Sun Life Assurance Company of Canada Refuses to Pay Long-term Disability Benefits to Gunshot Victim
The pain associated with a disability can be difficult to bear. The pain of being denied long-term disability insurance benefits by your long-term disability insurance carrier - in this case, Sun Life assurance Company of Canada - exacerbates the physical pain of a disabling condition.
Marilyn Ellis will always have a constant reminder of what happened to her on October 27, 2006. It was on that day Ms. Ellis became disabled as a result of a gunshot wound while she was at work. The stray bullet that hit her left her unable to work with any continuity, thus leaving her unable to pay her bills and other financial obligations. Ms. Ellis did, however, receive a settlement from a civil suit along with workers compensation benefits. Ms. Ellis was also allowed to make a claim for long-term disability benefits with Sun Life assurance Company of Canada, the long-term disability carrier contracted by her employer.
As a result of her gunshot wound, Ms. Ellis continues to experience a litany of symptoms contributing to her disability. The grip in her right hand is weak. She has pain in her upper and lower back. The pain makes her unable to sit, stand, walk, or lay down for any extended period of time. She has ongoing numbness and trembling in her fingertips with her right hand. Psychologically, Ms. Ellis experiences anxiety, anger, fear, depression, crying spells, and resentment. To make matters worse, she also experiences a sense of hopelessness, nightmares, and, naturally, a fear of guns.
Since one of the provisions that came about as result of Ms. Ellis’ civil suit was the opportunity to apply for disability benefits with her employer’s long-term disability insurance carrier, Sun Life Assurance Company of Canada, Ms. Ellis submitted a claim for long-term disability benefits. Ms. Ellis filed the claim with Sun Life because she was unable to work in any occupation.
Sun Life sent Ms. Ellis a letter dated May 12, 2009, informing her that her claim had been denied. Sun Life made the assertion that Ms. Ellis is not entitled to receive benefits under the long-term disability plan because of the type of work she was doing prior to the time she became disabled. Sun Life contended that Ms. Ellis’ duties as a front office assistant were the same as that of a receptionist. A receptionist, in the opinion of Sun Life, has the functional capacity to see, hear, sit, finger, talk, and work with continuity even with the symptoms Ms. Ellis presents.
However, Ms. Ellis and her California disability attorney disagree. They allege that Sun Life wrongfully denied Ms. Ellis's claim and Sun Life is in breach of terms of the long-term disability plan under the Employee Retirement Income Security Act of 1974 (ERISA).
Furthermore, Ms. Ellis alleges Sun Life did not help her find suitable employment through “vocational rehabilitation and a return to work plan created by [Sun Life's] certified rehabilitation counselors.” Ms. Ellis and her California disability lawyer also allege Sun Life “[failed] to act with respect and integrity, applying inequitable and unfair claim review standards.”
Ms. Ellis' disability attorney intends to prove the monetary amount to which Ms. Ellis should be entitled as a result of having her long-term disability claim denied by Sun Life, along with all court costs and attorney fees.
ABOUT THE AUTHOR: Gregory Dell
The Law Firm of Dell & Schaefer is a dedicated disability law firm established in 1979. Our firm has represented thousands of clients with their claims against insurance companies. As long term disability attorneys, we represent individuals at all stages of a claim for disability income benefits, which includes the disability application process, denial of disability benefits, lawsuits to recover disability benefits and lump sum disability policy buyouts for individuals that are currently being paid disability income benefits. We only represent claimants and we never represent insurance companies.
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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer. For specific technical or legal advice on the information provided and related topics, please contact the author.