Courtroom: United States District Courtroom, Jap District of Louisiana
Insurance coverage Provider: Guardian Life Insurance coverage Firm of America
Plaintiff’s Employer: Gulf Coast Specific Carriers, Corp.
Plaintiff’s Occupation: Industrial Truck Driver
Background of the Declare
Douglas Domino, Sr. began working as a business truck driver for Gulf Coast Specific Carriers, Corp. on February 20, 2020. His position concerned hauling masses and working heavy equipment for sixty hours per week. On March 8, 2021, Domino visited his main care doctor, Dr. Sunil Bharwani, complaining of dizziness and lightheadedness because of hypertension. On March 31, 2021, Domino was recognized with diabetic ketoacidosis and insulin-dependent kind 2 diabetes mellitus, stopping him from persevering with his duties as a business truck driver in keeping with Division of Transportation pointers.
Causes for Denial of Incapacity Advantages
Domino filed a declare for short-term incapacity (STD) advantages in March 2021, which was accredited and paid for the utmost 13-week interval. Nevertheless, 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 throughout the look-back interval, was excluded beneath the coverage. His employment was terminated on October 6, 2021, after exhausting paid break day (PTO) and being on unpaid medical depart since March 14, 2021.
Points Raised by Plaintiff and Defendant
The difficulty offered is whether or not plaintiff was lined beneath defendant’s coverage when he was recognized with insulin-dependent diabetes mellitus. This subject activates whether or not he was thought of to be in “lively full-time service” throughout the that means of the coverage whereas on sick depart after exhausting his paid break day (“PTO”). Plaintiff argued that he was nonetheless in “lively full-time service” whereas on medical depart, asserting that prolonged sick depart shouldn’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. Nevertheless, Guardian countered that the coverage explicitly required lively full-time work to keep up protection, and the household depart of absence provision didn’t apply because it was not required beneath federal legislation.
Decide’s Ruling
The court docket discovered Guardian’s interpretation of the coverage to be constant and affordable. It granted Guardian’s movement for abstract judgment, agreeing that the denial of LTD advantages was not an abuse of discretion. The choose discovered that Domino was not in lively full-time service when recognized with diabetes, as he had exhausted his PTO and was on an indefinite unpaid medical depart. Consequently, the court docket denied Domino’s movement for abstract judgment and upheld Guardian’s choice 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 cherished one the incapacity advantages you deserve, contact the Ortiz Regulation Agency for knowledgeable help in navigating the attraction course of. Name us at present at (888) 321-8131 to get assist along 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
