Free Complaint - District Court of Delaware - Delaware

Case 1:07-cv-00056-SLR

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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF DELAWARE DIANA PHILLIPS, Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant. ) ) ) ) ) ) ) ) ) ) C. A. No.

COMPLAINT 1. Plaintiff Diana Phillips ("Ms. Phillips) brings this action against

Metropolitan Life Insurance Company for violation of the Employment and Retirement Income Security Act of 1974, as amended, 29 U.S.C. §1001, et seq., ("ERISA"). Ms. Phillips was a participant in the plan, an ERISA welfare benefit plan, as administered by Metropolitan Life Insurance Company. This Complaint challenges the Defendant's

unlawful termination of Ms. Phillips' long-term disability income benefits despite medical evidence demonstrating Ms. Phillips' qualification for said benefits, and thereby depriving Ms. Phillips of the appropriate LTD benefits due to her under the plan/policy. Specifically, Ms. Phillips is filing this action to recover benefits due under a policy of insurance to enforce the present rights existing therein, to declare her rights under the terms of the policy, and to recover costs and attorney's fees as provided by ERISA. Jurisdiction 2. This Court has personal and subject matter jurisdiction over this case

pursuant to 29 U.S.C. §1132(e) and (f) because of Defendant's breach of its ERISA obligation to her.

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3.

Plaintiff Diana Phillips is a resident the State of Delaware, residing in

Milford, Delaware. 4. Plaintiff Phillips, at all times pertinent, was a participant within the

meaning of 29 U.S.C. §1002(2)(7) in the group long-term disability ("LTD") plan that was insured by policy number 98416 (hereinafter "Policy") issued to Waverly, Inc., Plaintiff's employer. 5. §1132(a). 6. Defendant Metropolitan Life Insurance Company has its corporate Plaintiff Phillips has standing to bring this action under ERISA, 29 U.S.C.

headquarters located at P.O. Box 14590, Lexington, Kentucky, 40511-4590. 7. Defendant is a for-profit corporation and does business in the State of

Delaware, deriving revenue from its business it conducts in Delaware. 8. The plan under which the Plaintiff is suing is a group disability plan

maintained by Waverly, Inc., and fully insured by a contract of insurance, policy number 98416, issued by Metropolitan Life Insurance Company. 9. Up until 1997, Ms. Phillips was working full-time for Waverly, Inc., in

Baltimore, Maryland. She has not worked since that time. 10. The plan's covered class included "all regular hourly, salaried or

commissioned employees". 11. 12. As a full-time employee, Ms. Phillips became insured under the plan. The policy provides for the payment of LTD benefits to cover the

employees who meet all contractual provisions, including the definition of disability. 13. The terms of the group policy defining disability are:

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Total disability or totally disabled means that, due to injury or sickness you: (1) are completely and continuously unable to perform each of the material duties of your regular job, (2) require the regular care and attendance of a doctor. 14. 15. 16. Ms. Phillips was enrolled in the disability plan. Ms. Phillips received long-term disability benefits on February 13, 1999. Her long-term disability benefits were interrupted when Metropolitan Life

Insurance Company terminated her benefits on or about June 2000. Those benefits were reinstated on or about August 28, 2003, after an appeal of her termination of benefits. 17. On June 18, 2003, Mr. Jose Castro issued a vocational assessment/earning

capacity report, concluding that Ms. Phillips was unable to work. 18. 19. 2005. 20. She has been treated by Dr. Maged Hosny for fibromyalgia and Her condition has not improved since that time. Her long-term disability benefits were again terminated on February 13,

osteoarthritis since April 2005. 21. On or about June 6, 2006, Dr. Hosny submitted a report indicating that she

could not work due to chronic pain from her muscle spasms. 22. Plaintiff has been found to be disabled by the Social Security

Administration since 1997. This determination was reviewed and affirmed on March 29, 2005. 23. On November 29, 2006, Defendant denied Plaintiff's final appeal of the

termination of her disability payments. 24. The Defendant, Metropolitan Life Insurance Company, funds the plan

which it administers.

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25.

The administration used a self-servicing approach to the evidence by

selectively relying upon evidence that supported a denial of benefits and rejecting the evidence that supported the granting of benefits to the Plaintiff. 26. 27. Plaintiff has exhausted all administrative remedies. The Defendant breached its fiduciary duty in violation of its fiduciary duty

in violation of 29 U.S.C. §1132 in the following ways: a) MetLife failed to explain how Plaintiff was deemed disabled for 7 years and without any improvement in her physical condition is now considered not disabled; b) MetLife failed to acknowledge the findings of the treating physician who diagnosed her with fibromyalgia; c) MetLife failed to take into account the subjective complaints of chronic pain; d) MetLife failed to take into account the effects of fibromyalgia; e) MetLife failed to take into account the side effects of the medications necessitated by the fibromyalgia f) There is no vocational evidence or medical evidence to suggest that Plaintiff's condition has improved. She was last determined to meet the disability requirements of Defendant's plan in February 2005; g) There has not been any consideration that Plaintiff has been and continues to be found disabled by the Social Security Administration. 27. The Defendant's denial of long-term disability benefits is a violation of 29

U.S.C. §1132(a)(1).

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WHEREFORE, Plaintiff Diana Phillips prays for the following relief: a) Declaratory relief that she is entitled to disability benefits, past and present, plus interest; b) reasonable attorney fees and costs pursuant to 29 U.S.C. §1132(a); c) Alternatively, a remand requiring MetLife to consider all of the evidence and how it impacts upon Plaintiff's ability to work; and d) Any other relief that this Honorable Court deems appropriate.

GRADY & HAMPTON, LLC

/S/ John S. Grady John S. Grady, Esquire (009) 6 North Bradford Street Dover DE 19904 (302) 678-1265 Attorneys for Plaintiff DATED: January 25, 2007

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