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Disability Insurance Law Blog

Dealing with a disability insurance claim denial

When a Florida resident gets seriously injured or sick and needs to file a claim on their disability insurance, they could be faced with an unexpected denial of benefits. Many group and other employer insurance plans are covered under ERISA, the federal Employment Retirement Income Security Act of 1974. In order to protect the right to sue the insurance company and receive deserved benefits, it can be particularly important to go through the appeals process with detailed preparation and key information.

Unfortunately, many claims for disability benefits are met with denials or lengthy delays on the part of the insurance company. Once an initial claim has been denied, the claimant has a specific period of time to respond and challenge that denial. By being prepared in advance, someone can be ready to respond in a timely fashion and protect their rights to further pursue their benefits claims.

Disability payments denied on grounds of preexisting condition

Some people in Florida who have long-term care insurance could have their claims denied if the insurer rules that it is related to a preexisting condition. This happened to a woman in Louisiana who had only a 1 percent chance in 2012 that breast cancer would return after undergoing chemotherapy, radiation, a double mastectomy and removal of her lymph nodes.

Scans over the following five years continued to indicate that the cancer had not returned. However, in early 2018, she developed lower back pain. An MRI detected a metastatic cancer in her spine.

Widow alleges breached contract in life insurance lawsuit

Life insurance is a common way for Florida residents to assure the continued security of family members in the event of one's death. A woman in Perryville has filed a lawsuit against Life Insurance Co. of North America, alleging breach of contract and claiming she is entitled to more benefits than were paid to her after the death of her husband.

According to the lawsuit, her husband died on Aug. 8 by self-inflicted hanging. The death was ruled a suicide by the county coroner, and the life insurance company paid the woman $114,000 in benefits.

Filing a life insurance claim may sound easier than it is

Losing a loved one is never easy, even if it was expected. After the funeral and burial, there are usually several matters to take care of in order to close out his or her estate. One of those items may be to file a claim against one or more life insurance policies your loved one had.

If you are the beneficiary on at least one of those policies, you will need to file a claim in order to collect the proceeds of the policy. Following certain steps may help ensure that the life insurance company does not deny your claim for some reason.

MetLife Approval of Fibromyalgia and Chronic Fatigue Syndrome Claim

Fibromyalgia and Chronic Fatigue Syndrome, also referred to as Myalgic Encephalomyelitis, are debilitating conditions characterized by feelings of extreme exhaustion, muscle and joint pain, memory problems, brain fog, and problems with concentration. Many of our clients who suffer from one or both of these conditions come to us frustrated that, despite letters and documentation from their doctor and health care professionals confirming that their condition is severe and greatly limits their ability to function at work, many insurance companies question these claims stating a lack of evidence or proof of disability. Unfortunately, the cause of these conditions remains unknown and it is often diagnosed only after physicians have run numerous tests to exclude other disorders. However, the disorder is real and for some, incapacitating.

Battle continues over man's life insurance policy

Collecting on a life insurance policy can sometimes lead to unexpected problems for bereaved Florida families. One case on the other side of the country illustrates the kind of difficulties that people can face. In Utah, a man was shot and killed by a police officer. While the police allege that the man had raised a handgun and pointed it at the officer, his family and others say that the man put down the gun and ran through a gate into his own yard.

The man was killed on April 13, 2014, but the life insurance battle has continued since that time. The man's wife is suing the insurance company in federal court for her late husband's $500,000 insurance policy. Earlier, the family sued the city for wrongful death; while it did not admit fault, the city paid the family $127,000 in damages. The wife had called the police the day of her husband's death; she was concerned because her husband had a gun and expressed suicidal ideas.

Court reverses Prudential Insurance Company's termination of Long-Term Disability benefits

Recently the United States District Court for the District of Colorado determined an insurance provider wrongfully terminated a client's long-term disability (LTD) benefits. Paquin v. The Prudential Insurance Company of America highlights potential issues for others receiving benefits for an extended period.

Court reverses insurance company's claim denial

People in Florida who have long-term disability insurance through their employers or as standalone policies may believe that they will be protected if they are disabled and no longer able to return to their jobs. Unfortunately, some insurance companies routinely deny valid claims. In one case, a federal judge reversed a long-term disability insurance company's denial of a claim by one of its insureds.

In the case, Reliance Standard Life Insurance Company denied a woman's claim for benefits. The 62-year-old woman had worked at a chicken processing plant in Mississippi in an area that was kept at a temperature of no more than 40 degrees Fahrenheit. The woman developed circulatory problems and Reynaud's disease, and her doctor said that she could not return to her job because exposure to cold temperatures could cause her veins to spasm and potentially result in gangrene.

Fighting for appropriate benefits for disabled nurses

Florida nurses face complex risks and hazards every time they clock in for work. Health care is an ever-changing and difficult industry, and the men and women who work in this field as nurses may face certain physical risks on the job. Nursing can be hazardous, no matter the particular environment, and some nurses experience incidents that leave them unable to return to work.

If you are a nurse and you consider yourself disabled after a work accident, you may have grounds to seek disability benefits through either a group disability plan or an individual policy. However, navigating insurance matters is quite complex. Many applicants find it difficult to get the help they need, even with a valid claim.

CTE, Concussions, and Proving a Disability Claim

In a clip from FRONTLINE's League of Denial, neuropathologist Dr. Ann McKee discusses the brain of Penn football player Owen Thomas, who took his own life at age 21. After Thomas's death, Dr. McKee studied Mr. Thomas's brain and was shocked to find evidence of Chronic Traumatic Encephalopathy.

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