UNITED STATES DISTRICT COURT 

NORTHERN DISTRICT OF ILLINOIS 

AT CHICAGO 

ANDREAS SCHOU : 

2300 Beau Monde Lane, Unit 206 

Lisle, IL 60532-3927 : CASE NO. 1:12-cv-2764 

 Plaintiff : JUDGE: 

vs. : MAGISTRATE JUDGE: 

COGNIZANT TECHNOLOGY SOLUTIONS 

LTD PLAN 

Robert J. Telesmanic : COMPLAINT 

500 Frank W. Burr Blvd;, Suite 50 

Teaneck, NJ 07666-6802 : 

and : 

METROPOLITAN LIFE INSURANCE : 

COMPANY 

200 Park Avenue : 

New York, NY 10166 

 : 

 Defendants 

 : 

 

 Now comes the Plaintiff, Andreas Schou, by and through counsel, and for his 

Complaint hereby states as follows: 

JURISDICTION AND VENUE

1. Jurisdiction of the Court is based upon the Employee Retirement Income 

Security Act of 1974 (ERISA) and in particular, 29 U.S.C. § 1132(e)(1) and 1132(f). 

These provisions give the district courts jurisdiction to hear civil actions brought to 

recover benefits due under the terms of an Employee Welfare Benefit Plan that, in this 

case, consists of group disability benefits available under a Plan that is provided for the 

employees of Cognizant Technology Solutions known as Cognizant Technology 

Solutions LTD Plan (hereinafter referred to as “CTS Plan”). The Plan and Policy 

documents should be included in the Administrative Record that will be filed with this 

Court; it is too voluminous to file. This action may be brought before this Court pursuant 

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to 28 U.S.C. § 1331 that gives the district court jurisdiction over actions that arise under 

the laws of the United States. 

2. The ERISA statute provides, at 29 U.S.C. § 1133, a mechanism for 

administrative or internal appeal of benefit denials. Those avenues of appeal have 

 been exhausted. 

NATURE OF ACTION

 3. This is a claim seeking an award to Plaintiff Andreas Schou of disability 

benefits pursuant to an Employee Welfare Benefit Plan (“Plan”) providing group disability 

benefits to employees of Cognizant Technology Solutions. This action, seeking recovery 

of benefits, is brought pursuant to § 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B). 

The Plaintiff also seeks to enforce the right to future benefits and demand the 

Defendants to account for past benefits and pay future benefits. 

THE PARTIES

 4. Plaintiff is now disabled but was an active employee under the Plan and 

eligible as a qualified employee when his medical condition deteriorated and he could no 

longer work. Venue is proper in the Northern District of Illinois because Plaintiff resides 

in Lisle, Illinois, which is located in Dupage County, Illinois. 

 5. At all times relevant hereto, the Plan constituted an “Employee Welfare 

Benefit Plan” as defined by 29 U.S.C. § 1002(1); and while employed, Plaintiff became 

disabled and has coverage under the Plan as an employee because he was a 

participant as defined by 29 U.S.C. § 1002(7). This claim relates to benefits under the 

foregoing Plan. 

 6. The Plan’s “Claim Administration” is run by a Plan Fiduciary, which upon 

information and belief is Metropolitan Life Insurance Company (hereinafter “Metlife”). 

STATEMENT OF FACTS 

 7. Plaintiff was a full time employee of Cognizant Technology Solutions and 

was actively engaged in employment until September 24, 2010, when he ceased 

working because of severe cerebrovascular accident (stroke; hereinafter “CVA”)). Due 

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to his impairment, Plaintiff has not engaged in any substantial gainful activity since 

September 2010. 

 8. Plaintiff made a claim for benefits under the Plan after being forced to 

stop work on September 24, 2010, from his position as a Senior Associate in Software 

Development, because of the severe symptoms he was experiencing subsequent to his 

CVA. 

 9. Under the “CTS Plan”, Mr. Schou was entitled to 180 days of short-term 

disability benefits. Mr. Schou received all of his short-term disability benefits for an 

inability to perform his “own occupation.” 

10. Long-term disability benefits were scheduled to begin on March 24, 2011. 

For the first 24 months of long term disability, benefits are paid based on an inability to 

perform the material and substantial duties of his “own occupation.” 

11. Plaintiff was hired on November 23, 2009 by Cognizant Technology 

Solutions. Because his disability commenced within 12 months from the date his 

benefits became effective, Mr. Schou’s elgibility for LTD benefits was subject to the “preexisting treatment” clause. Metlife’s examination of the records revealed that Mr. Schou 

was using aspirin at a rate of one per day. Based upon Aspirin use, Metlife denied Mr. 

Schou’s claim for LTD benefits. Metlife felt Aspirin was treatment for a stroke that Mr. 

Schou had not had yet. 

 12. “Metlife” issued a denial letter dated May 16, 2011 denying Mr. Schou’s 

access to long-term disability benefits under the “pre-existing” condition clause of the 

Plan. 

 13. In September 2011, Mr. Schou retained your undersigned to prepare the 

appeal to the May 16, 2011 denial of benefits. On November 11, 2011, counsel 

submitted an extensive appeal letter (attached hereto as Exhibit A), which embraced the 

specific long-term use of a daily Aspirin for years prior to his stroke because of the 

benefits for his heart. 

 14. This information was reviewed by “Metlife” and a denial of benefits was 

issued on January 12, 2012. To support their denial, “Metlife” had the case reviewed by 

a “peer review” physician. In her report, “Metlife’s” paid physician recommends denial of 

the claim without embracing the duration and purpose of daily Aspirin use. 

 15. Plaintiff has exhausted his administrative remedies and has chosen to file 

this lawsuit to obtain the long-term disability benefits owed to him. 

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CAUSE OF ACTION 

16. Plaintiff incorporates as if fully restated herein the allegations in 

paragraphs 1 through 15 of the Complaint. 

17. Defendant “CTS Plan” failed to exercise the statutorily required duty of 

care and prudence, failing to administer the Plan solely in the interests of the participants 

and beneficiaries as required under 29 U.S.C. § 1104(a)(1), and by denying the benefits 

to the Plaintiff contrary to the law and terms of the Plan. The Plan, through its designated 

fiduciaries, has arbitrarily ignored and selectively reviewed documents Plaintiff has 

submitted and has failed to provide a full and fair review. 

 18. Defendant “Metlife”, has the authority to make the claims determination, 

but the language of the Policy does not give sufficient deference to “Metlife”, as Plan 

Fiduciary, and the benefit determination must be made de novo. 

19. Nevertheless, this Court must give a full de novo review of this decision 

and the evidence in the claim file and may not abrogate its statutory duty to do so 

because a plenary review is required and failure to give such a review would deprive 

Plaintiff of his constitutional rights and violate the U.S. Constitution and the principles of 

separation of power amongst others. 

 20. Plaintiff has exhausted his administrative remedies. The “CTS Plan” still 

wrongfully denies benefits to which Mr. Schou is entitled. 

21. ERISA requires that an Employee Benefit Plan be established and 

maintained pursuant to a written instrument, 29 U.S.C. § 1192(a)(1). 

22. The disability Plan under which the Plaintiff Andreas Schou was a 

participant at the time of his disability should be included in the Administrative record 

filed with this Court; it is too voluminous to attach. This document sets forth the sole 

criteria for benefits for the Plaintiff. 

23. The Plaintiff is entitled to these benefits and they are due and owing to 

the Plaintiff in an amount not yet ascertainable, and the Plaintiff seeks the payment of 

these benefits under 29 U.S.C. § 1132(a)(1). 

24. ERISA maintains an employee benefit plan shall be established and 

maintained pursuant to 29 U.S.C. § 1192(a)(1). Under the clear terms of this Plan 

document that will be filed with the Administrative record, the termination of benefits was 

unreasonable and without basis under the Plan document. 

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WHEREFORE, Plaintiff Andreas Schou prays for the following relief: 

A. That the Court enter judgment in Plaintiff Schou’s favor and against the 

Defendant and that the Court order the Defendant to account and pay 

disability income benefits to Plaintiff Schou in an amount equal to the 

contractual amount of benefits to which Schou is entitled; 

B. That the Court order the Defendant to pay Schou’s pre-judgment interest 

on all benefits that have accrued prior to the date of judgment and enter 

judgment accordingly and that the Court reserve jurisdiction to enforce 

the equitable decree; 

C. That the Court declare Andreas Schou’s rights under the ERISA Plan, the 

ERISA statute, and the applicable insurance laws and order the 

Defendant to continue paying Plaintiff Schou’s benefits until such time as 

the Court decides that he meets the policy conditions for discontinuance 

of benefits and this is perfected by an Order of this Court; 

D. That the Court award the Plaintiff his attorney fees pursuant to 29 U.S.C. 

§ 1132(g) and; 

E. That Plaintiff recovers any and all other relief to which he may be entitled, 

as well as the costs of the suit. 

Dated this 16th day of April, 2012 

 Respectfully submitted, 

 

 /s/ Joseph P. McDonald 

 

 

 Joseph P. McDonald (0055230) 

 McDonald & McDonald Co., L.P.A. 

 200 E. Spring Valley Rd., Suite A 

 Dayton, OH 45458 

 Tel: 937-428-9800 

 Fax: 937-428-9811 

Email: joseph@mcdonaldandmcdonald.com 

 Attorney for Plaintiff, Andreas Schou 

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