Court docket: United States District Court docket, Jap District of Louisiana
Insurance coverage Service: Guardian Life Insurance coverage Firm of America
Plaintiff’s Employer: Gulf Coast Specific Carriers, Corp.
Plaintiff’s Occupation: Business Truck Driver
Background of the Declare
Douglas Domino, Sr. began working as a industrial truck driver for Gulf Coast Specific Carriers, Corp. on February 20, 2020. His position concerned hauling masses and working heavy equipment for sixty hours every week. On March 8, 2021, Domino visited his major care doctor, Dr. Sunil Bharwani, complaining of dizziness and lightheadedness resulting from hypertension. On March 31, 2021, Domino was identified with diabetic ketoacidosis and insulin-dependent sort 2 diabetes mellitus, stopping him from persevering with his duties as a industrial truck driver based on Division of Transportation tips.
Causes for Denial of Incapacity Advantages
Domino filed a declare for short-term incapacity (STD) advantages in March 2021, which was accepted and paid for the utmost 13-week interval. Nonetheless, Guardian Life Insurance coverage Firm denied his declare for long-term incapacity (LTD) advantages, citing a pre-existing situation clause. Domino’s pre-existing hypertension, which was handled inside the look-back interval, was excluded beneath the coverage. His employment was terminated on October 6, 2021, after exhausting paid day without work (PTO) and being on unpaid medical go away since March 14, 2021.
Points Raised by Plaintiff and Defendant
The difficulty introduced is whether or not plaintiff was coated beneath defendant’s coverage when he was identified with insulin-dependent diabetes mellitus. This challenge activates whether or not he was thought of to be in “energetic full-time service” inside the which means of the coverage whereas on sick go away after exhausting his paid day without work (“PTO”). Plaintiff argued that he was nonetheless in “energetic full-time service” whereas on medical go away, asserting that prolonged sick go away mustn’t disqualify him from protection. He additionally contended that his protection ought to proceed beneath the Household and Medical Go away Act (FMLA) provision of the coverage, as he paid premiums till June 20, 2021. Nonetheless, Guardian countered that the coverage explicitly required energetic full-time work to keep up protection, and the household go away of absence provision didn’t apply because it was not required beneath federal legislation.
Decide’s Ruling
The courtroom discovered Guardian’s interpretation of the coverage to be constant and cheap. It granted Guardian’s movement for abstract judgment, agreeing that the denial of LTD advantages was not an abuse of discretion. The decide discovered that Domino was not in energetic full-time service when identified with diabetes, as he had exhausted his PTO and was on an indefinite unpaid medical go away. Consequently, the courtroom denied Domino’s movement for abstract judgment and upheld Guardian’s resolution to disclaim LTD advantages .
Get Assist with Your Lengthy-Time period Incapacity Declare
This case illustrates the complexities surrounding incapacity claims and the significance of understanding coverage phrases. If Guardian has denied you or a liked one the incapacity advantages you deserve, contact the Ortiz Regulation Agency for knowledgeable help in navigating the enchantment course of. Name us immediately at (888) 321-8131 to get assist together with your incapacity declare.
Disclaimer: The Ortiz Regulation Agency didn’t deal with this declare. It’s merely summarized right here to assist claimants perceive how Federal Courts deal with long-term incapacity insurance coverage claims.
Here’s a copy of the choice in PDF: Domino v. Guardian
