In December 2014, a Northern California woman filed a lawsuit against disability insurer Unum Life Insurance Company alleging that the company wrongfully denied her claim for long-term disability (LTD) benefits under the long-term disability insurance plan issued to her employer and governed by ERISA (Employee Retirement Income Security Act). An LTD plan is intended to provide financial benefits to workers when they are unable to perform their job duties because of a disability – even if the injury or illness is unrelated to their employment.
The plaintiff, alleged that Lyme disease rendered her unable to work, and that she was therefore entitled to LTD benefits. Her claim was filed pursuant to a group disability insurance policy sold to her former employer by Unum. The LTD Policy provided LTD benefits to full-time workers. She filed a claim with Unum in April 2012, and her claim was initially approved, with Unum concluding that her disability began September 2011.
However, in December 2013, Unum is alleged to have notified the insured that she no longer met the definition of disability, and had the ability to return to work for her former employer. The insured appealed that decision and provided additional medical documentation of her Lyme disease to Unum supporting her disability claim.
The lawsuit alleges that, despite this additional documentation, she was again denied any further benefits under the Unum LTD policy – without an adequate explanation from the company. The insured also claimed that Unum violated ERISA by failing to provide a reasonable and prompt explanation for why her claim for LTD benefits was denied.
Are such actions common among insurers? Yes. Unfortunately many Americans regularly and faithfully have money deducted from their paychecks in order to cover premiums for their disability insurance benefits under LTD plans. However, when it comes time to collect those benefits due to a disability or illness, many insured find themselves in the midst of a battle that threatens their ability to pay their mortgage, car loans or other bills.
Various companies have been known to use certain tactics to avoid paying disability benefits. Among them: Changing the terms of policies after a claim is filed; failing to adequately investigate a claim; using biased physicians; refusing to examine an insured, instead relying on “paper reviews” by a so-called “independent” consultant; misreading or ignoring important medical documents and records; and, simply refusing to acknowledge that a disability exists.
In these circumstances, however unfortunate, it is critically important to have an attorney on your side to represent your interests vigorously and fairly – one who has previously represented insurance companies and now wants to fight for you. Contact us to request a free consultation today.