Group Health Plan Inc's Actuary sues Reliastar and ING Disability Claims Management Services for recovery of disability benefits under The Ramsey Health Care Services Short Term Disability Plan
A disability attorney recently filed a lawsuit on behalf of a client against the Reliastar Life Insurance Company and ING Disability Claims Management Services (Reliastar & ING) for denying her claim for short term disability benefits. The case against Ramsey Health Care Services Short Term Disability Plan, Reliastar Life Insurance Company, and ING Disability Claims Management Services was filed at the District Court for the District of Minnesota. This case was not handled by our law firm.
The Facts of the Case
The plaintiff was employed as an Associate Actuary by Group Health Plan Inc. She was a participant in a self funded employee benefit Plan called the “Ramsey Health Care Services Short Term Disability Plan” which was governed by the Employee Retirement Income Security Act of 1974 (ERISA). The Reliastar Life Insurance Company (Reliastar) acted as the claim paying agent of the Plan while ING Disability Claims Management Services (lNG) acted as the decision making unit for the plans administered by Reliastar.
Under the terms of the Plan, the plaintiff was considered “totally disabled” if she was unable to do the essential duties of her own occupation, because of sickness or injury. The Plan provided for disability income benefits in the event of disability of either 60 percent of the plaintiff’s weekly earnings or $3,750, minus other income, whichever is the lesser amount.
Claim and Denial of Disability Benefits Income
On February 20th 2009, the plaintiff became disabled and was unable to perform the essential duties of her own occupation. Under the terms of the Plan, before the plaintiff qualifies to receive any benefits, she was required to be continuously disabled for seven (7) days. Hence, the plaintiff submitted a claim for disability income benefit under the Plan in March 2009. In the lawsuit, the plaintiff stated that Reliastar & ING wrongfully denied her application for disability income benefits. With her final appeal on November 3rd 2010, the plaintiff stated that she had exhausted all her administrative remedies under the Plan.
Disability Lawyer Files Lawsuit Against Reliastar and ING
In the lawsuit, the plaintiff stated that she was entitled to recover benefits due under the terms of the Plan, to enforce her rights under the terms of the Plan, and to clarify her right to future benefits under the Plan under ERISA. She also argued that Reliastar & ING had breached their contract by failing to pay disability income benefits to which the plaintiff was entitled to under the terms of the Plan.
In addition, the plaintiff also alleged that Reliastar & ING being fiduciaries had failed breached their fiduciary duties by:
- Failing to pay disability income benefits to the plaintiff.
- Arbitrarily and capriciously denying disability income benefits to the plaintiff despite having knowledge that she was disabled, met the terms and conditions of the Plan to qualify for disability income benefits, and sustained the requisite loss of earnings to be eligible to receive the disability income benefits.
- Requiring “objective” proof of the plaintiff’s depression, anxiety, and insomnia, despite no such requirement being contained in the Plan.
- Otherwise denying the plaintiff benefits to which she would have been entitled had Reliastar & ING complied fully with their fiduciary obligations.
Relief Sought by the Plaintiff
As a result of Reliastar & ING’s actions, the plaintiff alleged that she had sustained damages and is seeking relief through Court for:
- A declaration that Reliastar & ING are in breach of their contract with the plaintiff and the Plan.
- An Order requiring Reliastar & ING to pay disability income benefits to the plaintiff in the amount required by the Plan, including all amounts past due and owing.
- An Order requiring Reliastar & ING to pay the plaintiff her costs, disbursements and attorney fees.
- An Award to the plaintiff any other and further relief which is just and equitable.
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