Disabled Georgia man sues Boston Mutual for denial of disability benefits
A Georgia disability attorney recently filed a federal ERISA disability lawsuit against Boston Mutual Insurance Company of America and Disability Reinsurance Management Services (DRMS) to recover long-term disability benefits that were wrongfully withheld.
The plaintiff was employed by Green Island Country Club who contracted with Boston Mutual Insurance Company to provide disability benefits to its employees. By virtue of his employment, the plaintiff was covered by Green Island Country Club’s Overall Welfare Benefit Plan.
The Facts of the Case Against Boston Mutual Insurance Company
The disability policy terms issued by Boston Mutual to Plaintiff defines “disability” and Boston Mutual’s financial responsibilities to disabled Participants as follows:
- Participant is not able to perform some or all of the material and substantial duties of his/her regular occupation and have at least a 20% loss in pre-disability earnings OR
- Participant is not able to perform some or all of the material and substantial duties of his/her regular occupation, is working in any occupation, and have had at least a 20% loss in his/her pre-disability earnings.
- Boston Mutual will provide payment beyond 24 months if Participant is disabled as defined above AND
- Participant is not able to continue performing one or more activities of daily living (ADL) without stand-by help OR
- Participant has a terminal illness
Plaintiff went on disability October 4, 2007, was found to be disabled, and was paid up until January 2, 2010.
Denial of Boston Mutual Benefits Claim
By letter dated May 14, 2009, Boston Mutual terminated Plaintiff’s benefits due to not enough medical evidence supporting disability claim.
On July 19, 2010, Plaintiff hired services of a disability lawyer who ordered the claims file.
The attorney discovered on or about August 24, 2010 via the claims file that a denial letter was dated December 23, 2009. Plaintiff did not appeal this denial within the 180-day period.
Plaintiff, through the attorney, requested DRMS via certified letter on August 24, 2010 to reopen the file, as it appeared that the Plaintiff was very mentally slow. Plaintiff added updated medical records to the file.
On September 7, 2010, Plaintiff received letter from DRMS that returned all of Plaintiff’s information and that stated that since the Plaintiff missed the 180-day period to appeal by 2 months, DRMS would not reopen Plaintiff’s claim.
On September 13, 2010, Plaintiff, via letter through the attorney, informed DRMS that he was uncertain whether he even received the denial letter from December 23, 2009. Since DRMS did not send the letter by certified mail or via any other traceable method, DRMS could not prove that it was sent, so Plaintiff asks again for DRMS to reopen the file, reiterating again that Plaintiff is very mentally slow.
On September 15, 2010, Plaintiff sends additional information and asks DRMS to reopen the file.
Two more attempts to reopen the file were denied by DRMS, even with an inclusion of a Neuropsychological Evaluation that showed that the Plaintiff had a cognitive disorder that caused severe deficits in his attention, concentration, visual memory, and processing speed.
Disability Lawyer Files Lawsuit Against Boston Mutual And DRMS
According to the lawsuit, Plaintiff alleged that Boston Mutual and DRMS have failed to:
- Provide their fiduciary duties to Plaintiff under ERISA
- Provide benefits stated in the policy
Relief Sought By The Plaintiff In The Boston Mutual And DRMS Lawsuit
As a result of Boston Mutual and DRMS’ actions, the Plaintiff seeks the following relief from the Court:
- Place judgment against Boston Mutual and DRMS for all disability benefits from January 2, 2010 and beyond, as well as interest on all back benefits OR
- Grant a remand to the administrative level and order the Defendants to consider additional medical evidence that allows the Plaintiff access to a full and fair review
- Place judgment that Defendants violated their fiduciary duty to Plaintiff and order the denial of benefits to claim to be reviewed under the de novo standard of review OR/AND place judgment that Defendants may not reduce amount of benefits from past benefits due or from future benefits to be received
- Award attorney’s fees, litigation expenses, and court costs
- Grant all other just and proper relief as Court deems appropriate
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Who are Dell Disability Lawyers?
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
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A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
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Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
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Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
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When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.