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The Collaborative Clearinghouse for Lawsuits and Other Claims Against ACE Group Insurance Companies

BAVA v. COMBINED INSURANCE COMPANY OF AMERICA

ATTENTION: It is possible that this information may no longer be current and therefore may be inaccurate. The index contains both open and closed cases and is not a complete list of cases in which an ACE Insurance Group company is involved. This information is provided to give interested persons an idea of the issues disputed in the indexed cases. For a full understanding of a case, one should read the rest of the court file, including the response. For the most up-to-date and complete information on a case, visit www.pacer.gov or contact the clerk of the relevant court.

Case Number: 
1:14-cv-01026 Search Pacer
Opposing Party: 
Daniele Bava
Court Type: 
Federal
US District Court: 
Eastern District of Virginia
Date Filed: 
Aug 11 2014

COMPLAINT
1. Plaintiff, Daniele Bava (hereinafter "Bava"), is a citizen and resident of
Loudoun County, Virginia.
2. Plaintiff Bava was employed, and is currently employed, by Koons Tyson
Toyota.
3. As an employee of Koons Tyson Toyota, Plaintiff Bava was covered
under the Koons Tyson Toyota Disability Plan (hereinafter the "Plan") under a group
disability policy No. W0708502.
4. Upon information and belief, Defendant Combined Insurance Company of
America (hereinafter "Combined Insurance") is a properly organized business entity
organized and existing under the laws of the State of Illinois.
5. Upon information and belief, the Plan policy No. W0708502 (hereinafter
the "Policy"), is a bona fide employee benefit covered under Section 502(a) of the
Employee Retirement Income Security Act of 1974 ("ERISA").
6. Upon information and belief, the Plan Administrator of the Plan is Koons
Tyson Toyota (hereinafter "Plan Administrator").
7. Upon information and belief the Plan Administrator has totally delegated
the function of determining disability under the Plan to Defendant Combined Insurance.
8. Upon information and belief, Combined Insurance is a fiduciary of the
Plan.
9. Upon information and belief, the Plan provides that Defendant Combined
Insurance has the authority to accept applications under the Plan, to allow benefits under
the Plan, to deny benefits under the Plan, and to terminate benefits under the Plan.
10. Upon information and belief, Defendant Combined Insurance makes the
benefit determinations for the Plan at issue in this claim.
JURISDICTION AND VENUE
11. This court has jurisdiction to hear this claim pursuant to 28 U.S.C. § 1131,
in that the claim arises under the laws of the United States. Specifically, Plaintiff Bava
brings this action to enforce his rights under ERISA, 28 U.S.C. § 1132. Venue in the
Eastern District of Virginia is appropriate because the employee lives in this district.
FACTUAL SUMMARY
12. At all times relevant to this action Plaintiff Bava was a covered
beneficiary under the Policy he received as an employee benefit under his employment
with Koons Tyson Toyota.
13. Upon information and belief, Defendant Combined Insurance is obligated
to furnish disability benefits to qualified Plan beneficiaries according to the terms of the
Policy.
14. Upon information and belief, Defendant Combined Insurance is obligated
to furnish disability benefits to qualified Plan beneficiaries according to the terms of the
Policy.
15. Plaintiff Bava worked as a sales professional at Koons Tyson Toyota until
May 12,2011.
16. On May 12, 2011, Plaintiff Bava became disabled under the terms of the
Plan due to accident and/or sickness and subsequently submitted a claim for disability
benefits to Defendant Combined Insurance.
17. Defendant Combined Insurance processed Plaintiff Bava's claim for
disability benefits (hereinafter "Disability Benefits") and denied his claim for Disability
Benefits.
18. Plaintiff Bava pursued administrative remedies under the Plan and timely
submitted further medical and vocational evidence demonstrating that he met Plan's
definition of "disability", and that he was entitled to Disability Benefits under the term of
the Plan.
19. Defendant Combined Insurance was furnished unrefuted medical
documentation that Bava continued to suffer from an injury and/or sickness that disabled
him until October 15, 2012, at which time he returned to work at Koons Tyson Toyota.
20. Plaintiff Bava exhausted his administrative remedies and his claim is ripe
for judicial review pursuant to 29 U.S.C. § 1132.
21. Defendant Combined Insurance has wrongfully terminated and denied
Plan benefits to Plaintiff Bava in violation of the Plan and ERISA for the following
reasons:
a. Plaintiff Bava was disabled under the Plan in that he was unable to work
and met the definition of "disabled" under the Plan from May 12,2011
through October 15, 2012;
b. Defendant Combined Insurance failed to afford Plaintiff Bava a full, fair
and impartial review of his disability benefits claim.
WHEREFORE, Plaintiff Bava prays that the court:
1. Grant Plaintiff Bava declaratory and injunctive relief finding that he is entitled
to Plan Disability Benefits under the terms of the Plan, and that Defendant Combined
Insurance be ordered to pay all benefits according to the terms of the Plan;
2. Enter an Order awarding Plaintiff Bava all reasonable attorney's fees and
expenses incurred as a result of Defendant Combined Insurance's wrongful denial; and
3. Enter an award for such other relief as may be just and proper.

The provided text is an excerpt from a document filed in this case. For a full understanding of the case, one should read the complete court file, including the response.

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