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Germana v. Reliance Standard Life Insurance Co.

United States District Court, D. Connecticut

August 28, 2018




         After the death of Dominic Acquarulo, Plaintiffs - Annunziata Germana, Mr. Acquarulo's widow and executrix of his estate, and Joker's Wild Entertainment, LLC, his former employer - filed an Amended Complaint to address his disability insurance and related benefits. They allege, on behalf of his estate, that Reliance Standard Life Insurance Company (“Reliance”) breached the terms of its insurance policy. See Am. Compl., ECF No. 22.

         Defendant now moves to dismiss the Amended Complaint. See Def. Mot. to Dismiss, ECF No. 24.

         For the reasons stated below, the motion to dismiss the Amended Complaint, ECF No. 24, is GRANTED in part and DENIED in part.


         Dominic Acquarulo, a Connecticut resident, worked for Joker's Wild Entertainment, LLC, a Connecticut limited liability corporation. Compl. ¶ 1, ECF No. 1-1. Annunziata Germana, also a resident of Connecticut; became Executrix of the estate of her husband, Dominic Acquarulo, on August 9, 2018. Amend. Compl. ¶ 2, ECF No. 22. Reliance Standard Life Insurance (“Reliance”) is an insurance company allegedly doing business in Connecticut. Amend. Compl. ¶ 2.

         A. Factual Background

         Reliance issued an insurance policy to Joker's Wild Entertainment, LLC, which provided Joker's Wild's employees with benefits for loss of time due to disability from sickness or injury.” Policy at 8.0, Def. Mot. to Dismiss, Ex. A, ECF No. 11-2).

         The policy provided “Weekly Income Benefits, ” if an individual “is disabled due to Sickness or Injury” and “becomes disabled while insured by this Policy.” Id. “[D]isabled” meant being “unable to do the material duties of his/her job, ” as well as “not doing any work for payment [and] under the regular care of a physician.” Id. at 2.0.

         According to the terms of the plan:

LEGAL ACTIONS: No legal action may be brought against us to recover on this Policy within sixty (60) days after written proof of loss has been given as required by this Policy. No action may be brought after three (3) years (Kansas, five (5) years; South Carolina, six (6) years) from the time written proof of loss is required to be given.

Id. at 6.0.

         Reliance allegedly provided Mr. Acquarulo with disability insurance and related benefits and, in exchange, he paid the insurance company a premium. Amend. Compl. ¶ 2.

         In August, 2014, Mr. Acquarulo submitted a claim for short term disability benefits under the Joker's Wild policy. See Letter from Asha Davis, STD Claims Department, to Dominic Acquarulo (“Denial Letter”) (January 12, 2015), Def. Mot. to Dismiss, Ex. B, ECF No. 11-3. He had been diagnosed with “glioblastoma multiforme IV, ” symptoms that first appeared in June 2014. Id.

         Reliance denied that claim. See Denial Letter at 5. The denial letter stated that to be covered individuals had to be “actively at work, ” which means “the person [is] actually performing on a full-time basis each and every duty pertaining to his/her job in the place where and the manner in which the job is normally performed.” Id. at 3.

         In rejecting the claim, Reliance also stated:

During the course of our investigation, we have also received information that during part of the period in which you were not working, that you were, in fact, incarcerated. We have learned that you were incarcerated on January 15, 2013 and were released from prison on April 9, 2014. During a recent telephone call, we were informed that you were actually released from prison sometime in January 2014, due to a compassionate release.
It is our contention that your Individual Insurance possibly terminated as early as January 2012, when you ceased full time work, but most certainly as late as January 15, 2013, the date of your incarceration. According to the contract, your Individual Insurance will be reinstated provided you return to Active Work within the period of time shown on the Schedule of Benefits.
According to the Schedule of Benefits, the Waiting Period for future employees is 90 days of continuous employment. The Individual Effective date is the first of the month coinciding with or next following completion of the Waiting Period. The policy requires that should you return to work more than 6 months after your Individual Insurance terminates, you would have to satisfy the Eligibility Requirements of the policy again.
Therefore, since the information that we have documents that you were released from prison on April 9, 2014, assuming you returned to work sometime in April, you would have satisfied the Service Waiting Period in July 2014. Therefore, your Effective Date of Individual Insurance would be August 1, 2014, which is prior to your claimed period of disability.

Id. at 4.

         Reliance noted, however, that it appeared Mr. Acquarulo had worked until September 2014. Ultimately “[s]ince you have continued to work and since we have not received the previously requested documentation, we are unable to complete the processing of your claim and determine whether benefits are ...

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