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Denied Disability Insurance Legal News Articles & Interviews

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Insurance Companies in Denial regarding Long COVID

Insurance Companies in Denial regarding Long COVID September 15, 2022. By Jane Mundy.
Santa Clara, CA Despite government entities recognizing Long Covid as a disability, attorneys are litigating against health insurance companies that deny disability benefits to COVID long haulers.
Read [ Insurance Companies in Denial regarding Long COVID ]

Covid Long-Haulers and Denied Disability

Covid Long-Haulers and Denied Disability June 24, 2022. By Jane Mundy.
Santa Clara, CA If you are a COVID 19 long-hauler and your disability claim has been denied, don’t give up – don’t accept excuses from your insurer. The medical and legal community, state and federal governments (including the CDC) and a recent global survey recognize Long COVID as a disability and insurers will increasingly find it difficult to deny LTD benefits.

Read [ Covid Long-Haulers and Denied Disability ]

Long-Term Disability Attorney Discusses Long-COVID Disability Claims

Long-Term Disability Attorney Discusses Long-COVID Disability Claims April 27, 2022. By Jane Mundy.
Northridge, CA It’s no surprise that some “long COVID-19” claims are denied by insurance companies: there was even a debate about whether it was real. But long-term disability attorney Brent Dorian Brehm, with Kantor & Kantor LLP has already won “post-COVID-19 syndrome” appeals for his clients. Brehm discusses how best to file a long-COVID LTD claim.
Read [ Long-Term Disability Attorney Discusses Long-COVID Disability Claims ]

COVID Long-Haulers Prepare for Wrongly Denied Disability Claims

COVID Long-Haulers Prepare for Wrongly Denied Disability Claims February 17, 2021. By Anne Wallace.
Washington, DCCOVID long-haulers, who suffer from debilitating COVID symptoms long after an initial infection, have had their complaints dismissed as “malingering.” The cruelest cut of all, though, may be the financial blow that lands when long term disability benefit claims are denied. As yet, there are few reported COVID related long term denied disability lawsuits, but long-haulers should anticipate that they are just around the corner.
Read [ COVID Long-Haulers Prepare for Wrongly Denied Disability Claims ]

LTD Claimants Win Big as Ninth Circuit Trims “Abuse of Discretion” Standard

LTD Claimants Win Big as Ninth Circuit Trims “Abuse of Discretion” Standard January 11, 2019. By Anne Wallace.
San Francisco, CA In one of the earliest decisions of 2019, the Ninth Circuit gave plaintiffs in long term denied disability lawsuits a new way to challenge benefit denial decisions. It may turn out to be significant.
Read [ LTD Claimants Win Big as Ninth Circuit Trims “Abuse of Discretion” Standard ]

Unum Disability Insurance Claimant Wins Reinstatement of LTD Benefits

Unum Disability Insurance Claimant Wins Reinstatement of LTD Benefits January 8, 2019. By Anne Wallace.
Santa Ana, CA On November 20, 2018, the U.S. District Court for the Central District of California handed Pamela Fleming a resounding victory in her Unum disability insurance lawsuit. Unum had been paying her LTD benefits since 2005, after a serious and well-documented neck injury sustained in a car accident. A change in her treating physician and a brief surveillance video led the insurer to re-evaluate her claim and declare that she had recovered. The insurer terminated her benefits. Judge Cormac J. Carney was not impressed and reinstated her benefits due under the policy.
Read [ Unum Disability Insurance Claimant Wins Reinstatement of LTD Benefits ]

Jury Awards $25.6 Million in Bad Faith Insurance Lawsuit

Jury Awards $25.6 Million in Bad Faith Insurance Lawsuit December 17, 2018. By Anne Wallace.

Oklahoma City, OK In November 2018, a jury awarded nearly $25.6 million to the family of a Oranna Cunningham, a woman who was diagnosed with advanced nasopharyngeal cancer. Her insurer, Aetna, refused to cover the cost of the proton beam therapy recommended by her physician, claiming that it was “experimental or investigational.” After her death, her husband brought a bad faith insurance lawsuit.


Through his attorney, he alleged that “Aetna’s denial of her claim involved overworked, under-qualified doctors working in the interest of their employer’s bottom line who are compensated in part based on the profitability of the company.”


The jury apparently agreed; nearly $10 million of the award is in the form of punitive damages, intended to punish the insurer for bad faith.

Over-worked, Under-qualified Medical Reviewers




Evidence was presented at trial that none of Aetna’s in-house medical reviewers was a specialist in proton beam cancer therapy. One was an internal medicine/family practice doctor who had not treated a patient in 25 years. Another was general surgeon, and the third was a hematologist/oncologist who had no experience with radiation therapy. None had spent more than 30-45 minutes reviewing the claim for treatment, and at least one had complained in an official personnel file of having to review 80 or more claims per day. None had read the insurance contract before denying the claim.


One of the reviewers allegedly spoke to a doctor treating Ms. Cunningham and acknowledged that the treating doctor’s recommendation for proton therapy was appropriate. However, he said that he had to deny the claim anyway.

Routine Denials for Innovative or Advanced Treatments




Proton beam therapy is an FDA-recognized treatment, often approved for pediatric and Medicare patients. It allows doctors to precisely focus cancer-fighting proton energy on cancerous cells, thereby minimizing stray damage to other healthy tissues. It’s targeted; it preserves organ health; and it may reduce other harmful side effects.


The location of Ms. Cunningham’s tumor made the risk of blindness, memory loss and other grievous consequences particularly acute. However, at 54, she was neither young nor old. She fell in the age gap. No one has yet explained why that put her outside the range of coverage.


According to the Alliance for Proton Therapy Access, nearly two-thirds of cancer patients between the ages of 18 and 64 whose physicians recommend proton therapy as the best course of treatment for their disease are initially denied by their insurer. Patients and their physicians are sometimes successful in reversing the initial denial, but the delay averages nearly three weeks in the end. According to their report, proton therapy is denied more than four times out of ten, and it takes an average of more than five weeks for patients to receive that final denial.


The problem of coverage denials for treatments deemed “experimental or investigational” is not limited to proton beam cancer treatments, as patients who have sought coverage for other forms of modern medical treatment, including technologically advanced pacemakers or microprocessor-augmented prosthetic knees can testify. Many physicians reportedly feel strongly that “experimental or investigational” denials are often a sham.


The denials may certainly add time and cost to a patient’s treatment, and the delay can affect the quality of outcome. Oranna Cunningham and her husband mortgaged their home to pay for proton beam treatment. She died shortly after receiving treatment anyway. There are apparently no allegations that a delay in treatment damaged her prognosis, but it might in other cases, especially in those where patients had no other financial recourse.

Challenges Ahead




The jury’s award is fairly certain to be appealed for a variety of reasons. The most obvious of these is the size of the punitive damages portion.


Oklahoma’s tort reform law limits non-economic damages, including punitive damages, to $350,000. The cap can be waived where there is clear and convincing evidence of reckless disregard for the rights of others, gross negligence, fraud or malice. The attorneys for the Cunninghams will certainly argue this, but the result is uncertain.


In addition, they may argue that the lawsuit was brought as a contract dispute, not a tort case, since it involved the interpretation of an insurance policy. Counsel for Aetna will certainly counter with a policy argument about runaway jury verdicts, especially in situations where the plaintiffs are as likeable and sympathetic as the Cunninghams appear to have been.


Finally, of course, there is the question of whether Aetna’s denial of coverage, in fact, caused Ms. Cunningham’s death. She received proton therapy, which appeared at the time of her death to be shrinking the dangerous tumor at the base of her brain stem. She died of an infection. Whether the infection can be traced to the denial of coverage will be a matter of potentially difficult proof.
Read [ Jury Awards $25.6 Million in Bad Faith Insurance Lawsuit ]

Unum: the Gift of Giving and Taking Away

Unum: the Gift of Giving and Taking Away December 6, 2018. By Jane Mundy.
Chicago, IL: Yet another lawsuit was filed in November against First Unum for allegedly denying long-term disability benefits. In the same month, Unum announced to the media that it had donated $300,000 to a high-school girls’ leadership program.
Read [ Unum: the Gift of Giving and Taking Away ]

Fibromyalgia Sufferer Brings LTD Lawsuit against Life Insurance Co. of North America

Fibromyalgia Sufferer Brings LTD Lawsuit against Life Insurance Co. of North America November 16, 2018. By Anne Wallace.
Los Angeles, CA On September 14, 2018 Marisa Finnerty filed a long term denied disability lawsuit against the Life Insurance Company of North America (LINA), alleging that she had been wrongly denied benefits under her employer, Quest Diagnostics’, long term disability and group life insurance plans. Two things stand out about this lawsuit.
Read [ Fibromyalgia Sufferer Brings LTD Lawsuit against Life Insurance Co. of North America ]

Unum’s Denial of Opioid Overdose Deaths

Unum’s Denial of Opioid Overdose Deaths November 15, 2018. By Jane Mundy.
New Orleans, LA: The giant insurance company Unum—also known as First Unum -- typically denies accidental death benefits (as do most other life insurance companies) by excluding in their policy coverage for deaths related to prescription overdose or for medical or surgical treatment of a sickness or disease. But Unum’s denial didn’t sway Judge Martin Feldman this past August.

Read [ Unum’s Denial of Opioid Overdose Deaths ]

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