Disability and Insurance Lawyer, Marc Whitehead represents a minor child and a resident of Texas, who is the beneficiary under a group accident policy issued and administered by Life Insurance Company of North America (LINA).
Plaintiff is the guardian of a minor child and beneficiary of a group accident policy obtained by the child’s father while formerly employed by Realogy. Plaintiff claims death benefits for her child through the life insurance policy provided by the deceased father.
Life Insurance Company of North America commonly referred to as LINA, is an insurance company based in Dallas, Texas. LINA is affiliated with Cigna Insurance.
Venue and Jurisdiction of Long Term Disability Lawsuit
Suit was filed in federal court in the Southern District of Texas pursuant to 28 U.S.C. § 1331. Specifically, Plaintiff brings this action to enforce plaintiff’s rights under the Employee Retirement Income Security Act (ERISA), as allowed by 29 U.S.C. §§ 1132, 1133, & 1140
Allegations of Wrongful Denial of Death Benefits Under ERISA:
Plaintiff brings this action to secure death benefits, to which Plaintiff is entitled under an accidental death policy underwritten and administered by LINA. Plaintiff is covered under the policy by virtue of decedent’s employment with Realogy Inc.
On November 19, 2009, LINA notified Plaintiff that Defendant affirmed its original decision to deny Plaintiff’s claim for life insurance benefits under the accidental death portion of the life insurance policy, totally ignoring the findings of the medical examiner as to cause of death i.e. drowning. To the contrary, LINA claims the insured worker died as a result of a heart attack, thereby giving LINA an excuse not to pay on the accidental portion of the life insurance policy.
LINA also notified Plaintiff on November 19, 2009, that Plaintiff had exhausted all administrative remedies and they would consider no further claims or evidence. LINA, in its final denial, discounted the opinions of Decedent’s autopsy report, consulting Pathologists and the testimony of the medical examiner. Plaintiff has now exhausted all available administrative remedies, and plaintiff is forced to file a lawsuit to obtain plaintiff’s rightfully owed disability benefits.
The Law – The Employee Retirement Income Securities Act (ERISA)
This claim is governed under federal ERISA law. All state law claims that may have been considered are preempted by federal ERISA law because the plaintiff is covered under an insurance policy issued through his employee benefits plan. ERISA stands for the Employee Retirement Income Security Act of 1974. ERISA is a federal law that regulates the handling of Employee Benefit Plans and the remedies of the beneficiaries of these Plans. ERISA applies to all employees benefit plans established or maintained by an employer engaged in commerce or by an employee organization representing employees engaged in commerce. Practically all long term disability or life insurance plans offered by a private employer are governed by ERISA. A claimant challenging a denial under an ERISA governed plan or policy must bring the claim pursuant to ERISA regulations and procedures. All state law remedies are preempted, meaning they do not apply to an ERISA claim.
Marc Whitehead’s Comments:
LINA, a multi-billion dollar insurance company, has arbitrarily decided to deny accidental death benefits to an orphaned child for the death of the child’s father. The basis for the denial is an unsubstantiated theory that the father must have had a heart attack and did not in fact drown, a theory that is in direct contradiction to the coroner’s finding that it was death by drowning. LINA is using federal ERISA law as a shield to deny paying the claim. Don’t let this happen to you. If you don’t call us, call someone. For more information on how to fight disability or life insurance denials, visit www.DisabilityDenials.com.