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COMPLAINT 

KANTOR & KANTOR LLP 

19839 Nordhoff Street 

Northridge, California 91324 

(818) 886 2525

Glenn R. Kantor – SBN 122643

 E-mail: gkantor@kantorlaw.net Peter S. Sessions – SBN 193301 

 E-mail: psessions@kantorlaw.net KANTOR & KANTOR, LLP 

19839 Nordhoff Street 

Northridge, California 91324 

Telephone: (818) 886-2525 

Facsimile: (818) 350-6272 

Attorneys for Plaintiff, 

THERESA DAY

UNITED STATES DISTRICT COURT 

NORTHERN DISTRICT OF CALIFORNIA 

SAN JOSE DIVISION 

THERESA DAY, 

Plaintiff, 

vs. 

ANTHEM BLUE CROSS LIFE AND 

HEALTH INSURANCE COMPANY, 

 Defendant. 

Case No.: 

COMPLAINT FOR: 

BREACH OF THE EMPLOYEE 

RETIREMENT INCOME 

SECURITY ACT OF 1974; 

ENFORCEMENT AND 

CLARIFICATION OF RIGHTS; 

PRE-JUDGMENT AND POSTJUDGMENT INTEREST; AND 

ATTORNEYS’ FEES AND 

COSTS 

Plaintiff Theresa Day herein sets forth the allegations of her Complaint 

against Defendant Anthem Blue Cross Life and Health Insurance Company. 

PRELIMINARY ALLEGATIONS 

1. “Jurisdiction” – This action is brought under 29 U.S.C. §§ 1132(a), (e), 

(f) and (g) of the Employee Retirement Income Security Act of 1974 (hereinafter 

“ERISA”) as it involves a claim by Plaintiff for employee benefits under an 

Case 5:16-cv-07397-BLF Document 1 Filed 12/29/16 Page 1 of 6
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COMPLAINT 

KANTOR & KANTOR LLP 

19839 Nordhoff Street 

Northridge, California 91324 

(818) 886 2525

employee benefit plan regulated and governed under ERISA. Jurisdiction is 

predicated under these code sections as well as 28 U.S.C. § 1331 as this action 

involves a federal question. This action is brought for the purpose of recovering 

benefits under the terms of an employee benefit plan, enforcing Plaintiff’s rights 

under the terms of an employee benefit plan, and to clarify Plaintiff’s rights to 

future benefits under an employee benefit plan. Plaintiff seeks relief, including but 

not limited to: payment of benefits, prejudgment and post-judgment interest, 

reinstatement to the benefit plans at issue herein, and attorneys’ fees and costs. 

2. Plaintiff was at all times relevant, an employee of Families First, Inc., 

and a resident of the City of San Jose, State of California. 

3. Plaintiff is informed and believes that defendant Anthem Blue Cross 

Life and Health Insurance Company (“Anthem”) is a corporation with its principal 

place of business in the State of Indiana, authorized to transact and transacting 

business in the Northern District of California and can be found in the Northern 

District of California. Anthem is the insurer of benefits under the Families First, 

Inc. Long Term Disability & Life Insurance Plan (“LTD & Life Insurance Plan”) as 

and acted in the capacity of a plan administrator. Anthem administered the claim 

with a conflict of interest and the bias this created effected the claims 

determination. 

4. Defendant can be found in this judicial district and the LTD & Life 

Insurance Plan is administered in this judicial district. The LTD claim at issue 

herein was also specifically administered in this judicial district. Thus, venue is 

proper in this judicial district pursuant to 29 U.S.C. § 1132(e)(2). 

/// 

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Case 5:16-cv-07397-BLF Document 1 Filed 12/29/16 Page 2 of 6
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COMPLAINT 

KANTOR & KANTOR LLP 

19839 Nordhoff Street 

Northridge, California 91324 

(818) 886 2525

FIRST CAUSE OF ACTION 

AGAINST ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE 

COMPANY FOR PLAN BENEFITS, ENFORCEMENT AND 

CLARIFICATION OF RIGHTS, PRE-JUDGMENT AND POSTJUDGMENT INTEREST, AND ATTORNEYS’ FEES AND COSTS 

(29 U.S.C. § 1132(a)(1)(B)) 

5. Plaintiff incorporates by reference all preceding paragraphs as though 

fully set forth herein. 

6. At all times relevant, Plaintiff was employed by Families First, Inc., 

and was a covered participant under the terms and conditions of the LTD and Life 

Insurance Plan. The Families First, Inc. LTD and Life Insurance Plan was insured 

by Defendant Anthem, and Anthem was also the Plan claims administrator and 

made all decisions to pay or deny benefit claims. 

7. During the course of Plaintiff’s coverage under the Anthem Policy, 

Plaintiff became entitled to benefits under the terms and conditions of the LTD Plan 

and Life Insurance Plan. Specifically, on or about August 20, 2013, while Plaintiff 

was covered under the LTD Plan, Plaintiff suffered a disability rendering Plaintiff 

disabled as defined under the terms of the LTD Plan. 

8. Pursuant to the terms of the LTD and Life Insurance Plan, Plaintiff 

made a claim to Anthem for LTD benefits under the LTD Plan, and for waiver of 

premiums under the life insurance portion of the plan. Specifically, while Plaintiff 

was covered under the LTD Plan, Plaintiff suffered a disability rendering Plaintiff 

disabled as defined under the terms of the LTD Plan. 

9. On or about August 20, 2013, the Plaintiff ceased work due to her 

disabling condition. She submitted a claim for benefits to Anthem, which Anthem 

identified as Claim #LT152450. Anthem paid Plaintiff’s benefits from the end of 

the policy elimination period through November 18, 2015, at which time Anthem 

denied Plaintiff’s claim for benefits. 

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COMPLAINT 

KANTOR & KANTOR LLP 

19839 Nordhoff Street 

Northridge, California 91324 

(818) 886 2525

10. Within the time frames provided by the LTD Plan, Plaintiff appealed 

this determination. Despite overwhelming evidence of a covered LTD claim, on 

August 11, 2016, Anthem upheld on appeal its decision to deny benefits. As such, 

the Plaintiff has exhausted her administrative remedies. 

11. Anthem breached the LTD and Life Plan and violated ERISA in the 

following respects: 

 (a) Failing to pay LTD benefit payments to Plaintiff at a time when 

Anthem knew, or should have known, that Plaintiff was entitled to those benefits 

under the terms of the LTD Plan, as Plaintiff was disabled and unable to work and 

therefore entitled to benefits. Even though Anthem had such knowledge, Anthem 

denied Plaintiff’s LTD benefits; 

 (b) Failing to provide a prompt and reasonable explanation of the 

basis relied on under the terms of the LTD Plan documents, in relation to the 

applicable facts and LTD Plan provisions, for the denial of Plaintiff’s claims for 

LTD benefits; 

 (c) After Plaintiff’s claim was denied in whole or in part, Anthem 

failed to adequately describe to Plaintiff any additional material or information 

necessary for Plaintiff to perfect her claim along with an explanation of why such 

material is or was necessary; and 

 (d) Failing to properly and adequately investigate the merits of 

Plaintiff’s disability claim and failing to provide a full and fair review of Plaintiff’s 

claim; and 

 (e) Failing to continue the waiver of her life insurance premiums 

based on her ongoing disability. 

12. Plaintiff is informed and believes and thereon alleges that Defendant 

wrongfully denied her disability benefits under the LTD Plan by other acts or 

omissions of which Plaintiff is presently unaware, but which may be discovered in 

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COMPLAINT 

KANTOR & KANTOR LLP 

19839 Nordhoff Street 

Northridge, California 91324 

(818) 886 2525

this future litigation and which Plaintiff will immediately make Defendant aware of 

once said acts or omissions are discovered by Plaintiff. 

13. Following the denial of benefits under the LTD Plan, Plaintiff 

exhausted all administrative remedies required under ERISA, and Plaintiff has 

performed all duties and obligations on Plaintiff’s part to be performed under the 

LTD Plan. 

14. As a proximate result of the aforementioned wrongful conduct of 

Anthem, Plaintiff has damages for loss of disability benefits in a total sum to be 

shown at the time of trial. 

15. As a further direct and proximate result of this improper determination 

regarding Plaintiff’s LTD claim, Plaintiff in pursuing this action has been required 

to incur attorneys’ costs and fees. Pursuant to 29 U.S.C. § 1132(g)(1), Plaintiff is 

entitled to have such fees and costs paid by Defendant. 

16. The wrongful conduct of Anthem has created uncertainty where none 

should exist, therefore, Plaintiff is entitled to enforce her rights under the terms of 

the LTD Plan and to clarify her right to future benefits under the terms of the LTD 

Plan. 

REQUEST FOR RELIEF 

 WHEREFORE, Plaintiff prays for relief against Defendant as follows: 

1. Payment of disability benefits due Plaintiff up to and including the date 

of Judgment; 

2. Waiver of Plaintiff’s life insurance premiums; 

 3. An order declaring that Plaintiff is entitled to immediate reinstatement 

to the LTD Plan, with all ancillary benefits to which she is entitled by virtue of her 

disability, and that benefits are to continue to be paid under the LTD Plan for so 

long as Plaintiff remains disabled under the terms of the LTD Plan; 

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COMPLAINT 

KANTOR & KANTOR LLP 

19839 Nordhoff Street 

Northridge, California 91324 

(818) 886 2525

 4. Pursuant to 29 U.S.C. § 1132(g), payment of all costs and attorneys’ 

fees incurred in pursuing this action; 

 5. Payment of prejudgment and post-judgment interest as allowed for 

under ERISA; and 

 6. Such other and further relief as this Court deems just and proper. 

DATED: December 29, 2016 KANTOR & KANTOR, LLP 

BY: /s/ Glenn R. Kantor 

Glenn R. Kantor 

Peter S. Sessions 

Attorneys for Plaintiff, 

THERESA DAY 

Case 5:16-cv-07397-BLF Document 1 Filed 12/29/16 Page 6 of 6