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Gonzales v. Unum Life Insurance Co.

October 2, 2009

RUBEN GONZALES, PLAINTIFF,
v.
UNUM LIFE INSURANCE COMPANY, ET AL., DEFENDANT.



The opinion of the court was delivered by: Honorable Barry Ted Moskowitz United States District Judge

ORDER DENYING MOTION TO DISMISS AND STRIKE

Defendants Unum Life Insurance Company of America ("Unum") and Provident Life and Accident Insurance Company ("Provident") move the Court to dismiss the second cause of action in Plaintiff Ruben Gonzales's Complaint. Defendants also move to strike Plaintiff's demand for a jury trial. For the reasons discussed below, Defendants' Motion to Dismiss and Strike is DENIED.

I. BACKGROUND

Starwood Hotels and Resorts ("Starwood") formerly employed Plaintiff as a sales team manager. (Compl. ¶ 9.) Plaintiff suffered a disability on June 8, 2007, at which time his Starwood employment ceased.

During his employment with Starwood, Plaintiff elected to participate in the Voluntary Workplace Disability Plan (the "VW Plan"), a short-term disability plan. The VW Plan provided voluntary workplace disability benefits through an insurance policy issued by Defendant Provident. (Compl. ¶ 10.) The terms of the VW Plan provided benefits in the amount of $5,000.00 per month for a maximum benefit period of six months. (Compl. ¶ 11.)

While a Starwood employee, Plaintiff also elected to participate in a long-term disability plan (the "LTD Plan") sponsored by Starwood. (Compl. ¶ 12.) Defendant Unum issued disability benefits under the LTD Plan to participating Starwood employees through a group insurance policy. (Compl. ¶ 12.) The LTD Plan provided benefits for Plaintiff in the amount of 60% of his monthly earnings for a period of 18 months following his disability. (Compl. ¶ 13.)

Plaintiff allegedly suffered a loss under both the VW and LTD Plans when he became totally disabled on June 8, 2007, following an operation for coronary stenting to address his coronary artery disease. (Compl. ¶¶ 17, 21.) On June 19, 2007, Plaintiff filed for benefits with Provident under the VW Plan. (Compl. ¶ 18.) On August 6, 2007, Provident granted Plaintiff's application for benefits. (Id.)

On June 20, 2007 Plaintiff applied for benefits with Unum under the LTD Plan. (Compl. ¶ 18.)

On July 11, 2007, Plaintiff's physician diagnosed him with Parkinson's disease and referred him to a neurologist. (Compl. ¶ 21.) On July 12, 2007, the neurologist confirmed this diagnosis. (Id.) Both doctors submitted attending physician reports to Provident and Unum. (Id.)

On December 19, 2007, Provident stopped paying benefits to Plaintiff under the VW Plan. (Compl. ¶ 18.) On February 11, 2008, Provident informed Plaintiff by letter that it would not pay any further benefits. (Compl. ¶ 19.)

On January 15, 2008, Unum denied long-term disability benefits to Plaintiff under the LTD Plan. (Compl. ¶ 19.)

On May 6, 2008, Plaintiff appealed the denial of benefits under both Plans. (Compl. ¶ 20.) On October 30, 2008, Provident and Unum denied Plaintiff's appeals. (Id.)

On November 14, 2008, Plaintiff submitted a neuropsychological evaluation to Defendants to appeal the denial of benefits under both Plans for a second time. (Id.) Plaintiff allegedly never received a decision on these appeals. (Id.)

On March 9, 2009, Plaintiff filed a Complaint with the Court. Plaintiff brings two causes of action against Defendants: (1) a claim pursuant to the Employee Retirement Security Act, 29 U.S.C. § 1001, et seq. for benefits denied under the LTD Plan and the VW Plan;*fn1 and (2) a claim for breach of the implied covenant of ...


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