Employee Disabled by Cancer Wrongly Denied Coverage, She Claims
9-29-2014 20:22:00
SAN FRANCISCO (CN) - After cancer, a Kaiser employee was wrongly denied long-term disability coverage although she cannot work, she claims in U.S. District Court, Northern District of California.
Deanna Spina sued Metropolitan Life Insurance Company (MetLife) and Kaiser Foundation Health Plan Inc. Long Term Disability Plan for breach of the Employee Retirement Income Security Act of 1974 (ERISA).
Spina says she worked as a senior level scheduling clerk.
“Plaintiff suffered from breast cancer. She underwent a modified radical bilateral mastectomy, intensive chemotherapy and surgical reconstruction. Subsequent to the chemotherapy treatments, plaintiff suffers on a daily basis from blurry vision, nausea, clenched teeth, headaches, forgetfulness, restlessness, physical and mental exhaustion, fatigue, and loss of concentration. Any kind of exertion, and particularly work, exacerbates these conditions,” her complaint states.
“Despite her post-cancer conditions, Mrs. Spina has done her best to continue working. However, her conditions, and the accompanying restrictions and limitations, limit her to a very limited schedule, part-time, in a greatly reduced capacity from her pre-cancer occupational duties and responsibilities,” it continues.
“Medical professionals who have treated plaintiff confirm that plaintiff is unable to return to full-time work as a result of her difficulty focusing, blurred vision, nausea, headaches, physical and mental strain, chronic fatigue, and lethargy,” according to the complaint.
Spina therefore filed a claim for long-term disability, but it was denied, according to the complaint. She appealed, but did not get a response for 123 days.
“As a result, under the ERISA statutes and the case law that has developed around ERISA, plaintiff’s appeal is ‘deemed denied,’ and plaintiff has exhausted all administrative remedies regarding the denial of plaintiff’s claim for LTD benefits,” the complaint states.
“By Denying plaintiff’s LTD claim and refusing to issue a timely decision on plaintiff’s appeal, defendants have violated, and continue to violate, the terms of the Plan, the terms of ERISA, and plaintiff’s rights thereunder,” it says.
Spina seeks declaratory relief, an order to pay benefits due, prejudgment interest, statutory penalties, attorney’s fees and costs.
She is represented by David M. Lilienstein of the DL Law Group in San Francisco.
