A woman seeking long term disability benefits alleges her claim was wrongfully denied by her insurance company.
Kellie Chrstman Duncan filed the complaint Aug. 6 in the U.S. District Court for the Southern District of Illinois against Anthem Life Insurance Company, alleging breach of statutory, contractual and fiduciary obligations. She also alleges the defendant violated the Employee Retirement Income Security Act of 1974.
According to the complaint, Duncan is a vested participant in a group insurance policy as an employee of Firstsource Group USA. Duncan claims she applied for long term disability benefits under her insurance plan on Nov. 4, 2018. She alleges Anthem denied her claim on Aug. 5, 2019. She fired an appeal of the denial, which included reports of her restrictions and limitations as well as medical records showing her permanent condition. The suit does not specify Duncan’s condition.
“Despite presenting objective evidence including the clinical determination of her treating physician that plaintiff was disabled and entitled to receive long term disability benefits, defendant denied her appeal on March 25, 2019,” the suit states.
Duncan claims that when considering her appeal, Anthem hired Dane Street to provide three medical reviews “with the knowledge that the reviewers would likely support the denial of benefits,” the suit states.
The plaintiff alleges the defendant’s denial of her disability benefits request was “arbitrary and capricious, and not based on substantial evidence, was a breach of their fiduciary duties and was the product of a conflict of interest and serious procedural irregularities.”
Duncan alleges she has exhausted her administrative remedies.
She asks the court to order the defendant to pay all benefits due under her insurance plan from Dec. 3, 2018 to the date of the judgment, plus interest.
She also seeks an order for restitution to “disgorge defendants’ unjust enrichment in wrongfully delaying and denying benefits and/or to make plaintiff whole for losses, and payment of her attorneys’ fees caused by defendant’s violation” of the Employee Retirement Income Security Act.
Duncan is represented by Matthew Davis of Gallagher Davis LLP in St. Louis.
U.S. District Court for the Southern District of Illinois case number 3:20-cv-767