ERISA Long Term Disability Case Citations and references

DISCLAIMER: Please note that every case is different and these verdicts and settlements, while accurate, do not represent what we may obtain for you in your case.

Plan Admin Loses Beneficiary’s Address, then Denies Coverage

After suffering a heart attack, Thomas Wenner was receiving disability benefits from Sun Life Assurance Company of Canada under his employer’s long-term disability benefits plan.  In 2002, Sun Life began the process of attempting to discontinue Mr. Wenner’s benefits. 

Sun Life notified Mr. Wenner via letter that he should submit updated medical and personal information, but they sent the letter to the wrong address.  Having not received a response, Sun Life sent another letter to the wrong address and left Mr. Wenner a voicemail (one he claims to not have received).  In its third letter, Sun life stated that they were terminated Mr. Wenner’s coverage because he had not returned the material requested.

Mr. Wenner received the third letter via mail forwarding and replied to dispute the claim, this time submitting all of the requested materials.  After reviewing his updated information, Sun Life sent him a fourth letter – saying that his benefits were being terminated because he was no longer physically incapable of doing the full-time work of a corporate executive (his former occupation). 

However, the fourth letter provided no mechanism for an internal appeal.  The United States Court of Appeals for the Sixth Circuit stated that because the fourth letter provided no mechanism for appeal and noted an entirely new reason for the termination of his benefits that Sun Life had denied him a full and fair review of his record.  The Court reinstated all of Mr. Wenner’s benefits from the beginning of the invalid termination.

Wenner v. Sun Life Assurance Company of Canada, 482 F.3d 878 (6^th Cir. 2007).