Case 2:20-cv-05994 Document 1 Filed 11/30/20 Page 1 of 5
`Ca e 2:20-cv-05994 Document 1 Filed 11/30/20 Page 1 of 5
`
`IN THE UNITED STATES DISTRICT COURT
`
`F R THE EASTERN DISTRICT OF PENNSYLVANIA
`
`
`
`
`
`
`CANDACE
`
`2771 Ruth St.
`
`Philadelphia, A 19134
`Plaintiff
`
`v.
`
`T-MOBILE,
`12920 SE 38‘h
`
`A, INC.
`t.
`
`Bellevue, WA 8006
`
`:
`
`Defendant
`
`:NO. :
`
`m
`
`NOW C MES, the Plaintiff, Candace Mercer, by and through her Counsel,
`
`Pond, Lehock , LLP, and hereby complains of the above referenced Defendant, T-
`
`Mobile, USA, nc., (hereinafter referred to as “T-Mobile”), as follows:
`
`I.
`
`STATE ENT 0F JURISDICTION:
`
`1.
`
`J
`
`isdiction is conferred upon this Honorable Court pursuant to 28
`
`U.S.C. § 1331
`
`d 29 U.S.C. § 133 2(e). This Honorable Court has jurisdiction over
`
`all issues raisi
`
`a federal question and this instant matter involves a disability policy
`
`issued to the
`
`aimant through her Employer, thus it is governed by the Employee
`
`Retirement Inc me Security Act of 1974 (ERISA) 29 U.S.C. § 1011, et seq.
`
`II.
`
`FACTS
`
`
`
`
`
`
`Ca e 2:20-cv-05994 Document 1 Filed 11/30/20 Page 1 of 5
`
`IN THE UNITED STATES DISTRICT COURT
`
`F R THE EASTERN DISTRICT OF PENNSYLVANIA
`
`
`
`
`
`
`CANDACE
`
`2771 Ruth St.
`
`Philadelphia, A 19134
`Plaintiff
`
`v.
`
`T-MOBILE,
`12920 SE 38‘h
`
`A, INC.
`t.
`
`Bellevue, WA 8006
`
`:
`
`Defendant
`
`:NO. :
`
`m
`
`NOW C MES, the Plaintiff, Candace Mercer, by and through her Counsel,
`
`Pond, Lehock , LLP, and hereby complains of the above referenced Defendant, T-
`
`Mobile, USA, nc., (hereinafter referred to as “T-Mobile”), as follows:
`
`I.
`
`STATE ENT 0F JURISDICTION:
`
`1.
`
`J
`
`isdiction is conferred upon this Honorable Court pursuant to 28
`
`U.S.C. § 1331
`
`d 29 U.S.C. § 133 2(e). This Honorable Court has jurisdiction over
`
`all issues raisi
`
`a federal question and this instant matter involves a disability policy
`
`issued to the
`
`aimant through her Employer, thus it is governed by the Employee
`
`Retirement Inc me Security Act of 1974 (ERISA) 29 U.S.C. § 1011, et seq.
`
`II.
`
`FACTS
`
`
`
`
`
`
`
`Case 2:20-cv-05994 Document 1 Filed 11/30/20 Page 2 of 5
`Ca e 2:20-cv-05994 Document 1 Filed 11/30/20 Page 2 of 5
`
`2.
`
`e Plaintiff, Candace Mercer, is an adult and competent
`
`individual wi ' a physical address of 2771 Ruth St., Apt 510, Philadelphia, PA
`
`19134
`
`3.
`
`T e Defendant, T—Mobile, under information and belief, is a business
`
`
`entity with a b siness headquarters at 12920 SE 38th St., Bellevue, WA 98006..
`
`
`4.
`
`T mobile is a business entity, which issues disability insurance
`
`
`policies which are governed by the Employee Retirement Insurance Security Act
`
`
`(ERISA), 29 SC. §1011, et seq.
`
`
`5. The
`
`efendant’s disability plan is administered by Broadspire, a Crawford
`
`Company.
`
`
`
`6.
`
`O a date certain, T-.Mobile, issued a policy providing disability
`
`
`insurance ben fits to the Plaintiff, as an employee.
`
`
`7.
`
`T e policy of insurance aforementioned provided for an employee
`
`
`benefit plan as defined and covered under the terms of ERISA.
`
`
`8.
`
`A all times material and relevant hereto, all policy premiums due on
`
`
`behalf of the P aintiff under said policy were paid.
`
`
`9.
`
`A all times material and relevant hereto, the Plaintiff performed all
`
`
`obligations re uired of her under said contract of insurance.
`
`9.
`
`A all times material and relevant hereto, the Plaintiff was a qualified
`
`
`participant in
`
`e employee benefit plan.
`
`
`
`Case 2:20-cv-05994 Document 1 Filed 11/30/20 Page 3 of 5
`Caste 2:20-cv-05994 Document 1 Filed 11/30/20 Page 3 of 5
`
`Ofn a date certain, the Plaintifffiled an application for short term
`10.
`disability benelfits.
`
`
`
`
`
`11.
`
`In its letter dated July 10, 2019, T-Mobile administered by Broadspire
`
`determined th re was a lack of clinical evidence to support Plaintiff’s inability to
`
`perform essen ial duties of her occupation, and therefore benefits were denied
`
`effective June 1, 2019.
`
`12. T
`
`Plaintiff filed an administrative appeal.
`
`Surh appeal was denied via letter dated October 15, 2019.
`13.
`14. The Plaintifffiled another administrative appeal and submitted additional
`medical records and opinions ofher treating doctors in support of her claim. The
`information priovided was sufficient to establish the proof of loss that the Plaintiff
`suffered in ordier to support her claim for short term disability benefits.
`
`15. By correspondence dated July 16, 2020, T-Mobile administered by
`
`Broadspire de ied the Plaintiff s appeal and advised her of her right to bring a civil
`
`action under E SA.
`
`16. T—M bile administered by Broadspire acted arbitrarily, capriciously, in a
`
`manner servin only its own business interest and in direct violation of ERISA when
`
`it denied the P aintiff 3 claim for disability benefits.
`
`17.
`
`T e Plaintiff is entitled to disability insurance benefits under the
`
`aforementione policy as she has satisfied through medical evidence that she meets
`
`
`
`Case 2:20-cv-05994 Document 1 Filed 11/30/20 Page 4 of 5
`Ca e 2:20-cv-05994 Document 1 Filed 11/30/20 Page 4 of 5
`
`
`
`the definition of disability and provided sufficient proof of loss to T-Mobile
`
`administered b Broadspire.
`
`18.
`
`
`
`e Plaintiff is entitled to recover the benefits due to her under the
`
`aforementione insurance policy in accordance with 29 U.S.C. §1132.
`
`19. A a direct and proximate result ofthe actions of T—Mobile administered
`
`by Broadspire as herein above more particularly described, the Plaintiff has been
`
`caused to incu attorneys’ fees in an amount not yet known.
`
`20. As direct and proximate result of the actions of T-Mobile administered
`
`
`
`by Broadspire the Plaintiffhas sustained damages in an amount not yet known to the
`
`Plaintiff; how er, upon information and belief, such damages will approximate the
`
`amount of ben fits due and owing to the Plaintiff from June 1, 2020 until the present
`
`and continuin into the future.
`
`
`
`
`Case 2:20-cv-05994 Document 1 Filed 11/30/20 Page 5 of 5
`Ca e 2:20-cv-05994 Document 1 Filed 11/30/20 Page 5 of 5
`
`
`
`
`
`WHE
`
`FORE,
`
`the Plaintiff, Candace Mercer, respectfillly requests that
`
`judgment be e tered against T-Mobile as follows:
`
`
`1.
`
`O dering T—Mobile to pay to the Plaintiff, Candace Mercer, short term
`
`
`di ability insurance benefits from her alleged onset date of disability,
`
`
`J ne 1, 2019 to the present and continuing into the future as provided
`
`
`in the policy of insurance;
`
`
`
`2.
`
`3 .
`
`A arding the Plaintiff, Candace Mercer, prejudgment interest on the
`
`
`a ard until the date ofjudgment;
`
`
`A arding the Plaintiff’ s attorney’s fees, court costs and other reasonable
`
`
`0 sts incurred for the prosecution of the instant action;
`
`
`4.
`
`G anting such other and further relief as the Court may deem just and
`
`p per.
`
`RESPECTFULLY SUBMITTED,
`
`BY: flfi/zd/«g/yf/f
`
`Michael J. Parker, Esquire
`PA Bar ID No.: 93 024
`
`Pond, Lehocky, LLP
`One Commerce Square
`2005 Market Street
`
`18th Floor
`
`Philadelphia, PA 19103
`(215)568-7500
`Mparker@PondLehocky.com
`
`
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