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Long Term Disability Insurance Fraud

Policyholders purchase long-term disability insurance to protect themselves in the event they become disabled and can no longer carry out their job duties. Unfortunately, some long-term disability (LTD) policyholders have their disability claims improperly denied. Policyholders who have their long-term disability claim denied can appeal the decision, but should speak with an attorney first, to ensure their rights are protected throughout the process.


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Long-Term Disability

ltdsupercasepageLong-term disability is supposed to protect policyholders in case they become sick, injured, or otherwise disabled for an extended period of time and are no longer able to carry out their work-related duties. When that happens, policyholders file a long-term disability claim to have their benefits begin. Long-term disability plans often begin to provide benefits after a policyholder has been unable for work for six months, and the LTD plans typically pay about 60-80% of the policyholder's pre-disability earnings. LTD plans differ according to the terms of the plan, so each individual's plan needs to be reviewed accordingly. Unfortunately, some long-term disability claimants find that their claim is denied or is originally approved only to be terminated later.

Long-Term Disability and ERISA

Often when long-term disability is discussed, it is mentioned alongside "ERISA." ERISA, the acronym for "Employee Retirement Income Security Act," is a federal law that was put in place to protect workers' pension plans. ERISA was expanded to also apply to employer-provided long-term disability plans. If you've purchased a long-term disability insurance plan on your own--i.e., not through your employer benefits plan--then ERISA law typically does not apply; state law governs individual long-term disability insurance plans.

Because of this, it is best to seek the assistance of a long-term disability attorney to help guide you through any issues you might face as you file your disability claim. Also, while ERISA laws were enacted to protect workers' rights, unfortunately, ERISA is known to favor the insurance companies.

Long-Term Disability Lawsuit

manwearingneckbraceDepending on the policyholder's circumstances, the policyholder may have to file an appeal before filing a lawsuit. If the disability insurance is purchased through an employer, the insurance is governed by ERISA. In such cases, any denials must first be appealed with the insurer. The appeals process must be exhausted before a lawsuit can be filed.

The administrative appeal, however, involves a great deal of paperwork, and you may be required to file one or more of these appeals. The paperwork filed in support of the appeal will be the only evidence considered for both the appeal and—if the appeal is denied—the lawsuit. All evidence—including medical records, expert opinions, and other supporting documentation—must be included in the administrative appeal or it will not be considered by the judge in a subsequent lawsuit.

If your long-term disability claim has been denied, you should first request a complete copy of your claims file from the plan administrator. Through ERISA, your insurance company is required to provide you with a copy of your claim file at no cost. This information is important to have in order for you to be able to identify and include additional evidence in your claim file. While the administrative appeal(s) needs to be exhausted according to ERISA, it is still wise to speak with a long-term disability lawyer to ensure you are following the LTD claim appeal process correctly, meeting your deadline dates, and adding as much supportive evidence to your claim file as possible.

Note, if the insurance is purchased directly by the policyholder, and not obtained through an employer's benefits plan, the policyholder can file a lawsuit without filing an appeal of the denial.

Policyholders have their insurance claims denied for many reasons. Sometimes the insurance company does not have an accurate picture of the claimant's work duties and believes the claimant can go back work. The insurance company might also claim that the policyholder is not as disabled as he or she claims, or that the claimed disability is not covered by the policy (this is sometimes the case with conditions such as fibromyalgia).

In other cases, insurance companies may claim not to have received important documentation or not received information from policyholder's medical care provider. Or the insurance company might claim the injury is pre-existing, there is no objective medical evidence for the claim, or that there is no injury at all.

One of the most common long-term disability denials, however, happens when the insurer claims that the LTD claim was filed too late. It is of utmost importance to ensure all key filing dates are met when filing your LTD claim.

Bad Faith Insurance

Insurance companies are required to pay claims in good faith—meaning the claims must be paid willingly, promptly, and properly. All denials must be made for legitimate reasons. When companies deny insurance claims for invalid reasons—such as to make quotas or protect profits—or otherwise breach their covenant of good faith and fair dealing, they are committing bad faith insurance.

Bad faith insurance can also involve failing to promptly pay or investigate an insurance claim, not properly disclosing policy benefits, or failing to provide benefits as written in the insurance policy.

Long-Term Disability Companies

All insurance companies have a claims procedure and have legitimate reasons for denying long-term disability claims.

Among the long-term disability insurance companies are:

  • Unum (previously called Unum Provident and First Unum), has faced lawsuits alleging improperly denying legitimate claims;
  • Aetna;
  • Cigna, which in 2013 reached a regulatory settlement with five states who alleged the company was improperly handling claims;
  • AIG;
  • LINA (Life Insurance Company of North America, also operating under the CIGNA banner);
  • Allstate;
  • Colonial Life & Accident Insurance Company;
  • The Guardian Life Insurance Company of America;
  • Liberty Mutual
  • John Hancock Life Insurance Company;
  • New York Life Insurance Company;
  • MetLife (Metropolitan Life Insurance Company;
  • Prudential;
  • Penn Mutual.

Long-Term Disability Insurance

Just because an insurance company denies a claim for long-term disability insurance doesn't mean the policyholder has an invalid claim. There are many reasons for denying a claim that go beyond the legitimacy of the illness or injury. When claims are denied, policyholders have a right to have that decision reviewed. An experienced attorney can help with the insurance claims process, which can be long and complicated.

Register your Long Term Care Disability Insurance Complaint

If you have had a long term disability insurance policy falsely represented to you, or been denied a long term care disability insurance claim, you may qualify for damages or remedies that may be awarded in a long term disability fraud insurance lawsuit. Please click the link below to submit your complaint to an insurance lawyer for a free evaluation.
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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

Aetna Long Term Disability Denial lawsuitalleging denied claims for legitimate claims

Cigna Long Term Disability Denial lawsuit alleging denied claims for legitimate claims

John Hancock Faces Insurance Class Action Over Long-Term Care 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 Denid Disability Insurance

California Launches Investigation Into MetLife Death Payment Practices

Sun Life Faces Potential Class Action Over Disability Contracts

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.

Denied Disability Insurance

Sun Life Assurance Co. for allegedly reducing monthly disability benefits from the company's group policies to reflect CPP child benefits.

Unum Insurance for allegedly denying long-term disability claims.


Unum Accused of Denying Disability Benefits as Corporate Profits Rise
Unum Accused of Denying Disability Benefits as Corporate Profits Rise
November 14, 2017
Philadelphia, PA: An Unum lawsuit alleging unpaid Unum disability benefits has been filed by a Pennsylvania nurse claiming her rightful benefits were not only denied, but that the insurer failed to consider evidence that duly supported her claim [READ MORE]

Pennsylvania CIGNA Denied Disability Lawsuit Seeks Compensation
Pennsylvania CIGNA Denied Disability Lawsuit Seeks Compensation
November 12, 2017
Johnstown, PA: A CIGNA long term disability lawsuit filed in September has been proposed as a class action on behalf of all persons who may have been adversely affected with regard to the handling of disability benefits by CIGNA Health and Life Insurance Co [READ MORE]

Sun Life Denied Disability Benefits Lawsuit Settled Previously, But Issues Remained
Sun Life Denied Disability Benefits Lawsuit Settled Previously, But Issues Remained
November 7, 2017
New York, NY: A Sun Life disability claims lawsuit dating back to 2009 initially settled, but took on added longevity with a dispute over attorneys’ fees. On Halloween day of this year a Ninth Circuit panel reversed a lower court’s ruling that originally denied an employee benefit plan appellate attorneys’ fees [READ MORE]


Posted by
Karen Erikson
Pleasrycall me I have much to say about this corrupt company, I would love to speak with thr media, as well as the EEOC, ERISA, the Federalelabor Board. Bring it on or are you scared. Have your Numbers with you because I will have mind!

Posted by
Cheryl Moniz
I have paid for long term disability through my employer for 21 years.I became disabled under UNUM guidelines and had been receiving payments. They suggest I file for SS benefits. They said it would lower their payment to make up the difference I receive from SS and what I was receiving for LYD. My SS claim was approved and had been handled by Genix. My case was approved and I received payment from SS as back payment for my application date. Unum is saying I have to pay them back for the back payments. SS's letter states the check is being issued to me and not a 3rd party. Do I have to give the UNUM company all of the back payment money I received from SS? Thank you.

Posted by
James Sullivan
That sounds so much like me. I experienced a very similar situation where the Standard Insurance company denied my claim because I tried to return to work. I never got approved for the Ltd which I was forced to have and to pay for. It's terrible that on top of his illness, the pathetic system fought against paying him.

Posted by
I have been in two vehicle accidents and have had back surgery, resulting in chronic pain, failed back syndrome after surgery, spondylosis, degenerative joint disease, bulging discs, etc.... All physicians I have seen said I was unable to work. I have lost everything because I'm caught between 'them' and 'us'. I have since remarried and moved to the UK. I have a person who is supposedly working on this, however it's been months. I tried handling it all on my own but got nowhere. I appealed through Prudential and never received a reply!

Posted by
I receive social security and was getting pension from GE. And they sent a letter informing me it was in error. I have a copy of the terms and do not see where this is. I have sent a certified letter and still no reply.


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