Free Complaint - District Court of Delaware - Delaware

Case 1:08-cv-00194-GMS

Document 1

Filed 04/07/2008

Page 1 of 4

IN

THE

UNI~D

STATES

DISTRICT

FOR

TfI~ISTRICT

OF

DELA

W

ERNEST T.

YOUNG,
Plaintiff,

\

v.

\

'\,

Civil

ARE

COURT

Action

No.

LIFE INSURANCE
OF NORTH AMERICA,

COMPANY

Defendant.

COMPLAINT
The plaintiff, Ernest T. Young ("Young"), states to the Court as follows:

1.

Young

files

this

action

under

29 D.S.C.

§

1132(a)(1)(B)

of the Employee

RetIrement

Income

SecurIty

Act

of

1974

2.

This

Court

has

jurisdiction

("ERISA").

over

this

action

under

29

D.S.c.

§

1132(e)

and

I

D.S.C. § 1331. Venue is proper in this judicial district under 29 D.S.C.

§ 1132(e).
resident of New Castle

3.

Young

is,

and

at

all

relevant

times

has

been,

a

citizen

County, Delaware. Young is, and at all relevaIlt times has been, a participant or beneficiary in a long-term disability benefit plan sponsoredby Hercules Incorporated.
4. The long-term disability plan was funded and insured by an insurance policy

(upon information

and belief, and .based upon documents obtained, policy

and

no. LK-O30292),

issued

by

defendant

Life

Insurance

Company

of

North

America

("LINA").

This

LINA

has been in full force and~effect at all relevant times. According to the policy provided to
Young, LINA is the named fiduciary for adjudicating claims for disability benefits and deciding

any appeals of denied claims.

policy

28

as

benefits, irrational, indicating submitted

provisions

policy.

proof

documented

required

of

10.

9. 8.

the applicable
loss

to pay benefits.

other things, the decision-maker
7.

rights to past-due and continuing disability benefits.

refused to pay long-term disability benefits to Young.

submitted

5.

UNA

He

and

that

appropriate

of

by

in

in~upport

that is

Young he

The

Young

,

the the

contrary

has

entitled

",'

did

policy.

policy.
applicable

UNA

Young

violated,

Case 1:08-cv-00194-GMS

by Young
refusal not is, proofs

was

,

of

to

and

to qualify

policy,

At

not

his

the

,

to

and

past-due

has of

all

claim.

l
accorded

terms

pay

his

,

relevant

co~~inues been for

ERISA

loss

disability

long-term

of

A

and

at

letter

a

to

the

disability

all

times,

ignored
I
to continuing relevant applicable violate, dated disability benefits he has February times, the satisfied long-term UNA to benefits terms disabled Young 13, policy. of the 2008, under the disability definition under was UNA By upheld the wrong, the refusing UNA policy benefits of terms the disability policy. unreasonable, earlier and to of under the pay Young's refusal under UNA UNA such the

(29

full

,
UNA.

UNA is an insuran~~arrier that is doing business this judicial district andthat in

appealed the refusal to pay benefits, submitting additional information and

and other information;
claim Young file received in the a possession letter dated of March UNA. 5, Young 2007,

D.S.C.

and

Document 1

or gave insufficient

failed

fair

§

review

1133),

of

and

his

CRF

claim

Filed 04/07/2008

§

2560.503-1.

for

consideration

to analyze and review

disability

benefits

Page 2 of 4

to information

the facts and

Among

future

UNA

conflict

circumstances

interest

disability policy

3. I. 13.

2. 12.

WHEREFORE,

circumstances

11.
of interest

and

bias

at'!ssue.

All

available

An

benefits

An

The

ERISA

Byr~llsiJ1g

of

benefits

the

(including

pre-judgment order

to

order

facts

the

claim

(29

owed

UNA

to

to

and

Ernest

detriment

and

and

him U.S.C. to

Young

by

but

to judgment

judgment is pay

the

by circumstances

him T.

"

,rlbt

responsibleifor

and

Case 1:08-cv-00194-GMS

UNA Young §

under

disability

decision-maker's

PRAYER

of

limited

'""

under

.-.

post-judgment

1132(ji)(1)(B»

Young.

in

reinstating

the

under

requests

the

favor

to

benefits

UNA

applicable

FOR

Upon

the

the

of

paying

of

biased

that

this

Document 1

applicable policy.

attorneys' fees against the defendant under 29 D.S.C.

interest

future, the

RELIEF

personnel

permits

information

to

§

investigation and review of the facts and circumstances.

the

1

past-due

matter

Young,

plaintiff

132(g)

plan

and

Court

allowed

ongoing

a

disability policy;

flawed

and

plan

and warrant

UNA

disability

against

grant

and

outside

by

related

participant

disability

clarify rights to future benefitsunder the plan. Young seeks relief. this
belief, evaluation has

the

law;

policy;

an

Filed 04/07/2008

UNA

following

benefits

also

consultants);

case

UNA

award

benefits

or

operated

for law.

of

beneficiary

is

and

the

all

of

relief:

the

facts

disability

ongoing,

owed

Young's

failed

Page 3 of 4

funding under

and

or

to

to

in a fair and rea:~on\~lemanner; failed to provide a claims process free of self-

have different people decide the original claim and the appeal; failed to reasonably;consider and

source and payor of all disability benefits owed to eligible claimants (including Young) under the
a

address the materials and proofs submitted; and failed to conduct a competent and reasonable

bring a civil action to recoverbenefitsdue under a plan, to enforcerights underthe plan, and to

Case 1:08-cv-00194-GMS

Document 1

Filed 04/07/2008

Page 4 of 4

4. 5. 6.

Attorney's fees abd'lQsts under 29 V.S.C. § 1132(g);
'""... Costs; and .\

.
All other available

'\
relief that is equitable and just.

PLAINTIFF ERNEST T. YOUNG

By:
Herbert G. Feuerhake, Esq.

521 West
Wilmington,

Street
DE 19801

(302)

658-6101

herb [email protected]

Attorney for Plaintiff

Date: April

~

,2008

-4~

#2590

Case 1:08-cv-00194-GMS
44 (Rev. 12/07)
""'JS

Document 1-2
COVER

Filed 04/07/2008

Page 1 of 1

CIVIL
sheet and the information contained herein neither replace (SEE INSTRUCTIONS ON THE REVERSE OF THE FORM.)

SHEET
supplement the filing and service of pleadings or other papers as required by law, except as provided

The

JS

44

civil

cover

by local rules of court. This form, approved by the Judicial Conference ofthe United Statesin September 1974, is required for the use of the Clerk of Court for the purposeofmitiating
the civil docket sheet.

~ I Original
V. ORIGIN

0 2 Removed from
(Place an "X" in One Box

0 3 Remanded from
Appellate Court
~
nor

0 4 Reinstated0 5 Transferred 0 6 Multidistrict0 7 Judge or from from
Appeal,to

Only)

Proceeding

State Court
cg'R?§~S(:@v~~§1~~~

Reopened
are filing

VI. CAUSEOF ACTION VII. REQUESTEDIN
COMPLAINT:

(Do not cite
jurisdictional

another dlstnct s ectf
statutes unless diversity):

Litigation

Magistrate Jud ment

ne fd escnpttOn0f cause: ..
.

B

Claim

for long-term

disability

benefits

0 CHECK THIS A CLASS IF IS ACTION
UNDER F.Rc.P. 23

DEMAND $

CHECK only demanded YES if incomplaint
JURY DEMAND: 0 Yes 0 No

VIII.
IF

CASE(S)
ANY (See

.
instructIOns):

.

RELATED

JUDGE

AMOUNT

APPLYINGIFP

JUDGE

RECEIPT

#

MAG.

JUDGE

District

Case 1:08-cv-00194-GMS

Document 1-3

Filed 04/07/2008

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