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Disability Insurance Law Blog

Court uses higher standard of review when insurer blew deadline

A federal appeals court decided that because a disability insurance plan administrator missed a strict ERISA deadline for issuing a benefits decision on review, the correct standard for the court reviewing the denial of benefits to use is "de novo" rather than "arbitrary and capricious."

Very broadly, if a disability insurance company does something negative or harmful to a claimant during the claim assessment process, there can be a variety of consequences. For example, the insurer may have violated the terms of the policy, which is like breaching a contract, or failed to comply with the Employee Retirement Income Security Act, known as ERISA, the main federal law governing the administration of most group insurance plans offered through employers.

What is a disability insurer's structural conflict of interest?

A large insurance company that sells short- or long-term disability coverage can intimidate an individual fighting for their rightful benefits after having become disabled. When that insurer decides its own claims internally, rather than outsourcing that decision-making process, it has a structural conflict of interest.

This means that although it's claims examiners are supposed to make decisions on disability claims reasonably, fairly and according to policy terms and applicable law, the examiners may feel pressure to deny claims. In an approved claim that very insurance company must then pay out benefits, sometimes for years, and sometimes at a high rate.

Female soccer players and disabling brain injury

At DI Law Group, we represent professional athletes in their claims for long-term disability insurance often based on debilitating mental or physical injuries. Obviously, professional sports are not gentle on bodies or brains and disabling injuries can prevent a pro athlete from continuing to earn a living in their sport. In severe cases, these injuries might keep them from working even in less strenuous jobs.

In those cases, it is appropriate for them to file claims for disability insurance benefits. Disability insurance for pro athletes might be provided through their team employers or professional sports associations, or they may purchase private disability insurance policies. Disability insurance companies are motivated to deny elite athletes’ claims because they can be very expensive if their payouts are based on previous income levels.

Court holds LTD claimant did not have a pre-existing condition

On Sept. 3, the U.S. Court of Appeals for the 1st Circuit held that Aetna had wrongly denied long-term disability insurance coverage to a claimant with malignant melanoma. The opinion turns on a legal issue that comes up often in LTD cases — whether the claimant had a pre-existing condition that invalidated his disability claim.

Man with severe heart condition denied disability by Cigna

When Florida residents have a medical disability that keeps them from working, they often depend on their disability insurance to help them financially survive. Unfortunately, insurance companies sometimes refuse to pay, leaving people between a rock and a hard place. Such is the case with a Chicago man.

According to a recent news report, the man was forced to leave his job as vice president of a magazine due to a debilitating heart condition. After he suffered two heart attacks, underwent a five-way bypass procedure and continued to experience chest pains, his doctor told him he was permanently disabled and his career was too stressful to safely continue. However, when he filed a claim for long-term disability benefits with Cigna, the insurance company denied his claim three times, arguing that his desk job wasn't stressful enough to threaten his health.

Work-related injuries may qualify for short-term and long-term disability benefits

Injuries that occur on the job may be compensated through a workers' compensation claim. However, injuries that result in a prolonged absence or even permanent disability may qualify the employee for benefits under their employer's short-term disability and/or long-term disability plans.

The thought of not being able to work but still having financial obligations can be frightening and overwhelming. Workers' compensation only goes so far. Understanding the benefits and rights provided under a short-term disability and/or long-term disability policy may provide the insured with the means to cover their expenses while unable to work.

Do you feel paralyzed with fear or anxiety when you leave home?

If you do, you could suffer from agoraphobia. The hallmark of this anxiety disorder is a need to get away from situations and places that make you feel panicked, helpless, embarrassed or trapped. You may feel like you need to get back into your comfort zone.

You may not even want to leave your home. Depending on its severity, this condition can prove debilitating. You may not be able to go out into your front yard, let alone to the grocery store, work or anywhere else for that matter.

Common exclusions found in life insurance policies

Florida residents and others looking to purchase life insurance should understand that policies are binding contracts. Therefore, they may contain exclusions or exceptions that buyers need to look for prior to making a purchase. The exclusions or loopholes included in a life insurance policy are there to ensure that insurance companies can keep potential losses to a minimum. They may also be included to allow insurance companies to offer lower premiums compared to their competition.

Typically, exclusions will be added to deny coverage for those who were under the influence of drugs or alcohol at the time of an injury or death. In some cases, a claim could be denied just because a person drank alcohol even if it didn't directly result in a person's death. Insurance companies may also choose to deny coverage to those who were killed while committing a crime or engaging in any other illegal activity.

Distinguishing between PTSD and TBI for your disability claim

When a person is unable to work due to a medical condition, he or she may need certain types of financial support. If you find yourself in this position, you may understand first-hand how complicated it can be to navigate the process of recovery, from getting the medical help you need to seeking financial support for your Florida family. You may find it necessary to pursue a disability insurance claim.

Unfortunately, insurance companies are more concerned with their own bottom line than they are with your recovery and support when you are unable to work. They often deny claims for seemingly minor reasons. It's important to be specific and clear about your disabling condition, especially when you are unable to work due to a mental disorder, such as a traumatic brain injury or post-traumatic stress disorder.

NFL Disability Claims

The National Football League is well known for denying the valid disability claims of its players. After submitting a claim for disability benefits to the NFL, which is self-insured and administrates all NFL claims, the player is often sent to numerous "neutral" medical examinations by physicians of the NFL's choosing. Not surprisingly, these doctors overwhelmingly find that the player is not disabled under the terms of the NFL's Disability Plan and the claim is denied.

Further complicating the disability process is that NFL claims, like many long term disability claims, fall under theERISA statute and are therefore subject to the limitations imposed by that statute. For example, the player must submit a comprehensive appeal within 180 days of the denial letter and the evidence submitted with that Appeal Letter will basically serve as his evidence at trial should the NFL issue a final denial after reviewing the Appeal.

Despite increasing information and proof that the head and body injuries sustained by football players are debilitating and leave them in chronic pain, functionally impaired and often with cognitive issues, the NFL fights tooth and nail to avoid paying these claims.

DI Law Group has handled NFL claims and hundreds of ERISA claims. We are familiar with the tactics used by disability carriers to unfairly deny claims and have successfully overturned hundreds of denials and obtained millions of dollars in recovery for our clients. If you are having problems getting the disability benefits you deserve and to which you are entitled under your disability policy feel free to contact us at (866) 363-3628 or through our website www.dilawgroup.com for a free consultation.

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