Long Term Disability Insurance ERISA
When a person becomes disabled from working due to an injury or illness, strain on the disabled victim as well as the victim’s family is tremendous.
Unfortunately, disabled individuals who have purchased long term disability insurance, whether privately or through their employers, are often shocked at their disability insurance company’s outright refusal to pay benefits.
Long term disability insurance claims are often denied - unfairly and without good reason, prompting a respected federal judge to say: “WHEN YOU BUY AN INSURANCE POLICY LIKE THIS, YOU ARE PURCHASING AN INVITATION TO A LEGAL RITUAL...AND YOU WILL BE DENIED BENEFITS.”
“Caveat Emptor! This case attests to a promise bought and a promise broken. This vendor of disability insurance now tells us, with some legal support furnished by the United States Supreme Court, that a woman determined disabled by the Social Security Administration because of multiple disabilities which prevent any kind of work cannot be paid on the disability insurance she purchased through her employment. The plan and insurance language did not say, but the world should take notice, that when you buy insurance like this you are purchasing an invitation to a legal ritual in which you will be perfunctorily examined by expert physicians whose objective it is to find you not disabled, you will be determined not disabled by the insurance company principally because of the opinions of the unfriendly experts, and you will be denied benefits. Fortunately, the law, through left moribund by the Supreme Court’s legal interpretations, does not allow the purveyor of such empty promises to win the day.”
Judge Elsen from the W.D.Mich. In Loucks v. Liberty Life Assur.Co. of Boston, 337 F.Supp.2d990; (W.D. MI. 2004).
In other words, most disability insurance policies are written favorably to the insurer in denying claims. The applicable law is, likewise, favorable to the insurer. However, an unfair disability claim denial can still be successfully fought and reversed if done properly.
At the Law Offices of J. Price McNamara, we have been fighting for disabled individuals against long term disability insurance companies for over a decade, winning successful trial verdicts and settlements for our clients whose claims were initially denied.
LONG TERM DISABILITY INSURANCE COMPANIES
Long term disability insurance companies are corporations whose goal is profit. After they receive insurance premiums from their insureds, they maximize their profits by minimizing what they pay in claims. The more they pay, the less they profit. After collecting premium payments from their insureds for years, they often refuse to uphold their end of the insurance policy bargain when an insured person becomes disabled.
Thus, the disability insurance company collects premiums from you as long as possible, then will often deny your claim no matter how legitimate it may be once you become disabled and need benefits. They may even initially approve you for short term disability (STD) or long term disability (LTD) only to buy time while gathering information in an effort to later deny your claim.
In many cases, policyholders do not even fight back after they have been unfairly denied the benefits to which they are entitled. They believe that the fight may be too costly, and likely unsuccessful. However, of those disabled who do fight back, many will win.
LONG TERM DISABILITY INSURANCE POLICIES
In order to be entitled to disability benefits, you must meet the insurance company’s policy definition of “disability.” The definition of “disability” varies from policy to policy. Even if you are found to be totally and permanently disabled in a Social Security disability claim, this does not automatically mean that you meet the disability insurance company’s definition of “disability.”
DISABILITY INSURANCE CLAIMS PROCESS
Disability insurance companies may deny claims on technicalities even when their insured is clearly severely disabled. The insurance companies will use their own paid medical consultants who have never met you to provide opinions to them stating that you are not disabled. These insurance company medical consultants will often even disagree with your own treating physician who sees you on a regular basis. Then the insurance company will often accept its own medical consultant’s opinion regarding disability and disregard the opinion of your treating physician completely.
The insurance company will also ask you to sign forms authorizing them to collect personal background and other information on you that is far beyond what they are entitled to see. They will even hire private investigators to investigate you, follow you and even photograph and take video of you to help destroy your disability claim. The disability insurers will often use your signed authorization forms to collect medical and other personal records dating back years and years prior to your disability to support any conceivable argument to deny your claim, invading your personal privacy and exposing background information that is absolutely unrelated to your disability.
Even if you know without question that you cannot continue working, the disability insurance company will consider your opinion to be basically worthless. As noted above, they will even disregard your treating physician’s opinions regarding your disability in favor of their own hired consultants who have never met you. The insurance company’s decision to deny your claim is often made by a claims examiner who has no formal medical training whatsoever.
The Employee Retirement Income Security Act of 1974, commonly known as ERISA, is a federal law that often controls long term disability claims when the long term disability coverage is provided through one’s employer rather than a private long term disability insurance policy that is individually purchased.
When a disabled person’s claim is governed by ERISA, the law is extremely unfavorable to the disabled claimant and extremely favorable to the disability insurance company or Plan.
WHEN TO HIRE AN ATTORNEY
Many people do not even think of hiring an attorney until they are denied long term disability benefits. If you are denied long term disability benefits, the best time to hire a lawyer is immediately, BEFORE AN ADMINISTRATIVE APPEAL OF THE CLAIM. An attorney experienced in long term disability insurance and ERISA claims will be able to gather and provide the evidence required to maximize the chances of winning the administrative appeal.
We answer any questions you have FREE OF CHARGE. We welcome telephone calls or the opportunity to visit you in person to answer any questions you may have about your case without charge and without any obligation on your part whatsoever to hire us as your attorney.
We also provide, FREE OF CHARGE, comprehensive case reviews. Just contact us and we are happy to speak with you by telephone or in person to speak with you about your case in detail without charge, no matter how long it takes. There is no obligation whatsoever to hire us as your attorney.
If you ultimately decide to hire us to represent you in a personal injury, wrongful death or disability insurance claim, we handle them on a contingent fee basis. Our fee is earned and our advanced litigation costs are recovered only when we recover for you by settlement or trial judgment. Our clients owe us nothing, no fee and no reimbursement of our advanced litigation costs, no matter how large, unless we recover.
Mr. McNamara holds the highest possible peer review rating of “AV” (“Very High to Pre-Eminent”) for professional excellence and ethical standards.
WITH OFFICES IN BATON ROUGE (HEADQUARTERS) AND METAIRIE, MR. MCNAMARA ACCEPTS SELECT LOUISIANA CASES STATEWIDE.