A Jefferson County man says his insurance company has denied him disability benefits based on an unrelated medical condition identified in an application for Social Security Disability Insurance benefits.
Guy York filed a lawsuit Aug. 1 in the Jefferson County District Court against One Beacon Insurance Co. and Brentwood Services Administration Inc., alleging breach of contract, breach of good faith and fair dealing and violation of prompt payment statute.
According to the complaint, York was involved in an automobile accident while on assignment in Utah when his truck struck a deer on the highway on May 23, 2011.
York claims he severely injured his back and the injury resulted in immediate and continued disability from his job, so he filed for Social Security Disability Insurance benefits, the suit states.
According to court papers, the SSDI application was based on his back injury and Chronic Obstructive Pulmonary Disease, the suit says he would not have applied for SSDI benefits based on the COPD alone because it didn't keep him from doing his job. The SSDI application was approved, the filing states.
The lawsuit says when the defendants were informed of the SSDI payments, they terminated his continuous total disability payments. The defendants did so because the SSDI payments were not solely based on his back injury.
The plaintiff says the defendants were wrong in misrepresenting the terms of the policy, which does not say the SSDI disability payments must be approved solely on the basis of disability caused solely by the accident. The defendants told the plaintiff's attorney the policy did not provide benefits unless the disability was caused solely by the accident, according to the complaint.
York seeks the full amount of continuous total disability benefits he would have received until the age of 70, which is more than 20 years from the date of the denial. He also seeks interest at the rate of 18 percent per year, pre- and post- judgment interest and economic damages in the amount of three times the economic damages caused by the defendants.
York is represented by Paul W. Gertz of The Gertz Law Firm in Beaumont.
Jefferson County District Court case No. B195-938
This is a report on a civil lawsuit filed at Jefferson County District Court. The details in this report come from an original complaint filed by a plaintiff. Please note that a complaint represents an accusation by a private individual, not the government. It is not an indication of guilt, and it represents only one side of the story.