Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 1 of 20 PageID #: 1

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK LISA KRAUSE, Plaintiff, -againstCIGNA CORPORATION, CIGNA GROUP INSURANCE, CIGNA LIFE INSURANCE COMPANY OF NEW YORK, INSURANCE COMPANY OF NORTH AMERICA, CONNECTICUT GENERAL LIFE INSURANCE COMPANY, Defendants. Plaintiff, Lisa Krause, by her attorneys, Pacheco & Lugo, PLLC, as and for her verified complaint, sets forth as follows, upon information and belief: NATURE OF ACTION 1. This action arises under the Employee Retirement Income Security Act of Index No. VERIFIED COMPLAINT (Jury Demand Requested)

1974, as amended, 29 U.S.C. 1001 et seq. (ERISA) and more particularly, Sections 404, 409 and 502 of the Act, 29 U.S.C. 1104, 1109 and 1132. THE PARTIES 2. New York. 3. On or about January 23, 1989, plaintiff Lisa Krause was employed by Plaintiff Lisa Krause is a resident of the County of Queens and State of

Catholic Charities Diocese of Brooklyn and Queens (hereinafter referred to as Catholic Charities) as a case manager. 4. As an employee of Catholic Charities, Ms. Krause was provided with long

term disability insurance benefits pursuant to the terms of a group long term disability insurance policy issued by CIGNA.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 2 of 20 PageID #: 2

5.

As an employee of Catholic Charities, Ms. Krause was provided with

waiver of premium coverage benefits pursuant to the terms of a group term life insurance plan issued by CIGNA. 6. At all relevant times, CIGNA was and presently is duly authorized to

transact business in the state of New York and is in fact transacting business in the state of New York and offers long term group disability insurance policies for sale in the State of New York. 7. At all relevant times, CIGNA was and presently is duly authorized to

transact business in the state of New York and is in fact transacting business in the state of New York and offers group term life insurance policies for sale in the State of New York. 8. At all relevant times, defendant CIGNA was and is an insurance company

that sold policies of long term disability insurance pursuant to a group plan with Catholic Charities which provided, among other forms of coverage, long term disability insurance benefits to employees of Catholic Charities. 9. At all relevant times, defendant CIGNA was and is an insurance company

that sold policies of group term life insurance pursuant to a group plan with Catholic Charities which provided, among other forms of coverage, waiver of premium coverage benefits to employees of Catholic Charities. 10. Plaintiff, Lisa Krause commenced her employment with Catholic Charities

in or about January 23, 1989. 11. At all relevant times, Ms. Krause was insured pursuant to the terms of a

group term life insurance plan underwritten by CONNECTICUT GENERAL LIFE INSURANCE COMPANY and issued by CIGNA. 12. At all relevant times, Ms. Krause was insured pursuant to the terms of a

group long term disability insurance plan underwritten by INSURANCE COMPANY OF NORTH AMERICA and issued by CIGNA. 13. At all relevant times, CONNECTICUT GENERAL LIFE INSURANCE

COMPANY, INSURANCE COMPANY OF NORTH AMERICA, CIGNA LIFE INSURANCE

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 3 of 20 PageID #: 3

COMPANY OF NEW YORK and CIGNA GROUP INSURANCE were subsidiaries of CIGNA CORPORATION (hereinafter referred to collectively as CIGNA). 14. Benefits for long term disability insurance payments are due and vested

under the group long term disability insurance policy with CIGNA. 15. Benefits for waivers of premium coverage are due and vested under the

group term life insurance plan with CIGNA. 16. At all relevant times, Ms. Krause complied with all conditions necessary

for her to receive benefits based on her disability and is a participant in and beneficiary of said policies. JURISDICTION AND VENUE 17. The Court has jurisdiction under 29 U.S.C. 1001 et seq., particularly

Sections 502(e) and (f) of ERISA 29 U.S.C. 1132(e)(f). 18. Venue is proper in the United States District Court for the Eastern District

of New York pursuant to 502(e)(2) of ERISA 29 U.S.C. 1132(e)(2) since the policies are administered in this district and defendant may be found here. 19. Venue is also proper in the United States District Court for the Eastern

District of New York pursuant to Title 28, U.S.C. 1391. FACTS RELATING TO THE POLICIES 20. CIGNA, for good and valuable consideration, sold, executed and

delivered to Catholic Charities, a group long term disability insurance policy known as and labeled policy no. GK0050017 (the CIGNA Disability Policy). The CIGNA Disability Policy was issued on printed forms prepared by defendant CIGNA. 21. CIGNA, for good and valuable consideration, sold, executed and

delivered to Catholic Charities, a group term life insurance plan known as and labeled policy no. 9967553 (the CIGNA Waiver of Premium Policy). 22. The CIGNA Disability Policy was in full force and effect during all relevant

times stated here within.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 4 of 20 PageID #: 4

23.

The CIGNA Waiver of Premium Policy was in full force and effect during

all relevant times stated here within. 24. At all relevant times, Catholic Charities established an Employee

Welfare Benefit Plan or a Welfare Plan (the Plan) pursuant to ERISA. 25. At all relevant times, Ms. Krause was an employee of Catholic Charities

and insured pursuant to the Plan for long term disability insurance under the CIGNA Disability Policy. 26. At all relevant times, Ms. Krause was insured pursuant the group term life

insurance policy for waiver of premium coverage benefits under the CIGNA Life Insurance Policy. 27. Ms. Krause was covered under the terms of the CIGNA Disability Policy

at the time her disabling condition commenced. 28. Ms. Krause was covered under the terms of the CIGNA Waiver of

Premium Policy at the time her disabling condition commenced. 29. CIGNA has wrongfully and maliciously concocted pretextual reasons for

the denial of benefits to Ms. Krause. CIGNA bases its decision on a selective and misleading representation of the record before it and upon selective and misunderstanding of Ms. Krauses capabilities ignoring the submissions presented by Ms. Krause and her treating physicians as a whole. 30. The CIGNA appeals process and the process by which they denied Ms.

Krauses claims are blatantly self-interested and prejudiced towards its policy holder Ms. Krause. 31. Ms. Krause was employed as a case manager. As part of her

responsibilities as a case manager, she was not only responsible for the training of employees but also for providing intake treatment plan recommendations, assessment, case management, crisis intervention, counseling and support to her 35 to 50 assigned clients.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 5 of 20 PageID #: 5

32.

In and around July 22, 1997, Ms. Krause was plagued with diminished

health and unwelcomed illness. 33. Ms. Krause was diagnosed with severe and irreversible curvature of the

spine which is approximately 85% irregularly curved at the point. Ms. Krause is in constant severe pain. 34. On top of her major painful medical problem, she has lumbar scoliosis,

cervical spondylitis, cervical radiculopathy, intestinal cystitis, urinary urgency, urinary incontinence and screw plates to the right forearm and wrist preventing rotation of arm. 35. 36. Ms. Krause has Total Disability. With these medical problems she cannot believe that the reviewer would

recommend that she should be a crossing guard or anything related thereto. 37. She cannot and has not been able to return to work. In fact, thereafter

CIGNA declared her disabled under the CIGNA Disability Policy conditions and coverage. Consequently CIGNA commenced payment of long term disability insurance benefits to Ms. Krause in and around April 20, 1995. CIGNA continued to make long term disability insurance payments to Ms. Krause consistent with the terms and conditions for payment under the CIGNA Disability Policy up and until June 29, 2011. 38. Since 1995, Ms. Krause has suffered from chronic, sharp, and severe

disabling pain to her back and lower left extremity which prevents her from doing much and most of the activities which made up her normal daily routine. 39. Ms. Krause has been in constant treatment since the onset of her injuries

and has undergone epidural and steroid injections, facet block injections as well as a facet ablation surgical procedure trigger point injections, physical therapy, and chronic pain management, to which treatment is ongoing. 40. As a result of her injuries, Ms. Krause suffers from constant, severe pain

and her injuries are permanent and disabling.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 6 of 20 PageID #: 6

41.

Ms. Krause cannot walk, sit, stand or drive for more than short periods of

time and can no longer engage in any activities which require range of motion as required by her job. 42. Due to her very limited ability to walk, stand, lift, or ambulate as needed

and without assistance, she is disabled under the terms of the CIGNA Disability Policy. 43. Even with medication, Ms. Krause is unable to sustain normal activities

which would permit her to engage in work activities and thus rendering her unable to earn a living. Ms. Krauses condition has not changed since the onset of her disability and she has failed to improve with time. 44. Ms. Krause cannot even manage the daily commute to her job, let alone

the sitting, standing, lifting, squatting, walking, bending and other work that her job or a similar situated job entails. 45. Currently Ms. Krause is undergoing a work up for a possible InterStim

device for treatment of urgency, frequency, and urinary over activity of the bladder. She is also a candidate for pelvic floor reconstruction. 46. As a result of her condition, Ms. Krause is totally disabled and completely

unable to engage or participate in her previous job as a case manager or a similarly situated position. 47. Despite the fact that Ms. Krauses condition has failed to improve, CIGNA

has wrongfully, maliciously and inappropriately denied Ms. Krauses long term disability insurance benefits in contravention of its obligations under the CIGNA Disability Policy. 48. Despite the fact that Ms. Krauses condition has failed to improve, CIGNA

has wrongfully, maliciously and inappropriately denied Ms. Krauses waiver of premium coverage benefits in contravention of its obligation under the CIGNA Waiver of Premium Policy. 49. Ms. Krause first requested long term insurance disability benefits during

the year of the onset of her disability in 1995. At that time, her disabilities included radicular dysfunction, median nerve entrapment, and ulnar nerve entrapment.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 7 of 20 PageID #: 7

50.

Thereafter, CIGNA examined Ms. Krauses claim, reviewed her medical

records, and rightfully approved Ms. Krauses request for long term disability insurance benefits under the CIGNA Disability Policy. commenced on April 20, 1995. 51. Thereafter, the waiver of premium benefits coverage under the Waiver of Her monthly long term disability insurance benefits

Premium Policy commenced on April 1, 1996. 52. Accordingly, CIGNA, at all times during the payment of benefits,

considered Ms. Krause disabled and meeting the definition of disability under the terms of the CIGNA Disability Policy. 53. CIGNA then temporarily continued to honor its obligations under ERISA

and under the CIGNA Disability Policy to pay on the long term disability insurance benefits as it was obligated to do. 54. Since the issuance of benefits, Ms. Krauses condition has not changed

and she failed to improve and in fact her condition has deteriorated further. 55. By letter dated May 24, 2011 but received in and around early June 2011,

CIGNA wrongfully and maliciously, in spite of the fact that Ms. Krauses condition has not improved at all, issued a denial of the continued benefits of a waiver of premium coverage under the CIGNA Waiver of Premium Policy. 56. By letter dated June 29, 2011, CIGNA wrongfully and maliciously, and in

spite of the fact that Ms. Krauses condition has not improved at all, issued a denial of the continued receipt of long term disability insurance benefits under the CIGNA Disability Policy. 57. Pursuant to the terms of the CIGNA Disability Policy, Ms. Krause

thereafter contested the denial of benefits and duly filed an appeal of the denial and wrongful termination of her long term disability insurance benefits by submissions dated August 12, 2011. 58. Pursuant to the terms of the CIGNA Waiver of Premium Policy, Ms.

Krause thereafter contested the denial of benefits and duly filed an appeal of the denial and

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 8 of 20 PageID #: 8

wrongful termination of her waiver of premium coverage benefits by submissions dated August 12, 2011. 59. By letter dated September 15, 2011, CIGNA acknowledged receipt of Ms.

Krauses appeals and proceeded to process the appeals. 60. By letter dated November 29, 2011, CIGNA affirmed its wrongful decision

to deny Ms. Krause benefits that she was properly entitled to under the CIGNA Disability Policy and the CIGNA Waiver of Premium Policy. 61. CIGNAs wrongful decision to deny Ms. Krauses appeal and decision to

wrongfully deny benefits to Ms. Krause sets forth obvious pretext and innuendo as the basis for denial of benefits and includes incorrect factual assumptions based on the selective reading and misreading of the records used for the basis for the erroneous decision. 62. It has been adjudicated that Ms. Krause is permanently and completely

disabled by the Social Security Disability as of October 1994. Ms. Krauses treating physicians, from North Shore LIJ, M. Darryl Antonucci, M.D., F.A.C.S., Steven Beldner, M.D., Charles Malone, Jr., M.D., George DiGiacinto, M.D., Mount Sinai Radiology, Spine Associates, Gordon M. Freedman, M.D., Hospital for Special Surgery, Beth Israel Medical Center, and etc. state definitively that Ms. Krause is permanently disabled. Her physicians opinion is that she is totally and permanently disabled and cannot work. Moreover, such opinion is known to CIGNA for well over a decade. 63. In fact Ms. Krause submitted tomes of medical records which are

conclusive in proving that she is permanently disabled and cannot work. 64. CIGNA did not properly consider submitted medical opinions that Ms.

Krause is disabled, unable to work and should be eligible for long term disability insurance benefits. 65. Instead, CIGNA maliciously and in bad faith, wrongfully inaccurately

asserts that under a transferable skill analysis, Ms. Krause would be able to perform certain crossing guard work positions. Their analysis completely ignores the record submitted to CIGNA

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 9 of 20 PageID #: 9

that she is unable to stand for any significant period of time and that she suffers from severe incontinence. 66. CIGNAs conclusions are based solely on an analysis which ignores the

medical records as a whole, ignores Ms. Krauses subjective complaints, and ignores the opinions of not only Ms. Krauses treating physicians, but also the Social Security Disability decision. 67. CIGNAs conclusions are in complete and malicious disregard of the

determinations of Ms. Krauses primary care physician, in complete disregard of her subjective physical complaints and in complete disregard of her job requirements. THE TERMS OF THE CIGNA DISABILITY POLICY 68. CIGNA, for good and valuable consideration, sold, executed and

delivered to Catholic Charities a group long term disability insurance policy. 69. The CIGNA Disability Policy was effective at all times mentioned herein

and provides that: [the CIGNA Disability Policy] shall be governed by the laws of the state in which it is delivered. 70. The CIGNA Disability Policy was renewable periodically and the CIGNA

Disability Policy has been continuously renewed and remains in full force. 71. Ms. Krause was covered under the terms of the CIGNA Disability Policy

at the time she first became unable to work in and around April 20, 1995, when she first applied for disability benefits under the terms of the CIGNA Disability Policy. 72. Ms. Krause notified CIGNA of her continued inability to work and

requested disability benefits in accordance with the definitions contained in the CIGNA Disability Policy. 73. CIGNAs Disability Policy provides that the term disability is defined as:

An Employee will be considered Disabled if because of Injury or Sickness: 1. he is unable to perform all the material duties of his regular occupation and after Monthly Benefits have been payable for 24 months, he is unable to perform all the material duties of

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 10 of 20 PageID #: 10

any occupation for which he is or may reasonably become qualified based on his education, training or experience. 74. Commencing on or about April 1995 and continuing through the present,

Ms. Krause has been unable to perform each of the material duties of her regular occupation and of any gainful occupation for which she is reasonably fitted by education, training or experience. 75. 76. and disabling. 77. Additionally, Ms. Krauses treating healthcare providers provided CIGNA Ms. Krause is disabled by the terms of the CIGNA Disability Policy. Ms. Krauses condition has not improved. Her condition is permanent

with dated reports concerning the nature and extent of her disability and the progression of her ailments. 78. Notwithstanding CIGNAs knowledge of Ms. Krauses condition, CIGNA

wrongfully, maliciously and in bad faith has denied Ms. Krauses continued receipt of long term disability insurance benefits due under the CIGNA Disability Policy. THE TERMS OF THE CIGNA WAIVER OF PREMIUM POLICY 79. CIGNA, for good and valuable consideration, sold, executed and

delivered to Catholic Charities a group term life insurance plan. 80. mentioned herein. 81. The CIGNA Waiver of Premium Policy was renewable periodically and The CIGNA Waiver of Premium Policy was effective at all times

the CIGNA Waiver of Premium Policy has been continuously renewed and remains in full force. 82. Ms. Krause was covered under the terms of the CIGNA Waiver of

Premium Policy at the time she first became unable to work in and around April 20, 1995. 83. 84. Ms. Krause notified CIGNA of her continued inability to work. Commencing on or about April 1995 and continuing through the present,

Ms. Krause has been unable to perform each of the material duties of her regular occupation

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 11 of 20 PageID #: 11

and of any gainful occupation for which she is reasonably fitted by education, training or experience. 85. and disabling. 86. Additionally, Ms. Krauses treating healthcare providers provided CIGNA Ms. Krauses condition has not improved. Her condition is permanent

with dated reports concerning the nature and extent of her disability and the progression of her ailments. 87. Notwithstanding CIGNAs knowledge of Ms. Krauses condition, CIGNA

wrongfully, maliciously and in bad faith has denied Ms. Krauses continued receipt of waiver of premium coverage benefits due under the CIGNA Waiver of Premium Policy.

AS AND FOR A 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. Krauses 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.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 12 of 20 PageID #: 12

92.

Moreover, the decision of CIGNA to deny Ms. Krauses 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 CIGNAs action, Ms. Krause

has been caused to incur substantial attorneys 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 attorneys 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 CIGNAs actions and by

virtue of CIGNAs 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 attorneys 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. Krauses claim for waiver of premium coverage benefits despite the demand, despite no change in condition, and despite her inability to work.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 13 of 20 PageID #: 13

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. Krauses 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 CIGNAs action, Ms. Krause

has been caused to incur substantial attorneys 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 attorneys fees and costs incurred in bringing her action to right the wrong done to her by defendant CIGNA. 104. By virtue of CIGNAs 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. Krauses 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.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 14 of 20 PageID #: 14

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 CIGNAs 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 CIGNAs 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

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 15 of 20 PageID #: 15

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 CIGNAs 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 ATTORNEYS 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 CIGNAs duty of good faith, skill, prudence and diligence is described herein above. 119. As a direct and proximate result of defendant CIGNAs actions, Lisa

Krause has been caused to incur substantial attorneys 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 attorneys 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.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 16 of 20 PageID #: 16

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 a deceptive 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 Plaintiffs 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 CIGNAs 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 CIGNAs willful and knowing deceptive acts and practices,

Plaintiff is entitled to three times her actual damages.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 17 of 20 PageID #: 17

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 insureds rights or wrongfully deny any benefits due under the contract of insurance or place its own interests above the interests of its insured. 134. faith and fair dealing. 135. CIGNA breached their implied covenant of good faith and fair dealing by CIGNA was at all times bound to honor such an implied covenant of good

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. without proper cause. 138. As a result of CIGNAs bad faith and breach of its implied covenant of CIGNAs actions in this regard were unreasonable, done in bad faith and

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.

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 18 of 20 PageID #: 18

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. Krauses 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 CIGNAs 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 CIGNAs 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 attorneys fees, costs and disbursements incurred in prosecuting her action, and any other attorneys 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 attorneys fees. (9) Upon the Eighth Cause of Action against CIGNA, CIGNA must compensate Plaintiff for three times the amount of those losses. Declare that CIGNAs 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. Dated: Brooklyn, New York October 23, 2012 Yours, etc.

Carmen A. Pacheco

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 19 of 20 PageID #: 19

A Member of the Firm

Attorneys for Plaintiff Lisa Krause

Case 1:12-cv-05543-FB-LB Document 1 Filed 11/08/12 Page 20 of 20 PageID #: 20

Docket No. Year 2012 RJI No. Hon.

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK ===================================================================== LISA KRAUSE, Plaintiff, -againstCIGNA CORPORATION, CIGNA GROUP INSURANSE, CIGNA LIFE INSURANCE COMPANY OF NEW YORK, INSURANCE COMPANY OF NORTH AMERICA, CONNECTICUT GENERAL LIFE INSURANCE COMPANY, Defendants. ===================================================================== SUMMONS AND VERIFIED COMPLAINT ===================================================================== PACHECO & LUGO, PLLC Attorneys for Plaintiff 340 Atlantic Avenue Brooklyn, NY 11201 (718) 855-3000 =====================================================================
To Signature (Rule 130-1.1-a)

Attorney(s) for

Print name beneath

Carmen A. Pacheco, Esq. =====================================================================

Service of a copy of the within Dated, Attorney(s) for is hereby admitted.

=====================================================================
Please take notice
NOTICE OF ENTRY

That the within is a (certified) true copy of a Duly entered in the office of the clerk of the within named court on
NOTICE OF SETTLEMENT

That an order settlement to the HON. on Dated,

at

of which the within is a true copy will be presented for one of the judges of the within named court, at m Yours, etc. PACHECO & LUGO, PLLC Attorneys for Plaintiff 340 Atlantic Avenue Brooklyn, NY 11201

To