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 and ERISA
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
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
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
Among the long-term disability insurance companies are:
- Unum (previously called Unum Provident and First Unum), has faced lawsuits alleging improperly denying legitimate claims;
- Cigna, which in 2013 reached a regulatory settlement with five states who alleged the company was improperly handling claims;
- 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;
- Penn Mutual.
Long-Term Disability Insurance
Register your Long Term Care Disability Insurance ComplaintIf 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
- 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.
- Denied Disability Insurance
- Unum Insurance for allegedly denying long-term disability claims.
Unum Disability Insurance Claimant Wins Reinstatement of LTD Benefits
Jury Awards $25.6 Million in 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
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.
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