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Court: United States District Court, Eastern District of Louisiana
Insurance Carrier: Guardian Life Insurance Company of America
Plaintiff’s Employer: Gulf Coast Express Carriers, Corp.
Plaintiff’s Occupation: Commercial Truck Driver
Background of the Claim
Douglas Domino, Sr. started working as a commercial truck driver for Gulf Coast Express Carriers, Corp. on February 20, 2020. His role involved hauling loads and operating heavy machinery for sixty hours a week. On March 8, 2021, Domino visited his primary care physician, Dr. Sunil Bharwani, complaining of dizziness and lightheadedness due to hypertension. On March 31, 2021, Domino was diagnosed with diabetic ketoacidosis and insulin-dependent type 2 diabetes mellitus, preventing him from continuing his duties as a commercial truck driver according to Department of Transportation guidelines.
Reasons for Denial of Disability Benefits
Domino filed a claim for short-term disability (STD) benefits in March 2021, which was approved and paid for the maximum 13-week period. However, Guardian Life Insurance Company denied his claim for long-term disability (LTD) benefits, citing a pre-existing condition clause. Domino’s pre-existing hypertension, which was treated within the look-back period, was excluded under the policy. His employment was terminated on October 6, 2021, after exhausting paid time off (PTO) and being on unpaid medical leave since March 14, 2021.
Issues Raised by Plaintiff and Defendant
The issue presented is whether plaintiff was covered under defendant’s policy when he was diagnosed with insulin-dependent diabetes mellitus. This issue turns on whether he was considered to be in “active full-time service” within the meaning of the policy while on sick leave after exhausting his paid time off (“PTO”). Plaintiff argued that he was still in “active full-time service” while on medical leave, asserting that extended sick leave should not disqualify him from coverage. He also contended that his coverage should continue under the Family and Medical Leave Act (FMLA) provision of the policy, as he paid premiums until June 20, 2021. However, Guardian countered that the policy explicitly required active full-time work to maintain coverage, and the family leave of absence provision did not apply as it was not required under federal law.
Judge’s Ruling
The court found Guardian’s interpretation of the policy to be consistent and reasonable. It granted Guardian’s motion for summary judgment, agreeing that the denial of LTD benefits was not an abuse of discretion. The judge found that Domino was not in active full-time service when diagnosed with diabetes, as he had exhausted his PTO and was on an indefinite unpaid medical leave. Consequently, the court denied Domino’s motion for summary judgment and upheld Guardian’s decision to deny LTD benefits .
Get Help with Your Long-Term Disability Claim
This case illustrates the complexities surrounding disability claims and the importance of understanding policy terms. If Guardian has denied you or a loved one the disability benefits you deserve, contact the Ortiz Law Firm for expert assistance in navigating the appeal process. Call us today at (888) 321-8131 to get help with your disability claim.
Disclaimer: The Ortiz Law Firm did not handle this claim. It is merely summarized here to help claimants understand how Federal Courts handle long-term disability insurance claims.
Here is a copy of the decision in PDF: Domino v. Guardian