Los Angeles and San Diego Disability Insurance and ERISA Claim Attorneys Fight Anthem Claim Denials
At McKennon Law Group PC, we represent a wide variety of policyholders and claimants, including those with bad faith claims, long-term disability, short-term disability, life insurance, health insurance, ERISA or employee benefits claims, long-term care insurance and more. We aggressively fight wrongful denials from life and disability insurers like Anthem. Several of our lawyers, including Robert J. McKennon, previously represented insurance companies in claim denial litigation for many years, which is part of the reason why we are so successful in our dogged pursuit of our clients’ insurance benefits.
Anthem and Well Point Health Networks, Inc., merged in 2004 to become one of the nation’s largest health benefits companies. Anthem and its affiliated companies serve over 74 million people, 40 million of which are within the family of health plans. As such, Anthem provides the nation’s leading source of health/medical insurance benefits. However, Anthem also provides a variety of related and specialty products, including life insurance, disability insurance benefits, dental, vision, behavioral health benefit services, long-term care insurance and flexible spending accounts.
In 2016, California Insurance Commissioner Dave Jones Formally Requests the U.S. DOJ Block a Proposed Merger Between Anthem and Cigna
In June 2016, the California Department of Insurance released a news bulletin documenting Insurance Commissioner Dave Jones’ request that the U.S. Department of Justice block the potential mega-merger between Anthem and Cigna. Commissioner Jones discussed his detailed findings about how the merger of these two companies, the second and fourth largest health insurers, would be detrimental to a competitive market in California, as well as California consumers and businesses. Commissioner Jones held several public meetings on the topic and gathered relevant data, studies, public comments and testimony from consumer advocates, Anthem and Cigna executives and other medical and health professionals. Ultimately, Commissioner Jones determined that the details of the merger did not support Anthem and Cigna’s claim of $2 billion in savings or a potential benefit in reduced prices. Upon review, California’s Commissioner determined that the merger would be anti-competitive and recommended that the DOJ oppose it.
In April 2017, a U.S. Federal Court of Appeal approved the district court’s ruling to block Anthem’s bid to merge with its rival Cigna. Shortly thereafter, Anthem announced that it would cease all effort to complete its merger, although it appears that Cigna maintains that it is owed the $1.85 billion break-up fee set out in the parties’ merger agreement.
How does Anthem Deny Life, Long-Term Care and Disability Insurance Claims?
Anthem may deny a claim for benefits for a variety of reasons. While this list is by no means exhaustive, we frequently see denials asserting various combinations of the reasons below.
- Anthem asserts that the medical evidence does not support the life, long-term care or disability claim
- Anthem asserts the claimant did not provide adequate medical support for the life, long-term care or disability claim
- Anthem asserts the claimant did not provide documentation or proof of loss evidence in a timely manner
- Anthem asserts the medical condition, illness, injury or sickness which is the subject of the claim is a pre-existing condition and thus excluded from coverage
- Anthem asserts that the insurance application contained materially false statements and so the policy will be rescinded
- Anthem asserts surveillance of social media, in-person or some other form suggests that the claimant is not totally disabled
- Anthem asserts the claimant’s policy has lapsed for failure to pay premiums
- Anthem asserts another exclusion in the life or disability policy precludes coverage of the claim
What Should Disability or Life Insurance Claimants Look for When Anthem Denies a Claim?
- Did they conduct a thorough and adequate investigation of the claim?
- Did the denial letter rely on the opinion of a clinical reviewer or a peer review physician you have never heard of before and who has never treated you in person? Did the insurer rely on this opinion over the opinion of your primary treating doctor?
- Does it seem like the insurer misread, misinterpreted or completely ignored pertinent medical records?
- Did the company deny your claim without conducting an in-person examination?
- Did they refer to your complaints of pain, fatigue or other medical evidence as “subjective” and deny your claim because there is not objective evidence of the condition? Frequently, we see this issue with mental disorders, autoimmune disorders, fibromyalgia and chronic fatigue syndrome.
- Did they deny your claim based on surveillance or social media evidence taken entirely out of context?
- Did the insurer require that you apply for state or federal disability benefits, but then ignore their decision when they approved your claim? For example, are you receiving Social Security Disability Insurance benefits, but were denied by your employer benefit plan?
If you feel you have a wrongfully denied ERISA or non-ERISA claim for disability, life, long-term care or other insurance involving Anthem, the McKennon Law Group PC will aggressively fight for your benefits
ERISA and non-ERISA disability, long-term care health and life insurance claims can be complicated and challenging. Hiring an attorney to handle your insurance claim is the most important decision you can make for the success of your insurance claim. If your claim for health, life, accidental death or dismemberment, short-term disability or long-term disability insurance has been wrongfully denied or suddenly terminated, fill out a free consultation form or call (949) 387-9595 to schedule a free consultation with the insurance litigation attorneys of the McKennon Law Group PC, several of whom previously represented insurance companies and are exceptionally experienced in handling ERISA and non-ERISA, bad faith insurance claims. Indeed, Robert McKennon, the principal and founder shareholder of McKennon Law Group PC, has been handling these types of claims for over 30 years.