.
Background of Case
Plaintiff is a fifty-one-year old woman who worked for the United States Postal Service until she suffered a severe injury to her knees and shoulder on September 23, 2008. She could no longer perform the work duties associated with her occupation. Because of this, she filed an application for disability benefits, including medical information and information regarding her employment duties to show she should receive disability benefits. Sun Life paid Plaintiff for 492 days of disability.
Sun Life Terminates Disability Benefits
Sun Life suddenly decided to stop paying for additional short term disability payments. It has also decided not to pay any long term disability payments. These decisions were based on Medical Disability Advisor guidelines, though these guidelines are not referred to in the policy or otherwise incorporated into or made a part of the policy.
Plaintiff filed an appeal of this denial, supplying additional information as requested by Sun Life. However, Sun Life denied this appeal on September 30, 2010. This letter also stated that she had exhausted all administrative remedies. This is why the Plaintiff has filed the lawsuit against Sun Life and the other Defendants.
Reasons Behind Lawsuit Filed By Plaintiff
The evidence submitted by Ms. Johnson establishes that she was unable to perform the substantial and material duties of her occupation, which satisfies the condition in the policy for Ms. Johnson to receive short-term disability payments. Additionally, Sun Life discounted the opinions of Plaintiff’s treating physicians, the limitations from which the Plaintiff suffers, and the effect of the Plaintiff’s impairment on her ability to perform her employment obligations. Sun Life also incorporated guidelines into the disability policy just to affirm the denial of benefits to the Plaintiff.
Sun Life failed to provide the short term and long term disability benefits that were due to the Plaintiff under the terms of the Plan. This is despite the fact that the Plaintiff has provided plenty of medical evidence to show that her condition has deteriorated through the course of time and has prevented her from performing the material duties of her occupation or of any occupation. Sun Life has failed to provide the proper weight to that medical evidence, leading to their wrongful decision to terminate the disability benefits to the Plaintiff. Sun Life also unreasonably, arbitrarily, and capriciously interpreted the definition of disability in violation of the policy’s plain language.
Plaintiff Seeks Following Relief From Sun Life and Defendants
Plaintiff wants the Court to provide the following relief:
- Short and long term disability benefits as defined under the terms of the Plan
- Continued long term disability benefits for as long as Plaintiff is eligible or until the termination age under the Plan has been reached
- Payment of actual damages
- Prejudgment and postjudgment interest
- All reasonable attorney fees
- All associated court costs
- All other relief decided upon the Court to be appropriate