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Edmundo P. Robaina (AZ Bar No. 018125) 

ROBAINA & KRESIN PLLC 

One East Camelback Road, Suite 710 

Phoenix, Arizona 85012 

Telephone: (602) 682-6450 

Facsimile: (602) 682-6455 

epr@robainalaw.com 

Attorneys for Plaintiff 

UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Cornelia Demers-Sborov, Ph.D.,

 Plaintiff, 

vs. 

Hartford Life and Accident Insurance 

Company, 

 Defendant. 

________________________________

 No. 

COMPLAINT 

PRELIMINARY STATEMENT

Plaintiff Cornelia Demers-Sborov, Ph.D., hereinafter referred to as “Plaintiff,” 

states for her Complaint as follows: 

1. This ERISA action against Hartford Life and Accident Insurance Company, 

in its capacity as Administrator of the Wentworth Institute of Technology Long Term 

Disability Plan, hereinafter referred to as “Defendant”. Plaintiff brings this action to secure 

all disability benefits, whether they be described as short term, long term and/or waiver of 

premium claims to which Plaintiff is entitled under a disability insurance policy 

underwritten and administered by Defendant. Plaintiff is covered under the policy by 

virtue of her employment with Wentworth Institute of Technology. 

PARTIES 

 2. Plaintiff is a citizen and resident of Tucson, Arizona. 

 3. Defendant is a properly organized business entity doing business in the State 

of Arizona. 

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4. The disability plan at issue in the case at bar was funded and administered by 

Defendant. 

5. Defendant is a business entity doing business in the District of Arizona. Defendant 

may be served with process by serving its registered agent, CT Corporation System, 3800 

North Central Avenue, Suite 460, Phoenix, Arizona 85012. 

JURISDICTION AND VENUE

6. This court has jurisdiction to hear this claim pursuant to 28 U.S.C. § 1331, 

in that the claim arises under the laws of the United States of America. Specifically, 

Plaintiff brings this action to enforce her rights under section 502(a)(1)(B) of the Employee 

Retirement Income Security Act, (ERISA), which provides “[a] civil action may be brought 

. . . (1) by a participant or by a beneficiary . . . (B) to recover benefits due to him under the 

terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to 

future benefits under the terms of the plan.” 29 U.S.C. § 1132(a)(1)(B). 

7. Venue in the District of Arizona is proper by virtue of Defendant doing 

business in the District of Arizona. Under the ERISA statute, venue is proper "in the 

district where the plan is administered, where the breach took place, or where a defendant 

resides or may be found." 29 U.S.C. § 1132(e)(2). Therefore, venue may also be proper 

under the third prong of ERISA's venue provision, specifically “where a defendant resides 

or may be found." (Id.) Here, Defendant is “found” within the District of Arizona, as it 

does business here, and the court has personal jurisdiction over Defendant, as it has 

sufficient ties to the United States. 

CONTRACTUAL AND FIDUCIARY RELATIONSHIP

8. Plaintiff has been a covered beneficiary under a group disability benefits 

policy issued by Defendant at all times relevant to this action. Said policy became effective 

January 1, 2008. 

9. The disability policy at issue was obtained by Plaintiff by virtue of Plaintiff’s 

employment with Wentworth Institute of Technology at the time of Plaintiff’s onset of 

disability. 

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10. Under the terms of the policy, Defendant administered the Plan and retained 

the sole authority to grant or deny benefits to applicants. 

11. Defendant funds the Plan benefits. 

12. Because the Defendant both funds the plan benefits and retains the sole 

authority to grant or deny benefits, Defendant has an inherent conflict of interest. 

13. Because of the conflict of interest described above, Defendant’s decision to 

deny disability benefits should be reviewed by this Court under a de novo standard of 

review. 

14. Further, in order for the Plan Administrator’s decisions to be reviewed by 

this Court under an “arbitrary and capricious” standard, the Plan must properly give the 

Plan Administrator “discretion” to make said decisions within the plain language in the 

Plan. 

15. Defendant has a fiduciary obligation to administer the Plan fairly and to 

furnish disability benefits according to the terms of the Plan. 

ADMINISTRATIVE APPEAL

16. Plaintiff is a 43 year old woman previously employed by Wentworth Institute 

of Technology as a “College Professor.” 

17. College Professor is classified under the Dictionary of Occupational Titles 

as Light with an SVP of 8 and considered to be skilled work. 

18. Due to Plaintiff’s degenerative and traumatic injuries, Plaintiff ceased 

actively working on April 30, 2011 as on this date Plaintiff suffered from cervical disc 

disorder with radiculopathy, cervical spondylosis, cervical vertigo phenomena, back pain, 

degenerative disc disease, and herniation at C4-5 with cord compression. 

 19. Plaintiff alleges that she became disabled on May 5, 2011. 

20. Plaintiff filed for short term disability benefits through the Plan administered 

by the Defendant. 

 21. Short term disability benefits were granted. 

 22. Plaintiff filed for long term disability benefits through the plan administered 

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by the Defendant. 

23. On September 19, 2014, Defendant denied long term disability benefits 

under the Plan. Said letter allowed Plaintiff 180 days to appeal this decision. 

24. At the time Defendant denied Plaintiff long term disability benefits, the 

disability standard in effect pursuant to the Plan was that Plaintiff must be considered 

unable to perform ”Any Occupation.” 

 25. If granted the plan would pay monthly benefit of $4,265.00. 

26. On March 20, 2015 Plaintiff pursued her administrative remedies set forth in 

the Plan by requesting administrative review of the denial of benefits. 

27. Plaintiff timely perfected her administrative appeal pursuant to the Plan by 

sending letter requesting same to the Defendant. 

28. Plaintiff submitted additional information including medical records to show 

that she is totally disabled from the performance of both her own and any other occupation 

as defined by the Plan. 

29. On or about May 7, 2015, Defendant’s paid consultant, Matthew H. Hine, 

M.D., MPH, occupational medicine, performed a paper review of Plaintiff’s claim file. 

30. On or about May 18 2015, Defendant’s paid consultant, Matthew H. Hine, 

M.D., MPH, occupational medicine, prepared a clarification to his paper review of 

Plaintiff’s claim file. 

There is an indication that a “Julie Wigington, RN,” clinical case manager, reviewed 

Plaintiff’s claim file, but Defendant failed to provide Plaintiff with said review. 

32. There is an indication that “Anne M. Haines, RN, CCM,” clinical case manager, 

reviewed Plaintiff’s claim file, but Defendant failed to provide Plaintiff with said review. 

33. There is an indication that an unnamed rehabilitation case manager reviewed 

Plaintiff’s claim file, but Defendant failed to provide Plaintiff with said review. 

34. Defendant’s consultants completed their reports without examining Plaintiff. 

35. On May 22, 2015, Defendant notified Plaintiff that Defendant affirmed its 

original decision to deny Plaintiff’s claim for long term disability benefits. 

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36. Defendant also notified Plaintiff on May 22, 2015 that Plaintiff had 

exhausted her administrative remedies. 

37. Defendant, in its final denial, discounted the opinions of Plaintiff’s treating 

physicians, among others, and the documented limitations from which Plaintiff suffers 

including the effects of Plaintiff’s impairments on her ability to engage in work activities. 

38. Plaintiff has now exhausted her administrative remedies, and her claim is ripe 

for judicial review pursuant to 29 U.S.C. § 1132. 

MEDICAL FACTS

39. Plaintiff suffers from multiple medical conditions resulting in both exertional 

and nonexertional impairments. 

40. Plaintiff suffers from cervical disc disorder with radiculopathy, cervical 

spondylosis, cervical vertigo phenomena, back pain, degenerative disc disease, and 

herniation at C4-5 with cord compression. 

41. Treating physicians document continued chronic back pain, radicular 

symptoms, as well as decreased range of motion and weakness. 

42. Plaintiff’s multiple disorders have resulted in restrictions in activity, have 

severely limited Plaintiff’s range of motion, and have significantly curtailed her ability to 

engage in any form of exertional activity. 

43. Further, Plaintiff’s physical impairments have resulted in chronic pain and 

discomfort. 

44. Plaintiff’s treating physicians document these symptoms. Plaintiff does not 

assert that she suffers from said symptoms based solely on her own subjective allegations. 

Physicians have prescribed Plaintiff with multiple medications, including narcotic 

pain relievers, in an effort to address her multiple symptoms. 

46. However, Plaintiff continues to suffer from break through pain, discomfort, 

and limitations in functioning, as documented throughout the administrative record. 

47. Plaintiff’s documented pain is so severe that it impairs her ability to maintain 

the pace, persistence and concentration required to maintain competitive employment on a 

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full time basis, meaning an 8 hour day, day after day, week after week, month after month. 

48. Plaintiff’s medications cause additional side effects in the form of sedation 

and cognitive difficulties. 

49. The aforementioned impairments and their symptoms preclude Plaintiff’s 

performance of any work activities on a consistent basis. 

50. As such, Plaintiff has been and remains disabled per the terms of the Plan 

and has sought disability benefits pursuant to said Plan. 

51. However, after exhausting her administrative remedies, Defendant persists 

in denying Plaintiff her rightfully owed disability benefits. 

DEFENDANT’S CONFLICT OF INTEREST 

52. At all relevant times, Defendant has been operating under an inherent and 

structural conflict of interest as Defendant is liable for benefit payments due to Plaintiff 

and each payment depletes Defendant’s assets. 

53. Defendant’s determination was influenced by its conflict of interest. 

54. Defendant has failed to take active steps to reduce potential bias and to 

promote accuracy of its benefits determinations. 

The LTD plan gave Defendant the right to have Plaintiff submit to a physical 

examination at the appeal level. 

56. A physical examination, with a full file review, provides an evaluator with 

more information than a medical file review alone. 

57. More information promotes accurate claims assessment, 

COUNT I 

WRONGFUL DENIAL OF BENEFITS UNDER ERISA, 29 U.S.C. § 1132 

58. Defendant incorporates those allegations contained in paragraphs 1 through 

57 as though set forth at length herein 

59. Defendant has wrongfully denied disability benefits to Plaintiff in violation 

of Plan provisions and ERISA for the following reasons: 

 a. Plaintiff is totally disabled, in that she cannot perform the material 

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duties of her own occupation, and she cannot perform the material 

duties of any other occupation which her medical condition, 

education, training, or experience would reasonably allow; 

 b. Defendant failed to afford proper weight to the evidence in the 

administrative record showing that Plaintiff is totally disabled; 

 c. Defendant’s interpretation of the definition of disability contained in 

the policy is contrary to the plain language of the policy, as it is 

unreasonable, arbitrary, and capricious, and; 

 d. Defendant has violated its contractual obligation to furnish disability 

benefits to Plaintiff. 

COUNT II 

 ATTORNEY FEES AND COSTS 

 60. Plaintiff repeats and realleges the allegations of paragraphs 1 through 59 

above. 

 61. By reason of the Defendant’s failure to pay Plaintiff benefits as due under 

the terms of the Plan, Plaintiff has been forced to retain attorneys to recover such benefits, 

for which Plaintiff has and will continue to incur attorney’s fees. Plaintiff is entitled to 

recover reasonable attorney’s fees and costs of this action, pursuant to Section 502(g)(1) 

of ERISA, 29 U.S.C. §1132(g)(1) 

WHEREFORE, Plaintiff demands judgment for the following: 

 A. Grant Plaintiff declaratory relief, finding that she is entitled to all past due 

short term and long term disability benefits yet unpaid; 

 B. Order Defendant to pay past short term and long term disability benefits 

retroactive to September 20, 2014 to the present in the monthly amount specified in the 

Plan and subject to such offsets as are permitted in the Plan, plus pre-judgment interest; 

 C. Order Defendant to remand claim for future administrative review and 

continue to make future long term disability benefits in the monthly amount specified in 

the Plan and subject to such offsets as are permitted in the Plan until such time as Defendant 

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makes an adverse determination of long-term disability consistent with ERISA and 

Plaintiff’s entitlements under the Plan. 

 D. Order Defendant to pay for the costs of this action and Plaintiff’s attorney’s 

fees, pursuant to Section 502(g) of ERISA, 29 U.S.C. § 1132(g); and 

 E. For such other relief as may be deemed just and proper by the Court. 

DATED this 2nd day of October 2015. 

ROBAINA & KRESIN, PLLC 

By /s/ Edmundo P. Robaina 

 Edmundo P. Robaina 

 Attorneys for Plaintiff 

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