Long Term Disability Insurers: Quick to Collect, Slow to Pay

Marshall, TXA Long term denied disability lawsuit that is so fresh it’s still warm from the oven was filed May 4 in US District Court, Marshall Division for the Eastern District of Texas, while a separate bad faith insurance claim proves the value of involving legal counsel when push comes to shove against a filibustering life insurance company.

In Texas, plaintiff Randall Goodwin holds that Life Insurance Company of North America violated workers’ compensation statutes and failed to uphold regulations inherent to The Americans with Disabilities Act.

Wrongly Denied Disability Claims occur when deserving claimants, having paid their premiums faithfully and with due diligence, suddenly find themselves through no fault of their own with a grievous health issue that either impedes their capacity to earn a living, or completely derails them from normal function. Insurance providers, happy to snap up the premiums of consumers month after month, tend to deny at the drop of a hat unless pushed to pay up.

According to the Southeast Texas Record (5/9/16), Goodwin reviewed short-term disability benefits from February 2012 through March 17, 2016. When it became necessary for Goodwin to apply for long-term disability, his claim was denied.

The plaintiff asserts in his bad faith insurance lawsuit that Life Insurance Company of North America relied too heavily on the evaluation of a physician representing the insurer, while dismissing a medical condition suffered by Goodwin that involved memory lapses and vascular dementia.

He is suing Life Insurance Company of North America for LTD benefits, as well as interest and legal fees. The long-term denied disability lawsuit is Goodwin v. Life Insurance Company of North America, Case No. 2:16-cv-00476-JRG-RSP, in the Marshall Division of the Eastern District of Texas.

Meanwhile, a claimant who was twice denied long-term disability benefits from CIGNA Corp. eventually won LTD benefits valued at close to $1 million over his lifetime after he involved a bad faith insurance attorney in the case.

The plaintiff, who was not identified, suffered an injury in a surfing accident in August 2014. The resulting fracture of his cervical vertebrae resulted in chronic, debilitating pain.

The plaintiff applied for LTD benefits through his employer’s ERISA long-term disability policy, and was denied. He appealed the denial, but was denied again.

For his second “voluntary” appeal, the injured man retained an attorney for an ERISA administrative appeal. The insured argued, in large measure, that CIGNA had not afforded the claimant the full and fair review guaranteed under ERISA because the file was not reviewed by an appropriate health care professional.

The appeal also argued that the internal medicine reviewer provided by CIGNA was not an appropriate medical professional under ERISA, in light of the extensive orthopedic, pain management and neurologic treatment the claimant had received. It was argued that a reasonable fiduciary could not simply ignore the well-documented pain and suffering, together with the opinions of the treating physicians regarding the debilitating nature of the claimant’s pain.

CIGNA, it was argued, had failed to undertake a proper assessment of the claimant’s occupational duties and had instead merely labeled the occupation as “sedentary.”

Thanks to the intervention of his bad faith insurance attorney, the claimant won the appeal with reinstatement of benefits.