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Denied Disability Insurance
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By Heidi Turner
Both short-term disability and long-term disability policies are purchased as insurance to protect you in the event that you become disabled and can no longer work. But countless policy holders are denied disability insurance by insurers who employ bad faith practices. Experienced long-term disability insurance lawyers can help consumers appeal wrongly denied disability claims and file a long term disability lawsuit.
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Denied Disability Insurance
Short-Term Disability Denial—Am I Eligible for Benefits?
These benefits can be funded and administered by an insurer or funded by the employer and administered by a third party administrator. The employer is usually involved with a short-term disability claim.
If you are denied short-term disability, you have the right to appeal. Disability insurance attorneys advise you to examine your policy and make sure your disability falls within its definition of STD. Next, have your physician re-evaluate your condition and obtain a copy of your medical record—it will be required as evidence with your appeal. Lastly, consult with a bad faith insurance attorney who is experienced in short-term disability claims.
Long-Term Disability Denial—Am I Eligible for Benefits?
Most people believe their long-term disability (LTD) benefits cover injuries that are work-related only. However, it is estimated that more than 95 percent of LTD claims are non-work related, such as chronic diseases, mental illness and cancer. These illnesses and more may be covered on your LTD benefits policy.
If you have made a claim under a long-term disability policy and have had your claim denied, or if your claim was approved and then later terminated, you have the right to appeal and an attorney can help determine if you are eligible for substantial additional benefits.
Long-term disability policyholders in Washington, Oregon, Hawaii, Alaska, Montana, Idaho, California, Nevada and Arizona who have had their LTD claims unfairly or unreasonably delayed or denied may be eligible to file a lawsuit against their long-term insurance company.
Long-term insurance companies that have or could face a denied disability claim include Cigna, The Hartford, Aetna, Lincoln Financial, Sunlife, Prudential, Liberty Life, Reliance Standard, Sedgwick, Dearborn National, MetLife, Principal Financial Group, Guardian Life, The Standard, Mass Mutual, Union Central, Lloyd's of London, Illinois Mutual, Assurity and Fidelity Insurance Group.
Denied Disability Lawsuit
Wrongfully Denied Disability and ERISA
The majority of people obtain long term disability coverage as part of an employee benefits plan. Most employee benefits are regulated under ERISA—the Employee Retirement Income Security Act. ERISA governs employer-issued group long term disability plans.ERISA is a government statute comprising a series of regulations. These regulations, however, are rarely enforced by the Department of Labor, thereby allowing the insurance industry to employ bad faith practices and denying your claim. Because ERISA is so complicated and evolving, you need an experienced attorney to understand and identify bad faith tactics by the insurer.
The ERISA law regulates most every aspect of employee welfare benefits. Even though it is a complex set of rules, ERISA was set up in 1974 to give you the right to pursue a lawsuit in federal court. Be aware that a disability lawsuit occurs before a judge only (no jury) who will review only those administrative documents on record—you seldom have a second chance so it is imperative that you seek an experienced ERISA attorney.
To file an ERISA claim you must do the following:
File an initial claim with your insurer and typically within 45 days a claims reviewer will determine whether you are entitled to disability benefits
If you are denied benefits, you can either accept that decision or appeal for another review by the insurance company. The insurance company must explain to you the reason for their denial.
Be aware that both processes involve deadlines, which should be clearly defined in your letter of denial. As a rule, you will have only 180 days to file an administrative appeal of the denial.
If you fail to meet these deadlines, you may lose all rights of appeal and your right to file a wrongfully denied disability lawsuit.
If you have appealed your case under ERISA and haven't received a decision within 45 days, disability insurance lawyers advise that you file a lawsuit sooner than later. It is advantageous for you that a judge receives documentation from your attorney rather than just reviewing documentation from the insurance company that denied your claim.
For more ERISA information visit The Department of Labor(DOL) website and ERISA commonly asked questions.
Common Claim Denials
Bad Faith Disability Insurance
Besides intentionally denying a claim, Insurers are well-versed in a number of insurance denial tactics, such as:
- Misclassifying injuries and/or insisting your medical condition is pre-existing
- Denying your medical records and/or claiming you lack "objective medical evidence"
- Relying on evidence by their independent medical examiner
- Partial payments on disability claims
- Unreasonable denial, delay, or policy termination
- Concealing benefits from policyholders
- Insisting you are able to work in another occupation
Register your Denied Disability Claim Complaint
If you or a loved one has been Denied a Short-Term or Long-Term Disability claim, you may qualify for damages or remedies that may be awarded in a possible lawsuit. Please fill in our form to submit your complaint and we will have a lawyer review your Insurance complaint.At LawyersandSettlements.com, it is our goal to keep you informed about important legal cases and settlements. We are dedicated to helping you resolve your legal complaints.
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DENIED DISABILITY INSURANCE LAWSUITS
- Reliance Standard Life Insurance Company Denied Disability policyholders have filed denied disability lawsuits claiming bad faith tactics
- Guardian Life Insurance Denied Disability Lawsuits policyholders claim the insurer has wrongfully denied disability benefits by practicing bad faith insurance
- Liberty Mutual Denied Disability Lawsuits alleging bad faith insurance practices and denying long-term disability insurance.
- The Standard Long Term Disability Denial lawsuit alleging denied claims for legitimate claims
- Metlife Long Term Disability Denial lawsuit alleging denied claims for legitimate claims
- Hartford Long Term Disability Denial lawsuit alleging denied claims for legitimate claims
- Cigna Long Term Disability Denial lawsuit alleging denied claims for legitimate claims
- Washington Long Term Disability Insurance alleging insurance fraud and denied claims.
- Oregon Long Term Disability Insurance alleging insurance fraud and denied claims.
- Idaho Long Term Disability Insurance alleging insurance fraud and denied claims.
- California Long Term Care Insurance alleging insurers negligently or fraudulently fail or refuse to pay benefits.
- CIGNA Denied Disability Insurance
- California Launches Investigation Into MetLife Death Payment Practices
- Sun Life Faces Potential Class Action Over Disability Contracts
- LINA Insurance alleging violations of disability insurance claims.
- Long Term Care Insurance Las compañías de seguro para cuidados por largo plazo parecen estar negligentemente o fraudulentamente no pagando o negandose a pagar los beneficios.
- Long Term Disability Insurance alleging insurance fraud and denied claims.
- Unum Insurance for allegedly denying long-term disability claims.
DENIED DISABILITY INSURANCE LEGAL ARTICLES AND INTERVIEWS
LTD Claimants Win Big as Ninth Circuit Trims “Abuse of Discretion” Standard
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 MORE
Unum Disability Insurance Claimant Wins Reinstatement of LTD Benefits
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 MORE
Jury Awards $25.6 Million in Bad Faith Insurance Lawsuit
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.
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.
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 reportedlyfeel 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.
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 MORE
January 11, 2019
READ MORE
Unum Disability Insurance Claimant Wins Reinstatement of LTD Benefits
January 8, 2019
READ MORE
Jury Awards $25.6 Million in Bad Faith Insurance Lawsuit
December 17, 2018
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
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 MORE
MORE DENIED DISABILITY INSURANCE LEGAL NEWS
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- Fibromyalgia Sufferer Brings LTD Lawsuit against Life Insurance Co. of North America
- Unum’s Denial of Opioid Overdose Deaths
- Is a Health Plan Liable for the Negligence of an Unqualified Claims Reviewer?
- UNUM LTD Claimants Must Beware of Exhaustion of Remedies Roadblock
READ MORE LTD Insurance Fraud Settlements and Legal News
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READER COMMENTS
Daniel Kallie
on
knowing they were taking money from my payroll from Dec.1,2006 up to Aug.1,2009 and the state dept. want talk about they agent of SRS filing this claim. So how can they do that. know they are the state dept. But they have nothing to say about this insurance co. who was part of the state.
SO I feel the state dept. don't wrong by not talking about one of they insurance dept. out of Dallas, Tx. filing this claim number under the state 's worker's comp. know I was in a Trucker's Group Insurance Policy over 2.5 yrs. and they seen the policy and never done anything at all .
They never seen any wrongdoing by this trucking co. at all. They never had a word to say from Sept. 9. 2009 up to now. So by law can the state dept. really do this. I have been trying to get money my self by keeping this case open.
Daniel Stokes
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Irene Carnahan
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Daniel kallie
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I had a workplace injury on the job as a stroke, why still under a dispatcher out on the road. My job knew about my injury/illness and didn't file no claim from my and knowing I was in the hospital.
This trucking co. take this money from my payroll twice a month for over 4 yrs. This is a OCC/ACC group plain insurance for all o/o truck driver.
It was over 30 days before any thing was done, that was because I call and told them I would file a lawsuit if nothing was done.
I was then set up with a outside insurance co. to call up for help. I wasn't thinking at the time that wasn't my insurance co. that was on my payroll who I was paying. This was just to get me to move on. I file my first claim with this insurance co.
And water on after 10 days I was call back up and told the job don't want to pay you. You need to file for worker's comp. I did that and later on I got a call back telling ,me they can't help me because I had paid into a insurance policy on the job and I need to go beck to them for help. But nothing happen.
I just like to know how can an outsider insurance co. play apart in a claim that they name is not on your policy and on your payroll to have money to come out to them. With the lies that was told to them by the job . The outsider insurance co. deny my claim for my benefits and they closed my claim.
How in the hell do this happen. Now the insurance co I was paying from my payroll never did come into play over 2 1/2 yrs. And then they lied about they closed the claim because I didn't answer them back.
I have been going back & force to the TDI for help and now they is tired of me and now don't want answer me any more. This is not a workers' comp. claim,because I paid into a policy
I just want to get paid for the benefit I paid into this policy on the job that's under a trucker's insurance policy. So is there any help for me.
This was really wrong what the trucking co. did to me. No one have every gave me any thing. I need to know if anything can be done. This trucking co. took my money for a insurance co.
That they didn't want them to know anything about my injury on the job. this is really hell. I don't know if they had to many claim or what? This outsider insurance didn't file the claim with the TDI but sent the file back to the trucking co. to file with the worker's comp. and that also didn't happen. I have the proof on paper this insurance co . help the trucking co. out, well wasn't nothing file with any body to have it in the T.D.I just what I sent to them.
Joanne A
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Mrs. Georgia
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wizbang2fl
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Daniel Kallie
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Lynn Tilmon
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Anyway, Sedgwick had my Disability Coordinator write me a letter dated 12/22/15 (which I did not receive until the second week of January 2016) that my LTD would end on January 22, 2016. The letter also states that my final benefit payment will be issued on 2/28/2016.
Now, I know that this is happening because I'm older than 65. I was 64 when I was re-injured on 1/23/13. I was told that since my injury happened after I was 62, but younger than 65, that placed me in a certain category where I could get benefits for 2-1/2 years. This sounded good at first because I thought that everything necessary would have been done during this time -- including my healing up and getting back to work no later than last year. Sedgwick, along with Allied Managed Care Incorporated, would not le this happen.
I was just able to fax my appeal letter to them this morning. Sedgwick did not give me the 180 days for appeal like they were suppose to. I was only given a month. I needed more time because of my injuries; and it has been a hassle trying to get someone to help me write the appeal. I was suppose to send my appeal by mail, but the post office told me that as of right now, it would not ge there by tomorrow, 2/19/16, which is why I faxed it.
I think Sedgwick will deny the appeal. If they do, I will really need your help with this. It is not fair that I am being discriminated against because of my age (I'm 67). These days, people have to work longer than they did back in the day. I cannot retire right now. I have to work at least three more years before I can get full retirement benefits. This Los Angeles County Code about stopping LTD upon becoming 65 must be challenged -- and changed.
Jesus Martinez
on
I receive the signed Final Order, I will only have 14 days to appeal
Demand for my Work Accident
Christine
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arizona
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"I did receive the additional claim information. The adjusted disability date was noticed, however, it was still noted that the claimant was hospitalized on October 30, 2015. The claimant obviously can’t work and be hospitalized at the same time. As well, she did not work the week of November 2, 2015. Her doctor has disabled her on November 2, 2015, and she was hospitalized on October 30, 2015. The additional documentation has not altered the decision that her claim is denied." I do not understand this and why it was denied. This is the second denial. I was told I would get a chance to appeal the first one but they never sent me any paperwork. I really need to rest and not drag myself into work after sitting for chemo the day before.
L N Shapiro
on
After my early csection, I was diagnosed with diastasis symphysis pubis - 2 cm pelvic internal fracture.
I had to relearn how to walk and am in constant pain from an unstable pelvis & S1.
Cigna approved (after 2 denials) to pay $11,000 for my STD after a Peer to Peer. I was approved for LTD from Cigna to start August 28, my employer terminated me from employment 28 days before that.
Per Cigna, I am entitled to LTD from my ex employers plan- since it was an optional paid policy (2 years)
Yes, Cigna approved me - then stated my ex employer MIS refused to provide any documents for my claim.
My ex employer went as far as to contact Cigna and state they had "no intention of producing documents for my claim now or in the future"
Due to this, I haven't been paid by a policy I paid into.
Cigna said they haven't encountered an employer policy where the employer fails to comply with a request .
Please help. Why is my ex employer allowed to just not produce documents and I do not receive my benefits?
Cigna & the employer should be held responsible ...
Due to none payment; I cannot afford insurance/bills - it's impede ding on my recovery.
L.Miller
on
Has any courtcase been filed and won regarding Chronic Lyme Disease and the denial of benefits?
Are there any class actions lawsuits being undertaken on behalf of Chonic Lymes Disease patients who lose their ability to function?
Currently the allopathic medical profession demonizes any Lymes Literate Medical Doctor.
I was denied short term disability past two months last year whilst undergoing intensive treatment at a clinic mostly at my expense.Returned to work from 01/15 to 04/15.I relapsed April this year and managed to find a specialist Doctor in my state to find I have several more co-infections that are debilitating and pretty much immobilized me,can be life threatening if not treated.I filed appeals more than once.My new Doctor provided their peer review Doctors with all additional paperwork,substantiating the additional onset and had already advised on paperwork that I am going to be disabled for at least a year,due to the nature of my additional coinfections,which had not come to light during my initial treatment of Chronic Lymes, and through experience of treatments for other patients,this was the time it apparently takes to return someone to a relative state of health to perform a job.
I can go on and on -but I wont.I wanted to know if any case has been won for Chronic Lymes disease patients?
I want to know if there has been any class action lawsuit undertaken?There are thousands of people who are not only suffering major debilitating disorders due to this disease, we experience denial of its existence by the medical profession,denial of suitable treatment, and denial of benefits.
I am afraid to say that this can no longer be hidden under a rug, people are dying from this all over the USA.
I want to know what the legal profession is doing about it to help patients that have been victimized on every level?
William from New York
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ira mickens
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IRA MICKENS
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Diane Rouleau
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Kam Gosal
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I was unable to fill out the 180 day appeal time. And just understood that I was denied and that was it. Now I have a MRI, I have had counseling and my counselor states that I have deficits in processing and communicating, along with the fact that I was granted Social security disability benefits in 2012 for borderline personality disorder.
I was wondering if I have a case, because many of diagnosis were not diagnosed at the time of the 180 days, and came up after. And also I was not able to function mentally or physically.
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