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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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Denied Disability Insurance

Unum Insurance for allegedly denying long-term disability claims.


Unum Insurance Lawsuits Gain Momentum
Unum Insurance Lawsuits Gain Momentum
May 18, 2018
Ellicott City, MD: A former Maryland project manager for a real estate company has accused the Unum Group of suspending her monthly disability payments after 26 years of payments when she was elected to serve part-time on the Howard County Board of Education. Five years after notifying Unum life insurance that she had been elected to the Board of Education position, her benefits were terminated and she does not know why [READ MORE]

Fibromyalgia sufferer wins denied disability claim lawsuit against Hartford
Fibromyalgia sufferer wins denied disability claim lawsuit against Hartford
May 4, 2018
Seattle, WA: Long term denied disability lawsuits have a way of careening into highly technical territory about the appropriate standard of legal review or the precise process for deciding appeals. Not so with Reetz v. Hartford Life & Accident Ins. Co. . This was an evidence case [READ MORE]

Another Chance after LTD Denial? Arbitrary and Capricious Standard Continues to Crumble in MetLife Lawsuit
Another Chance after LTD Denial? Arbitrary and Capricious Standard Continues to Crumble in MetLife Lawsuit
April 25, 2018
New York, NY Alexander Sigal was deeply depressed and, after a period of hospitalization, found himself unable to work as a computer programmer. Benefits under his employer’s MetLife long term disability plan were eventually terminated, and his administrative appeal was denied. His ensuing MetLife LTD lawsuit, however, revealed a fatal flaw in the denial of his appeal [READ MORE]


Posted by
Daniel Stokes
I was denied ltd because principal insurance is a corrupt and horrible company i hope there is a class action lawsuit against them real soon

Posted by
Adrianne Brown
Was told that because I went out on long term disability in 2009 that I would recieve payments until my retirement year. I was also tokld that my payment after getting Socia security disability that I would those payments and the long term insurance if I was permanently disabled up to the amount of my established long term payment until I retired as soon as I got social security they started sending monthlyrequired paperwork late and requested I pay back all disability they had given me? I know I was on serious meds because of my injuries but it felt scammy!

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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