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UNITED STATES DISTRICT COURT 

NORTHERN DISTRICT OF ILLINOIS 

AT CHICAGO 

MICHAEL PITTMAN : 

 CASE NO. 1:20-cv-4493 

 : 

 Plaintiff JUDGE: 

 : 

vs. MAGISTRATE JUDGE: 

 : 

AETNA LIFE INSURANCE COMPANY 

151 Farmington Avenue : 

Hartford, CT 06156 

 : 

 COMPLAINT 

And : 

 

AEP GROUP BENEFITS PROGRAM : 

95 Chestnut Ridge Road 

Montvale, NJ 07645 : 

 Defendants : 

 

 Now comes the Plaintiff, Michael Pittman, 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 statutory provisions give district courts jurisdiction to hear civil actions brought to 

recover benefits due under the terms of Employee Welfare Benefit Plans. In this case, 

the Plaintiff, Michael Pittman, asserts a claim for group disability benefits available under 

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a long-term disability Plan provided for the employees of AEP Industries, Inc. The Plan 

and policy documents should be included in the Administrative Record that Defendants 

file with this Court. This action is also brought pursuant to 28 U.S.C. § 1331 which 

gives district court’s 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. Plaintiff has exhausted those avenues 

of appeal. 

NATURE OF ACTION

 3. Plaintiff, Michael Pittman, seeks an award of disability benefits, including 

disability income benefits pursuant to an Employee Welfare Benefit Plan providing group 

disability benefits to employees of AEP Industries, Inc. This action is brought pursuant to 

§ 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B). Plaintiff also seeks to enforce the 

right to future benefits and demand that Defendants account for past benefits and pay 

future benefits. 

THE PARTIES 

 4. Plaintiff was an active employee under the Plan and eligible for benefits as 

a qualified employee when his medical condition deteriorated, and he could no longer 

work. Plaintiff is now disabled. Venue is proper in the Northern District of Illinois, at 

Chicago, because the Plaintiff is a resident of Richton Park, Cook County, Illinois and 

Aetna Life Insurance Company may be found in this district. Aetna Life Insurance 

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Company conducts ongoing business with Cook County, Illinois residents, employs Cook 

County, Illinois residents and has extensive contacts within Cook County, Illinois. 

 5. At all times relevant hereto, the long-term disability plan constituted an 

“Employee Welfare Benefit Plan” as defined by 29 U.S.C. § 1002(1). Plaintiff became 

disabled while employed under the Plan and has coverage as a Plan participant as defined 

by 29 U.S.C. § 1002(7). 

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

upon information and belief, is Aetna Life Insurance Company (hereinafter, "Aetna"). 

The Aetna insurance policy issued to AEP Industries, Inc. was delivered to Plaintiff's 

employer. 

STATEMENT OF FACTS 

 7. Michael Pittman was hired by AEP Industries, Inc. on February 1, 1995 

and worked as a Reclaim and Receiving Manager, before having to leave work on August 

23, 2016, due to symptoms associated with severe chronic spinal stenosis, bilateral 

degenerative joint disease of the knees, lumbar radiculopathy and left hip osteoarthritis. 

Mr. Pittman under a total left hip arthroscopy on January 9, 2017. 

 8. The occupation of Reclaim and Receiving Manager is classified as 

medium in physical demand and classified as a skilled occupation. 

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 9. Mr. Pittman applied for long-term disability benefits upon his departure 

from work and benefits were approved and paid from August 31, 2016 through February 

21, 2017. 

 10. Long-term disability (LTD) benefits began on February 19, 2017 and were 

paid for Plaintiff's inability to perform his own occupation until April 2, 2019. 

 11. The definition of disability for "any occupation" that Plaintiff must meet 

under the AEP Industries, Inc. policy, is as follows: "After 24 months of your disability 

that monthly benefits are payable, you meet the plan's test of disability on any day you 

are unable to work at any reasonable occupation solely because of an illness, injury or 

disabling pregnancy-related condition." 

 12. Aetna issued its initial denial of long-term disability benefits on April 2, 

2019, because Mr. Pittman would be able to perform a sedentary or light occupation. 

Without an examination, Jamie L. Lewis, M.D. wrote an opinion in favor of work 

capacity for Aetna and a Transferable Skills Analysis was created by Aetna's vendor, 

Coventry, which followed Dr. Lewis' speculation of capacity for work. These 

occupations offered by Coventry could not be done by Plaintiff without additional 

training. 

 13. Plaintiff filed his own appeal on June 24, 2019, which included a letter 

written by Plaintiff, an MRI of the lumbar spine dated February 12, 2019, which showed, 

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"multilevel degenerative lumbar spondylosis with dextroscoliosis and multilevel canal 

and foraminal stenosis" and a letter from his primary care physician, Howard Robinson, 

M.D., who advised that Mr. Pittman was taking pain medications and that, "It is noted 

that he does have occasional flare ups of his pain which prevents him from standing, 

sitting or lifting for 3 or 4 days at a time." Mr. Pittman describes in his letter that the 

narcotic pain medications that he is currently taking cause dizziness, drowsiness, fatigue 

and has occasionally caused him to fall. 

 14. In response to Plaintiff's appeal, Aetna, hired Nakul Mahajan, M.D., to 

perform another non-examining medical file review. Dr. Mahajan concluded, without 

examination, that Plaintiff had no restrictions and limitations based on the information 

that he reviewed. Dr. Mahajan did not mention that Plaintiff had won his Social Security 

disability benefits in his opinion. 

 15. After two additional office notes from Plaintiff's physicians were received, 

Aetna rehired Dr. Mahajan on September 4, 2019 and requested an addendum to his 

original report. Dr. Mahajan concluded that the additional medical information did not 

change his prior assessment and that, "no restrictions and limitations as supported as most 

of his complaints are subjective." (Emphasis added). 

 16. Aetna issued its final denial of long-term disability benefits on September 

23, 2019, which was supported by Dr. Mahajan's non-examining file review. 

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 17. Plaintiff was awarded Social Security disability benefits with a disability 

onset date of August 23, 2016. These benefits were awarded on application without a 

need for a hearing. 

FIRST CAUSE OF ACTION 

CLAIM FOR BENEFITS UNDER 29 U.S.C. § 1132(a)(1)(B) 

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

paragraphs 1 through 17 of the Complaint. 

19. Defendant Plan and Aetna 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. Aetna and the Plan 

have arbitrarily ignored and selectively reviewed documents Plaintiff has submitted and 

has failed to provide a full and fair review. 

20. Defendant Aetna has an inherent “conflict of interest” as it has a dual role 

as both evaluator and payor of benefit claims, which is to be considered as a factor in the 

review of any benefit determination. The conflict of interest effected the decision to deny 

benefits. The conflict allowed Aetna an overreliance on non-examining physicians’ 

opinions. The conflict of interest caused Aetna to disregard relevant evidence with no 

explanation and totally or partially caused the denial of benefits without using a reasoned 

process. 

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 21. While Defendant Aetna may have the authority to make claims 

determinations under applicable law and the language of the Policy, Aetna's 

determinations as Plan Fiduciary are not entitled to deference and the review of any 

benefits determination must be made de novo. 

 22. As a full de novo review of this decision and the evidence in the claim file 

is required by statute, this Court may not abrogate its duty to perform such a review. Any 

failure to provide such a review would violate the US Constitution and deprive Plaintiff 

of constitutional rights, including under Article III and the principles of separation of 

powers, amongst others. 

 23. If the Court determines that an arbitrary and capricious standard of review 

applies to this case rather than a de novo standard, Aetna's denial of benefits must be 

overturned due to the faulty evaluation, confusing methods and below market standards 

employed by Aetna in the evaluation of evidence. Standards applicable under ERISA, 

including as enumerated by this Court, the Seventh Circuit Court of Appeals and the 

United States Supreme Court have been violated by Aetna and an examination of the 

record reveals that Aetna's decision to discontinue benefits is not the result of a reasoned 

process and that it is, therefore, arbitrary and capricious. 

24. Aetna and the Plans have violated their duty to provide a full and fair 

review of claimant’s evidence by engaging in the following acts: 1) Defendants have 

ignored evidence supplied by Plaintiff which supports his disability; 2) Defendants relied 

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upon non-examining peer reviews that mischaracterized Plaintiff’s medical severity; 3) 

Defendants have improperly relied upon conclusion based peer reviews which failed to 

address the claimant’s actual limitations, which included pain, weakness, fatigue, and 

severe side effects of medications; 4) Defendants have engaged in a selective review of 

evidence presented by the claimant; and 5) Defendants ignored the terms of their insuring 

agreement by suggesting that he could perform occupations which required training and 

education that Plaintiff does not possess. 

25. ERISA requires that an Employee Welfare Benefit Plan be established 

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

 26. The disability Plan under which the Plaintiff Michael Pittman was a 

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

filed with this Court as those documents set forth the sole criteria for benefits for the 

Plaintiff. 

 27. ERISA provides that an Employee Benefit Welfare Plan shall be 

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

Plan documents, to be filed with the Administrative record, the termination of Plaintiff’s 

benefits was clearly unreasonable and without basis. 

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 28. Plaintiff is entitled to benefits and benefits are due and owing to Plaintiff 

from Defendants in an amount not yet ascertainable. Plaintiff seeks the payment of these 

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

WHEREFORE, Plaintiff, Michael Pittman, prays for the following relief: 

A. That the Court enter judgment in Plaintiff Pittman's favor and against the 

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

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

contractual amount of benefits to which Pittman is entitled; 

B. That the Court order the Defendants to pay Pittman's pre-judgment interest 

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

judgment accordingly; 

C. That the Court declare Michael Pittman's rights under the ERISA Plan, the 

ERISA statute, and the applicable insurance laws and order the 

Defendants to continue paying Plaintiff Pittman 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), after the filing of a Motion more fully establishing his entitlement 

to such fees; 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 31st day of July, 2020 

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 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: 937-347-5441 

Email: joseph@mcdonaldandmcdonald.com 

 Attorney for Plaintiff, Michael Pittman 

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