Free Complaint - District Court of California - California

Case 3:08-cv-03116-SI

Document 1

Filed 06/27/2008

Page 1 of 5

TEAL MONTGOMERY &
STEVEN 0. TEAL (Bar No. 58454) MICHAELS. HENDhSUN (Bar No. t75608) 8 15 Fifth Street, Suite ZW Sanra Rosa, California 95404 Telephone: (7074 525-1212 Facsimhe: (797)544-1388

5

I

ATTORNEYS FOR PLAINTIFF

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF CALIFORNIA

ROBERT HEIDINGSFELDER, Plaintiff,
VS.

COMPLAINT M)R BENEFITS UNDER 29 U.S.C. 1132

ALLIED WASTE INDUSTRIES, INC. OROW' LONG TERM DISABILITY PLAN, and DOES 1 through 100, inclusive,

PlaintEROBERT HEIDINGSFELDER ("HEIDINGSFELDER"), by and through his attorneys,
20 21

for his complaint against defendants alleges as follows: I.
JURISDIC%TON

1.

This action arises under the Employer Retirement and Income Security Act
1001 et. seq, as hereafter more filly idleged. This is an action far

24 ("ERISA") 29 U.S,C.

1 I

disability benefits owed to HEIDINGSFE%DER under a benefit plan governed by ERISA.

26

COMPLAINT FOR BENEFITS UNDBR 29 U,S.C. 5 1132

Case 3:08-cv-03116-SI

Document 1

Filed 06/27/2008

Page 2 of 5

11.
PARTIES
7 -.

Plaintiff is an individual residing in Santa Rosa, California. At all times relevant

herein, plaintiff was employed by Allied Waste Industries, Inc. ("ALLIED"). 3. Upon information and belief, defendant ALLIED WASTE INDUSTRIES, WC.

LONG TERM DISABILITY PLAN ("LTD P L A N ) was the enlployee benefit plan sponsored by ALLIED. The precise name of the LTD disability plan is not stated in the insurance policy issued to underwrite the plan and therefore is alleged upon information and belief.
4.

The true names and capacities, whether individual, corporate, associate, or

otherwise, of defendants named herein as DOES I through 100, inclusive, are unlcnown to plaintiff who therefore sues said defendants by such fictitious names. Plaintiff will seek leave of court to amend this Complaint to show their true names and capacities when the same have been ascertained.

5.

At all time herein mentioned, each of the defendants herein named as a DOE was,

and still is, legally responsible in some manner for the events and happenings herein referred to, and legally caused all the injuries and damages to plaintiff as herein alleged.

I

At all times herein mentioned, defendants, and each of them, named herein as 6. DOES 1 through 50, were the agents, servants andlor employees of each of the other, acting within the course and scope of their agency andlor employment. To the extent that DOES 1 through 50 were not acting in the capacity of an agent, servant or employee, they are sued herein in their individual capacities.

111. FACTUAL ALLEGATIONS
7.

As an employee of ALLIED, HEID~NGSFELDER eligible for, and at all was

times relevant herein, participated in the LTD PLAN. The LTD PLAN is an employee benefit plan subject to the requirements and protections of ERISA in that it is a fund or plan established or maintained by ALLIED for the purpose of providing disability benefits to participating

COMPLAINT FOR BENEFITS UNDER 29 U.S.C. 5 1132

Case 3:08-cv-03116-SI

Document 1

Filed 06/27/2008

Page 3 of 5

employees. As a plan participant, HEIDINGSFELDER was eligible for benefits pursuant to the terms and conditions set forth in the LTD PLAN.

8.

Under the t e ~ m s the LTD PLAN, employees are eligible for benefits equal to of

60% of their pre-disability earnings to a maximum of age 65 in the event of a disability. Disability is defined as the inability to perfom, with reasonable continuity, the material duties of the employee's own occupation, resulting in a loss of at least 20% of the employee's indexed pre-disability earnings. After 24 months, this definition changes to require the employee to be unable to perfom with reasonable continuity, the material duties of any occupation which the employee is able to perform due to education, training, or experience, and in which he or she can be expected to earn at least 60% of their indexed pre-disability earnings. 9. Plaintiff is unable to determine at this time who is the named plan administrator

for the LTD PLAN. This information is not contained in the disability policy issued to underwrite the LTD PLAN. The disability policy is issued by Standard Insurance Company and, pursuant to its terms, claims are administered by Standard Insurance Company. 10. HEIDINGSFELDER was a sales manager for ALLIED, worlting a sedentary to

light level occupation involving frequent travel, neck rotation, and lifting up to 20 pounds. On or about May 10, 2006, HEIDINGSFELDER suffered a disabling injury to his neck. 11. HEIDINGSFELDER'S LTD benefits were initially approved by Standard

Insurance Company and he began receiving monthly payments. 12. On or about November 6,2007, HEIDINGSFELDER'S were terminated. The

decision to terminate benefits was based upon provisions of the LTD PLAN which limit payments to 12 months for disabilities caused or contributed to by "Other Limited Conditions." The LTD PLAN defines "Other Limited Conditions" to mean, among other things, "diseases or disorders of the cervical, thoracic, or lumbosacral back and its surrounding soft tissue, and sprains or strains ofjoints or muscles." The LTD PLAN states that "Other Limited Conditions" does include certain specified conditions, including among others, "herniated discs with

neurological abnormalities that are documented by electromyogram and computerized

COMPLAINT FOR BENEFITS UNDER 29 U.S.C. 5 1132

1

Case 3:08-cv-03116-SI

Document 1

Filed 06/27/2008

Page 4 of 5

tomography or magnetic resonance imaging." 13. HEIDINGSFELDER disability was caused by severe neck pain which caused

intermittent numbness and weakness in his upper extremity. MRI studies demonstrated herniated discs, at least one of which protruded upon and made contact with the spinal cord. This condition qualifies as a herniated disc with neurological abnormalities documented on magnetic resonance imaging and, therefore, HEIDINGSFELDER is entitled to have his LTD

I/
Il

benefits paid beyond the 12 month limitation in the LTD PLAN 14. HEIDINGSFELDER appealed the termination of his benefits. His appeal was

rejected and the decision to limit his benefits to 12 months was confirmed.

IV.
FIRST CAUSE O F ACTION (Claim for Benefits - 29 U.S.C. § 1132 (a)(l)(B)) 15. Plaintiff incorporates by reference each and every allegation set forth above in

this Complaint. 16. Section 1 132(a)(l)(B) of ERISA authorizes plan participants and/or beneficiaries

to bring an action to recover benefits, to enforce their rights under the plan. 17. HEIDINGSFELDER has exhausted his right to appeal the termination of his

benefits and, therefore, he is entitled to seek recourse with this court. 18. Defendants have wrongfully, and in breach of their fiduciary duty to

HEIDINGSFELDER, terminated his benefits and refused to pay further benefits due and owing under the LTD PLAN. WHEREFORE, plaintiff prays for judgment against defendants, and each of them as follows:

1.
2.

An award of past due benefits under the plan, with interest; An order compelling defendants to reinstate HEIDINGSFELDER benefits and to

forthwith begin paying those benefits to the maximum of age 65, or until HEIDINGSFELDER is no longer disabled, whichever occurs first;

COMPLAINT FOR BENEFITS UNDER 29 U.S.C. 1132

Case 3:08-cv-03116-SI

Document 1

Filed 06/27/2008

Page 5 of 5