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

KRAUSE v. CIGNA CORPORATION et al

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Case Number: 
1:12-cv-05543 Search Pacer
ACE Group party(s): 
Opposing Party: 
Lisa Krause
Court Type: 
Federal
US District Court: 
Eastern District of New York
Date Filed: 
Nov 8 2012

"FIRST CAUSE OF ACTION FOR WRONGFUL DENIAL OF LONG TERM DISABILITY INSURANCE BENEFITS

88. Plaintiff repeats, reiterates and realleges each and every allegation contained in paragraphs 1 through 87 as if set forth in full herein.

89. All conditions precedent to the commencement of this action have been met and Ms. Krause has fully performed all of her obligations to CIGNA under the Plan and under the CIGNA Disability Policy.

90. Ms. Krause has properly and completely exhausted all of her administrative remedies under the Plan. Defendant CIGNA wrongfully denies and refuses Ms. Krause’s claim for long term disability insurance benefits despite the demand, despite no change in condition, and despite her inability to work.

91. Ms. Krause has been treated wrongfully and unfairly by defendant CIGNA and in violation of Section 502, 404 and 409 of ERISA 29 U.S.C. §§ 1132, 1104, and 1109, as well as in violation of applicable plan documents and related policies in effect.

92. Moreover, the decision of CIGNA to deny Ms. Krause’s long term disability insurance benefits under the terms of the Plan and under the terms of the CIGNA Disability Policy was made in bad faith and in violation of ERISA.

93. Ms. Krause asserts her claim pursuant to Section 502 of ERISA, 29 U.S.C. § 1132 to recover the long term disability insurance benefits due under the Plan and to enforce her rights of the CIGNA Disability Policy under the Plan.

94. As a direct and proximate result of defendant CIGNA’s action, Ms. Krause has been caused to incur substantial attorney’s fees and costs in an amount not currently known.

95. Pursuant to Section 502(g) of ERISA, 29 U.S.C. § 1132(g), Ms. Krause is entitled to recover her attorney’s fees and costs incurred in bringing her action to right the wrong done to her by defendant CIGNA.

96. As a direct and proximate result of defendant CIGNA’s actions and by virtue of CIGNA’s breach of its contractual obligations under the CIGNA Disability Policy to pay Ms. Krause for a covered loss, CIGNA is liable to Ms. Krause in the amount of her claim for monthly benefits from the date of its denial through present, together with interest as allowed by law and attorney’s fees.

AS AND FOR A SECOND CAUSE OF ACTION FOR WRONGFUL DENIAL OF WAIVER OF PREMIUM COVERAGE BENEFIT

97. Plaintiff repeats, reiterates and realleges each and every allegation contained in paragraphs 1 through 96 as if set forth in full herein.

98. Ms. Krause has properly and completely exhausted all of her administrative remedies under the Plan. Defendant CIGNA wrongfully denies and refuses Ms. Krause’s claim for waiver of premium coverage benefits despite the demand, despite no change in condition, and despite her inability to work.

99. Ms. Krause has been treated wrongfully and unfairly by defendant CIGNA and in violation of Section 502, 404 and 409 of ERISA 29 U.S.C. §§ 1132, 1104, and 1109, as well as in violation of applicable plan documents and related policies in effect.

100. Moreover, the decision of CIGNA to deny Ms. Krause’s waiver of premium coverage benefits under the terms of the Plan and under the terms of the CIGNA Waiver of Premium Policy was made in bad faith and in violation of ERISA.

101. Ms. Krause asserts her claim pursuant to Section 502 of ERISA, 29 U.S.C. § 1132 to enforce her rights of the waiver of premium coverage benefits under the CIGNA Life Insurance Policy.

102. As a direct and proximate result of defendant CIGNA’s action, Ms. Krause has been caused to incur substantial attorney’s fees and costs in an amount not currently known.

103. Pursuant to Section 502(g) of ERISA, 29 U.S.C. § 1132(g), Ms. Krause is entitled to recover her attorney’s fees and costs incurred in bringing her action to right the wrong done to her by defendant CIGNA.

104. By virtue of CIGNA’s breach of its contractual obligations under the CIGNA Waiver of Premium Policy to grant Ms. Krause the waiver of premium coverage benefit, CIGNA is liable to Ms. Krause for the enforcement of the waiver of premium coverage benefits.

AS AND FOR A THIRD CAUSE OF ACTION FOR ESTOPPEL

105. Plaintiff repeats, reiterates and realleges each and every allegation contained in paragraphs 1 through 104 as if set forth in full herein.

106. CIGNA, as at all times mentioned herein, accepted timely payment of premiums for Ms. Krause’s long term disability insurance coverage for the entire time of her employment beginning in approximately January 1989, making Ms. Krause eligible for long term disability insurance coverage.

107. CIGNA wrongfully, maliciously, and improperly denied benefits to Ms. Krause in and around June 29, 2011 in breach of its obligations under the CIGNA Disability Policy and under ERISA.

108. Based upon CIGNA’s correspondence with Ms. Krause, CIGNA acknowledges and admits its obligations under the Plan.

109. Ms. Krause has reasonably relied to her detriment on her deserved payment of benefits promised to her by CIGNA under the CIGNA Disability Policy and justice demands that said promise be enforced.

110. By virtue of the actions of CIGNA, and its agents, servants, employees, and a consequent reliance by Ms. Krause, CIGNA is estopped in asserting that Ms. Krause is not entitled to payment by CIGNA of long term disability insurance benefits.

AS AND FOR A FOURTH CAUSE OF ACTION FOR ESTOPPEL AGAINST CIGNA

111. Plaintiff repeats, reiterates and realleges each and every allegation contained in paragraphs 1 through 110 as if set forth in full herein.

112. CIGNA wrongfully, maliciously, and improperly denied waiver of premium coverage benefits to Ms. Krause in and around May 24, 2011 in breach of its obligations under the CIGNA Waiver of Premium Policy and under ERISA.

113. Based upon CIGNA’s correspondence with Ms. Krause, CIGNA acknowledges and admits its obligations under the CIGNA Life Insurance Policy.

114. By virtue of the actions of CIGNA, and its agents, servants, employees, and a consequent reliance by Ms. Krause, CIGNA is estopped in asserting that Ms. Krause is not entitled to the continued waiver of premium coverage benefits by CIGNA.

AS AND FOR A FIFTH CAUSE OF ACTION FOR DECLARATORY JUDGMENT

115. Plaintiff repeats, reiterates and realleges each and every allegation contained in paragraph 1 through 114 as if set forth in full herein.

116. Ms. Krause seeks a declaration that she is permanently disabled pursuant to CIGNA’s long term disability insurance policy and is entitled to long term disability insurance benefits each month until the age of 65 and beyond as appropriate.

AS AND FOR A SIXTH CAUSE OF ACTION FOR ATTORNEY’S FEES

117. Plaintiff repeats, reiterates and realleges each and every allegation contained in paragraph 1 through 116 as if set forth in full herein.

118. In violation of Section 409 of ERISA, 29 U.S.C. § 1109, defendant CIGNA has breached its responsibilities and obligations under the Plan to employees of Catholic Charities, including Ms. Krause. Her breach of CIGNA’s duty of good faith, skill, prudence and diligence is described herein above.

119. As a direct and proximate result of defendant CIGNA’s actions, Lisa Krause has been caused to incur substantial attorney’s fees and costs in an amount not currently known.

120. Pursuant to Section 502(g) of ERISA, 29 U.S.C. § 1132(g), Ms. Krause is entitled to recover her attorney’s fees and costs incurred in bringing her action to right the wrong done to her by defendant CIGNA and in treating her in bad faith.

AS AND FOR A SEVENTH CAUSE OF ACTION FOR PAYMENT OF INTEREST

121. Plaintiff repeats, reiterates and realleges each and every allegation contained in paragraph 1 through 120 as if set forth in full herein.

122. Plaintiff was entitled to timely payment of long term disability insurance benefits upon her first request.

123. Said benefits were unjustly denied by defendant CIGNA and continued non-payment of benefits to which Plaintiff is entitled has denied Ms. Krause the full value of what was promised her, and afforded CIGNA an unjust enrichment.

124. In addition to other remedies requested, an award of interest to Ms. Krause will provide an equitable make-whole remedy for their non-payment under § 502(a)(3)(B) of ERISA, 29 U.S.C. § 1132(a)(3)(B).

AS AND FOR AN EIGHTH CAUSE OF ACTION FOR VIOLATION OF GENERAL BUSINESS LAW

125. Plaintiff repeats each and every allegation contained in paragraphs 1 through 124 as if set forth fully herein.

126. CIGNA willfully, knowingly or recklessly engaged in conduct that is deceptive and misleading in a material respect, including without limitation, engaging in adeceptive practice and pattern of terminating valid disability claims, and that conduct is aimed at the general public as well as Plaintiff.

127. CIGNA, which has a common law obligation and statutory prohibition against engaging in deceptive acts and practices in the conduct of its business, is engaged in consumer-oriented conduct within New York State.

128. CIGNA profited by terminating Plaintiff’s benefits by engaging in deceptive acts and practices in violation of Section 349 of the General Business Law.

129. Plaintiff has been injured by reason of CIGNA’s deceptive practices, including loss of her monthly disability benefits, loss of her monthly pension contribution, and the loss of her home, and Plaintiff is entitled to reimbursement and restitution of all sums that Plaintiff lost and CIGNA gained as a result of its deceptive acts and practices.

130. As a result of CIGNA’s willful and knowing deceptive acts and practices, Plaintiff is entitled to three times her actual damages.

131. As a result of Defendants’ deceptive acts and practices, Plaintiff is entitled to an award of reasonable attorney fees.

AS AND FOR A NINTH CAUSE OF ACTION FOR BAD FAITH

132. Plaintiff repeats and realleges each and every allegation contained in paragraphs numbered 1 through 131, of this complaint as if fully set forth at length herein.

133. Under New York law, in every contract of insurance, there is an implied covenant of good faith and fair dealing that the insurer will do nothing to injure or prejudice the insured’s rights or wrongfully deny any benefits due under the contract of insurance or place its own interests above the interests of its insured.

134. CIGNA was at all times bound to honor such an implied covenant of good faith and fair dealing.

135. CIGNA breached their implied covenant of good faith and fair dealing by failing and refusing to pay Ms. Krause, as required under the terms of the CIGNA Disability Policy.

136. CIGNA breached its implied covenant of good faith and fair dealing by failing to pay and for terminating her benefits for no good or proper reason.

137. CIGNA’s actions in this regard were unreasonable, done in bad faith and without proper cause.

138. As a result of CIGNA’s bad faith and breach of its implied covenant of good faith and fair dealing, Ms. Krause has sustained damages in an amount to be proven at trial.

139. As a result of the foregoing, Ms. Krause is entitled to a judgment against CIGNA in an amount to be proven at trial plus interest as provided by law.

140. Plaintiff demands a jury trial of all claims.

WHEREFORE, plaintiff Ms. Krause, respectfully requests the Court to enter an Order granting the following relief:

(1) Upon the First Cause of Action against CIGNA entering an award of judgment in favor of the plaintiff against defendant CIGNA for the amount of Ms. Krause’s monthly disability benefits in amounts owed under the terms of the Plan from May 2011 until present, together with interest as allowed by law;
(2) Upon the Second Cause of Action against CIGNA declaring the enforcement of the waiver of premium coverage benefits;
(3) Upon the Third Cause of Action against CIGNA declaring that CIGNA is estopped from asserting that Ms. Krause is not entitled to CIGNA’s long term disability insurance benefits;
(4) Upon the Fourth Cause of Action against CIGNA declaring that CIGNA is estopped from asserting that Ms. Krause is not entitled to a continued waiver of premium coverage benefit from CIGNA;
(5) Upon the Fifth Cause of Action against CIGNA for an order, award and judgment declaring that Ms. Krause is permanently disabled pursuant to CIGNA’s Total Disability Policy and is entitled to long term disability insurance benefits in a monthly amount to be determined by the Court, each month until the age 65, and beyond as appropriate;
(6) Upon the Sixth Cause of Action against CIGNA for reasonable attorney’s fees, costs and disbursements incurred in prosecuting her action, and any other attorney’s fees and disbursements approved by the Court;
(7) Upon the Seventh Cause of Action against CIGNA for interest as the Court deems just and proper on benefits past due to Ms. Krause; and
(8) For such other and further relief as the Court deems just and proper under the circumstances including interest and attorney’s fees.
(9) Upon the Eighth Cause of Action against CIGNA, CIGNA must compensate Plaintiff for three times the amount of those losses. Declare that CIGNA’s deceptive practices violate GBL §349 and resulted in Plaintiff losing her monthly disability benefits, her monthly pension contribution, and her home,
(10) Upon the Ninth Cause of Action against CIGNA must compensate Plaintiff for damages resulting from CIGNA bad faith dealings.
(11) For such other relief which the Court may feel that is 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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