CASE NO. 1 COMPLAINT

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James P. Keenley (State Bar No. 253106)

Brian H. Kim (State Bar No. 215492)

BOLT KEENLEY KIM LLP

1010 Grayson Street, Suite Three

Berkeley, California 94710

Phone: (510) 225-0696

Fax: (510) 225-1095

Attorneys for Plaintiff

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

SAN FRANCISCO / OAKLAND DIVISION

STEPHANIE FORBES,

Plaintiff,

v.

SUN LIFE AND HEALTH INSURANCE 

COMPANY,

Defendant.

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Case No.: 

COMPLAINT (ERISA)

INTRODUCTION

This case challenges Defendant Lincoln National Life Insurance Company’s (“Lincoln’s”) 

denial of Plaintiff Forbes’s claim for disability benefits under the Local Initiatives Support Corporation 

Long Term Disability Plan (the “Plan”). Plaintiff was and is disabled under the terms of the Plan and is

entitled to retroactive and ongoing benefits under the Plan. 

JURISDICTION

Plaintiff brings this action for declaratory, injunctive, and monetary relief pursuant to 

section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 

Case 3:17-cv-00915-EDL Document 1 Filed 02/22/17 Page 1 of 5
CASE NO. 2 COMPLAINT

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1132(a)(1)(B). This Court has subject matter jurisdiction over Plaintiff’s claim pursuant to ERISA § 

502(e) and (f), 29 U.S.C. § 1132(e) and (f), and 28 U.S.C. § 1331.

VENUE

Venue lies in the Northern District of California pursuant to ERISA § 502(e)(2), 29 

U.S.C. § 1132(e)(2), because the breaches alleged occurred in this District, and the ERISA-governed 

plan at issue was administered in part in this District. Venue is also proper pursuant to 28 U.S.C. § 

1391(b) because a substantial part of the events or omissions giving rise to Plaintiff’s claim occurred 

within this District.

INTRADISTRICT ASSIGNMENT

This case should be assigned to the San Francisco Division because the Plan is 

administered in this division, Plaintiff resides in this division, and the relevant acts and omissions 

occurred within this division.

PARTIES

At all relevant times, Plaintiff was a participant, as defined by ERISA § 3(7), 29 U.S.C. 

§ 1002(7), in the Plan. Defendant can identify Plaintiff by the claim number 281013-07993-00.

At all relevant times, the Plan was an employee welfare benefit plan within the meaning 

of ERISA § 3(1), 29 U.S.C. § 1002(1), sponsored by Plaintiff’s employer. Defendant Sun Life

administered claims for benefits under the Plan and paid the benefits due under the Plan pursuant to a 

group insurance policy bearing policy number 63003-GD Long Term Disability. 

FACTS

At all relevant times the Plan offered, among other things, disability benefits to 

employees of the Local Initiatives Support Corporation, including Plaintiff, provided that an employee 

could establish that she was disabled within the meaning of the Plan.

Plaintiff has been disabled within the meaning of the Plan since April 29, 2013, due to

chronic fatigue syndrome and other comorbid conditions. Plaintiff suffers from debilitating malaise

and post-exertional fatigue that has been persistent and unexplained by any other diagnosis for a period 

of several years.

Case 3:17-cv-00915-EDL Document 1 Filed 02/22/17 Page 2 of 5
CASE NO. 3 COMPLAINT

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Prior to becoming disabled, Plaintiff was a program director for Local Initiatives 

Support Corporation.

Plaintiff filed a timely claim for benefits under the Plan, and Defendant initially found 

that she was disabled within the meaning of the Plan and approved her claim and paid twenty-four 

months of benefits. 

Defendant terminated Plaintiff’s claim effective October 25, 2015 by letter dated 

December 22, 2015.

Plaintiff filed a timely appeal of Defendant’s determination and submitted, among other 

evidence, additional medical records and the results of a Functional Capacity Evaluation, and a job 

simulation assessment.

By letter dated January 19, 2017, Defendant denied Plaintiff’s appeal.

Plaintiff has exhausted her administrative remedies under the Plan.

Defendant has failed to pay benefits owed to Plaintiff under the Plan from October 25, 

2015 to the present.

Plaintiff remains disabled to this day and has no prognosis for regaining the ability to 

work. She will be eligible for benefits until he reaches the maximum age under the Plan on April 30, 

2029.

As a direct and proximate result of the aforementioned acts of Defendant, Plaintiff 

suffered damages in the form of unpaid disability benefits, interest thereon, and attorney’s fees and 

costs of suit.

FIRST CLAIM FOR RELIEF

[Claim for Benefits Pursuant to ERISA § 502(a)(1)(B) Against Defendant]

Plaintiff incorporates Paragraphs 1 through 16 as though fully set forth herein.

ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B), permits a plan participant to bring a 

civil action to recover benefits due to him under the terms of a plan, to enforce his rights under the 

terms of a plan, and/or to clarify his rights to future benefits under the terms of a plan.

Case 3:17-cv-00915-EDL Document 1 Filed 02/22/17 Page 3 of 5
CASE NO. 4 COMPLAINT

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At all relevant times, under the terms of the Plan as set forth in the governing plan 

instruments, Plaintiff became and remains entitled to disability benefits under the Plan.

By denying Plaintiff’s claim for benefits, and by related acts and omissions, Defendant

has violated, and continues to violate, the terms of the Plan and Plaintiff’s rights thereunder. 

Defendant’s refusal to pay Plaintiff benefits violates the terms of the Plan, and Defendant’s actions in 

administering Plaintiff’s claim and in denying benefits were wrongful and an abuse of discretion. At 

all material times herein, Defendant failed and refused to honor the terms of the Plan. 

As a proximate result of Defendant’s actions, Plaintiff has been deprived of her benefits 

to which she was and is entitled and has suffered damages as set forth above. Plaintiff further seeks a 

declaration as to her entitlement to future disability benefits, as follows: an injunction prohibiting 

Defendant from terminating or her disability benefits until the end of the maximum benefit period.

PRAYER FOR RELIEF

WHEREFORE, Plaintiff prays that the Court grant the following relief:

A. Declare that Defendant violated the terms of the Plan by denying Plaintiff’s 

claim for benefits;

B. Order that Defendant pay Plaintiff’s past benefits owed under the terms of the 

Plan through to the date that judgment is rendered herein, together with prejudgment interest on each 

and every such payment through to the date that judgment is rendered herein;

C. Declare Plaintiff’s right to receive future benefits under the terms of the Plan;

D. Issue an injunction requiring Defendant to issue monthly benefit payments until 

Plaintiff reaches the maximum benefit duration without subjecting Plaintiff to further claims procedures 

with respect to his claim for benefits under the Plan;

E. Award Plaintiff attorneys’ fees and costs of suit incurred herein pursuant to 

ERISA § 502(g), 29 U.S.C. § 1132(g);

F. Provide such other relief as the Court deems equitable and just.

Respectfully submitted,

Case 3:17-cv-00915-EDL Document 1 Filed 02/22/17 Page 4 of 5
CASE NO. 5 COMPLAINT

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Dated: February 22, 2017 BOLT KEENLEY KIM LLP

By: /s/ James P. Keenley

James P. Keenley

Attorneys for Plaintiff 

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