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NORTHERN CALIFORNIA RECORD

Thursday, March 28, 2024

Physician claims insurance company wrongly denied him long-term disability

Insurance 08

SAN FRANCISCO — A doctor suffering from depression alleges his long-term disability plan administrator incorrectly denied his disability claim.

Malcolm Smith filed a complaint Sept. 27 in U.S. District Court for the Northern District of California against Life Insurance Co. of North America and Does 1-10, alleging that it violated the federal employment act by non-payment of benefits.

According to the complaint, the plaintiff alleges that in April 2013, he filed a disability claim for a psychiatric disability and although the defendants had approved his claim, he was advised that his psychiatric disability claim would end April 8, 2015, if he remained totally disabled due to the psychiatric condition. On May 4, 2015, the defendant allegedly advised the plaintiff that he was no longer eligible for long-term disability benefits, so the plaintiff submitted an appeal stating that his chronic and acute nerve damage is evidence of his disability. On July 1, the defendant denied his final appeal. 

The plaintiff holds Life Insurance Co. of North America and Does 1-10 responsible because the defendants allegedly failed to extend the plaintiff's disability benefits despite remaining in a disabled condition, failed to contact any of his treating physicians to inquire about his impairments and limitations and failed to take into account his cervical radiculopathy and post-operative disabilities.

The plaintiff requests a trial by jury and seeks judgment in his favor, declaratory relief, interest, attorney's fees, costs, reimbursement of expenses and other relief that the court deems just. He is represented by John F. Martin and Marta R. Vanegas of Law Offices of John F. Martin PC in Walnut Creek.

U.S. District Court for the Northern District of California case number 3:16-cv-05507

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