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Scott E. Davis 

State Bar No. 016160 

SCOTT E. DAVIS, P.C. 

8360 E. Raintree Drive, Suite 140 

Scottsdale, AZ 85260 

Telephone: (602) 482-4300 

Facsimile: (602) 569-9720 

email: davis@scottdavispc.com

Attorney for Plaintiff Kimberly Corona 

UNITED STATES DISTRICT COURT 

DISTRICT OF ARIZONA 

Kimberly Corona, 

 Plaintiff, 

 v. 

The Standard Insurance Company; Arizona 

State Credit Union; Arizona State Credit Union 

Disability Plan, 

 Defendants. 

Case No. 

COMPLAINT 

 

 Now comes the Plaintiff Kimberly Corona (hereinafter referred to as “Plaintiff”), by 

and through her attorney, Scott E. Davis, and complaining against the Defendants, she 

states: 

Jurisdiction 

 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). 

Those provisions give the district courts jurisdiction to hear civil actions brought to recover 

employee benefits. In addition, this action may be brought before this Court pursuant to 28 

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U.S.C. §1331, which gives the Court jurisdiction over actions that arise under the laws of 

the United States. 

Parties 

 2. Plaintiff is a resident of Maricopa County, Arizona. 

3. Upon information and belief, Arizona State Credit Union (hereinafter referred 

to as the “Company”) sponsored, administered and purchased a group short term disability 

insurance policy which was fully insured by The Standard Insurance Company (hereinafter 

referred to as “Standard”). The specific group short term disability insurance policy is 

known as group policy number 148504-B (hereinafter referred to as the "Policy"). The 

Company’s purpose in sponsoring, administering and purchasing the Policy was to provide 

short term disability insurance for its employees. Upon information and belief, the 

Standard Policy may have been included in and part of an employee benefit plan, 

specifically named the Arizona State Credit Union Disability Plan (hereinafter referred to 

as the “Plan”) which may have been created to provide the Company’s employees with 

welfare benefits. At all times relevant hereto, the Plan constituted an “employee welfare 

benefit plan” as defined by 29 U.S.C. §1002(1). 

4. Upon information and belief, Standard functioned as the claim administrator 

of the policy; however, pursuant to the relevant ERISA regulation, the Company and/or the 

Plan may not have made a proper delegation or properly vested fiduciary authority or power 

for claim administration in Standard. 

5. Standard had an inherent conflict of interest in evaluating Plaintiff’s short 

term disability claim due to the fact that it operated in dual roles as the decision maker with 

regard to whether she was disabled, as well as the payor of benefits if it determined Plaintiff 

was disabled. 

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6. The Company, Standard and the Plan conduct business within Maricopa 

County and all events giving rise to this Complaint occurred within Arizona. 

Venue 

7. Venue is proper in this district pursuant to 29 U.S.C. §1132(e)(2) and 28 

U.S.C. §1391. 

Nature of the Complaint 

8. Incident to her employment, Plaintiff was a covered employee pursuant to 

the Plan and the relevant Policy and a “participant” as defined by 29 U.S.C. §1002(7). 

Plaintiff seeks short term disability (STD) benefits from the Plan and the relevant Policy 

pursuant to §502(a)(1)(B) of ERISA, 29 U.S.C. §1132(a)(1)(B), as well as long term 

disability (LTD) benefits from the relevant Plan and Policy and any other employee benefits 

she may be entitled to from the Company, the Plan and any other Company Plan as a result 

of being found disabled in this action. 

9. With regard to her claim for LTD benefits, Plaintiff seeks a determination that 

she is disabled and also meets the definition of disability set forth in the LTD Policy which 

contains essentially the same definition as is set forth in the STD Policy. Plaintiff’s 

eligibility to receive LTD benefits is ripe before this Court to make a determination as her 

disability and inability to work have continued to exist throughout the STD timeframe, 

through the LTD timeframe and to the present date. All of the evidence Plaintiff submitted 

to Standard in her STD claim proves that she also meets any definition of disability in the 

relevant LTD Plan and/or Policy. 

10. In the alternative, with regard to her LTD claim, Plaintiff’s seeks a 

determination in this action that she is eligible to file an LTD claim and to have Standard 

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determine whether she is entitled to receive LTD benefits pursuant to that Plan and/or 

Policy as a result of being found disabled for the entire STD timeframe in this action. 

11. After working for the Company as a loyal employee, Plaintiff became 

disabled on or about June 25, 2014, due to serious medical conditions and was unable to 

work in her designated occupation as an Administrative Clerk III. Plaintiff has remained 

disabled as that term is defined in the relevant Policy continuously since that date and has 

not been able to return to any occupation as a result of her serious medical conditions. 

12. Following her disability, Plaintiff filed a claim for STD benefits under the 

relevant Policy which was administered by Standard, meaning that it made the decision with 

regard to whether Plaintiff was disabled. 

13. The Standard Policy provides the following definition of disability pertaining 

to STD benefits: 

 You are Disabled if you meet the following Own Occupation definition of 

Disability. 

 You are required to be Disabled only from your Own Occupation. You are 

Disabled from your Own Occupation if, as a result of Physical Disease, Injury, 

Pregnancy or Mental Disorder: 

1. You are unable to perform with reasonable continuity the Material 

Duties of your Own Occupation; and 

2. You suffer a loss of at least 20% in your Pre-disability Earnings when 

working in your Own Occupation. 

14. In support of her claim for STD benefits, Plaintiff submitted to Standard 

medical evidence which supported her allegation that she met the definition of disability as 

defined in the relevant Policy. 

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15. In a letter dated September 30, 2014, Standard informed Plaintiff it was 

denying her claim for STD benefits. Plaintiff alleges that in denying her claim, Standard’s 

decision abused any discretion that may have been afforded to it in the Policy. 

16. Pursuant to 29 U.S.C. §1133, Plaintiff timely appealed Standard’s September 

30, 2014 denial of her claim and in support of her claim for STD benefits, Plaintiff 

submitted to Standard additional medical, vocational and lay-witness evidence 

demonstrating she met the definition of disability set forth in the Policy. 

17. Plaintiff submitted to Standard a January 7, 2015 narrative letter from her 

board certified treating physician who confirmed it is his medical opinion, “...[Plaintiff] has 

not been able to work in any capacity since 07/07/2014. The medical conditions that 

support this will continue indefinitely. She will not be able to work in any occupation 

indefinitely.” 

18. Plaintiff also submitted to Standard a Functional Capacity Evaluation report 

dated November 12, 2014, wherein after an extensive several hour test and evaluation with a 

qualified physical therapist to determine her ability to work, the therapist concluded, 

“...[Plaintiff] is unable to perform any categorical work at this time, even sedentary.” 

(original emphasis). 

19. Further supporting her claim, Plaintiff submitted a vocational report from a 

certified vocational expert dated March 27, 2015, who after reviewing Plaintiff’s medical 

evidence, the definition of disability and interviewing Plaintiff, they concluded, “...it is my 

professional opinion to a reasonable degree of vocational probability that [Plaintiff] meets 

the own occupation Definition of Disability in The Standard policy and she is entitled to 

disability benefits on that policy.” 

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20. In addition to the medical evidence and reports submitted to Standard, 

Plaintiff submitted a sworn affidavit from her mother, who confirmed Plaintiff is unable to 

work in any occupation and that her medical condition has not improved in any way since 

her date of disability. 

21. Plaintiff also submitted updated medical records from each of her treating 

providers and a list of her current medications, as well as the side effects they cause and the 

impact they would have on her ability to work in any work environment. 

22. As part of its review of Plaintiff’s claim for STD benefits, Standard obtained 

medical records only "paper reviews" from two physicians of its choosing. Standard did not 

disclose to Plaintiff the name of its reviewing physicians, either during its administrative 

review of Plaintiff’s claim or after the final determination had been made. 

23. Upon information and belief, Plaintiff alleges the reviewing physicians may 

be long time medical consultants for the disability insurance industry and/or Standard. As a 

result, Plaintiff alleges the reviewing physicians may have incentives to protect their own 

consulting relationships with the disability insurance industry and/or Standard, by providing 

medical records only paper reviews which selectively review or ignore evidence such as 

occurred in Plaintiff’s claim, in order to provide opinions and report(s) which are favorable 

to insurance companies and which supported the denial of Plaintiff’s claim. 

24. In a letters dated April 15, 2015 and June 2, 2015, in order to engage Standard 

in a dialogue so she could perfect any alleged deficiencies in her claim, Plaintiff requested a 

complete copy of any and all medical records only “paper reviews” from Standard and the 

opportunity to respond to these reviews as well as to provide them to her treating physicians 

for their response prior to Standard rendering a determination in her claim. 

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25. Prior to rendering its final denial in Plaintiff’s claim, Standard never shared 

with Plaintiff the reports authored by its reviewing physicians and never engaged Plaintiff or 

her treating medical providers in a dialogue so she could respond to the reports and perfect 

her claim. Standard’s failure to provide Plaintiff with the opportunity to respond to the 

reports precluded a full and fair review pursuant to ERISA. Standard’s action is also an 

ERISA procedural violation and a violation of Ninth Circuit case law. 

26. In a letter dated July 20, 2015, Standard notified Plaintiff it had again denied 

her claim for STD benefits under the Policy. In the letter, Standard also notified Plaintiff 

she had exhausted her administrative levels of review and could file a civil action lawsuit in 

federal court pursuant to ERISA. Plaintiff alleges that Standard’s decision to again deny her 

claim abused any discretion that may have been afforded to it in the Policy. 

27. Upon information and belief, Standard’s July 20, 2015 denial letter confirms 

it failed to provide a full and fair review, and in the process committed several procedural 

violations pursuant to ERISA due to among other reasons, completely failing to credit, 

reference, consider, and/or selectively reviewing and de-emphasizing most, if not all of 

Plaintiff’s reliable evidence which proved she was disabled and met the definition of 

disability in the policy. 

28. In evaluating Plaintiff’s claim on appeal, Standard owed her a fiduciary duty 

and had an obligation pursuant to ERISA to administer her claim, “solely in her best 

interests and other participants” which it failed to do. 1

 

 

1

 It sets forth a special standard of care upon a plan administrator, namely, that the 

administrator "discharge [its] duties" in respect to discretionary claims processing "solely 

in the interests of the participants and beneficiaries" of the plan, § 1104(a)(1); it 

simultaneously underscores the particular importance of accurate claims processing by 

insisting that administrators "provide a 'full and fair review' of claim denials," Firestone, 

489 U.S., at 113, 109 S. Ct. 948, 103 L. Ed. 2d 80 (quoting § 1133(2)); and it 

supplements marketplace and regulatory controls with judicial review of individual claim 

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29. Standard failed to adequately investigate and failed to engage Plaintiff in a 

dialogue during the appeal of her claim with regard to what evidence was necessary so 

Plaintiff could perfect her appeal and claim. Standard’s failure to investigate the claim and 

to engage in this dialogue and to obtain the evidence it believed was important to perfect 

Plaintiff's claim is a violation of ERISA and Ninth Circuit case law, and is a reason she did 

not receive a full and fair review. 

30. Plaintiff alleges Standard provided an unlawful review which was neither full 

nor fair and that violated ERISA, specifically, 29 U.S.C. § 2560.503-1, failing to 

adequately investigate her claim; failing to have her personally examined by a medical 

professional when the policy allowed for one; failing to credit Plaintiff’s reliable evidence; 

providing one sided reviews of Plaintiff’s claim that failed to consider all the evidence 

submitted by her and/or de-emphasizing medical evidence which supported Plaintiff’s 

claim; disregarding Plaintiff’s self-reported symptoms; failing to consider all the diagnoses 

and/or limitations set forth in her medical/vocational evidence as well as the impact the 

combination of those diagnoses and impairments would have on her ability to work; failing 

to engage Plaintiff in a dialogue so she could submit the necessary evidence to perfect her 

claim and failing to consider the impact the side effects from Plaintiff's medications would 

have on her ability to engage in any occupation. 

31. Plaintiff alleges a reason Standard provided an unlawful review which was 

neither full nor fair and that violated ERISA, specifically, 29 U.S.C. § 2560.503-1, is due in 

part to its conflict of interest that manifested as a result of the dual roles Standard undertook 

 

denials, see § 1132(a)(1)(B). Metro. Life Ins. Co. v. Glenn, 128 S. Ct. 2343, 2350 (U.S. 

2008). 

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as the decision maker and payor of benefits. Standard’s conflict of interest provided it with 

motivation and a financial incentive to deny her claim. 

32. Plaintiff is entitled to discovery regarding Standard’s aforementioned 

conflicts of interest, potential conflicts of interest of the reviewing physicians, as well as any 

other individual who reviewed her claim and the Court may properly weigh and consider 

extrinsic evidence regarding the nature, extent and effect of any conflict of interest and/or 

ERISA procedural violation which may have impacted or influenced Standard’s decision 

to deny her claim. 

33. With regard to whether Plaintiff meets the definition of disability set forth in 

the Policy, the Court should review the evidence in Plaintiff’s claim de novo, because even 

if the Court concludes the policy confers discretion, the unlawful violations of ERISA 

committed by Standard as referenced herein are so flagrant they justify de novo review. 

34. As a direct result of Standard’s decision to deny Plaintiff’s STD claim, she 

has been injured and suffered damages in the form of lost STD benefits, in addition to other 

potential employee benefits she may have been entitled to receive through or from the Plan, 

any other Company Plan and/or the Company as a result of being found disabled. Plaintiff 

believes other potential employee benefits may include but not be limited to, long term 

disability benefits (LTD), health and other insurance related coverage or benefits, retirement 

benefits or a pension, life insurance coverage and/or the waiver of the premium on a life 

insurance policy providing coverage for her and her family/dependents. 

35. As referenced supra, pursuant to ERISA 29 U.S.C. §1132(a)(1)(B), in 

addition to seeking a determination in this action that she met the definition of disability and 

was disabled throughout the entire STD timeframe and is entitled to all those benefits, 

Plaintiff seeks a determination that she is disabled and also meets the definition of disability 

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set forth in the LTD Policy which contains essentially the same definition as is set forth in 

the STD Policy. Plaintiff’s eligibility to receive LTD benefits is ripe before this Court to 

make a determination as her disability and inability to work have continued to exist 

throughout the STD timeframe, through the LTD timeframe and into the present date. All 

of the evidence Plaintiff submitted to Standard in her STD claim proves that she also meets 

any definition of disability in the relevant LTD Plan and/or Policy. 

36. In the alternative, with regard to her LTD claim, Plaintiff’s seeks a 

determination in this action that she is eligible to file an LTD claim and to have Standard 

determine whether she is entitled to receive LTD benefits pursuant to that Plan and/or 

Policy as a result of being found disabled for the entire STD timeframe in this action. 

37. In a letter dated October 27, 2014, Plaintiff notified Standard that she 

intended to file an LTD claim and requested for Standard to provide her with the necessary 

LTD application documents. In a letter dated January 12, 2015, as well as in its July 20, 

2015 final denial, Standard informed Plaintiff she was not eligible to file a claim for LTD 

benefits until all STD benefits had been exhausted. 

38. Plaintiff alleges that a motivating factor in why Standard denied her STD 

claim is because if it found Plaintiff disabled for the entire STD timeframe and she 

exhausted those benefits, Standard’s financial liability/exposure in Plaintiff’s LTD is 

significantly larger than it is in Plaintiff’s STD claim. Plaintiff alleges that but for 

Standard’s unlawful and erroneous denials of her STD claim as referenced herein, she 

would have exhausted all of her STD benefits. As a result, Plaintiff would have already 

been eligible for and be receiving LTD benefits at the present time pursuant to the LTD Plan 

and/or Policy. 

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39. Pursuant to 29 U.S.C. §1132, Plaintiff is entitled to recover unpaid benefits, 

prejudgment interest, reasonable attorney's fees and costs from Defendants. 

40. Plaintiff is entitled to prejudgment interest at the legal rate pursuant to A.R.S. 

§20-462, or at such other rate as is appropriate to compensate her for losses she incurred 

as a result of Defendants’ nonpayment of benefits. 

 WHEREFORE, Plaintiff prays for judgment as follows: 

 A. For an Order requiring Defendants to pay Plaintiff her STD benefits and 

any other employee benefits she may be entitled to as a result of being found disabled 

pursuant to the STD Plan and/or Policy, from the date she was first denied these benefits 

through the date of judgment and prejudgment interest thereon; 

 B. For an Order directing Defendants to continue paying Plaintiff the 

aforementioned benefits until such time as she meets the conditions for termination of those 

benefits; 

 C. For an Order that Plaintiff is eligible to file a claim for LTD benefits as a 

result of being found disabled for the entire STD timeframe and exhausting her STD 

benefits; 

 D. In the alternative, for an Order that as a result of being found disabled for the 

entire STD timeframe and exhausting those benefits, Plaintiff is eligible for LTD benefits 

and the evidence supports a finding that she also meets the definition of disability set forth 

in the LTD Plan and/or Policy and is entitled to receive LTD benefits along with any other 

employee benefits that she may be entitled to as a result of being found disabled pursuant to 

the LTD Plan and/or Policy; 

 E. For an Order directing Defendants to continue paying Plaintiff the 

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aforementioned LTD benefits and other employee benefits until such time as she meets the 

conditions for the termination of those benefits; 

 F. For attorney’s fees and costs incurred as a result of prosecuting this suit 

pursuant to 29 U.S.C. §1132(g); and 

 G. For such other and further relief as the Court deems just and proper. 

 

DATED this 24th day of September, 2015. 

 SCOTT E. DAVIS. P.C. 

 By: /s/ Scott E. Davis Scott E. Davis 

 Attorney for Plaintiff

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