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Disability Insurance Law Blog

Insurance company faces alleged violation of ERISA

A long-term disability policy is designed to help a Florida resident pay for costs related to treating medical issues. According to one woman, Liberty Life Assurance Co. failed to live up to the terms of a policy that she participated in. The suit was filed in U.S. District Court for the Southern District of Illinois, and it claimed that Liberty's actions were in violation of the Employee Retirement Income Security Act (ERISA).

According to the woman's complaint, she stopped receiving benefits in April 2016. Furthermore, the complaint states that her claim was not given a fair review by Liberty Life Assurance. As a result, she is asking that Liberty pay the benefits that she is owed under the policy plus interest. The lawsuit also requests that court costs and legal fees be paid for by the defendant in this matter.

Widow sues over denied life insurance claim

When a family in Florida loses a loved one, the pain and grief can be immense. Unfortunately, the practical costs can also be significant. This includes dealing with final expenses, hospital bills and funeral costs. When a life insurance policy refuses to pay out, surviving family members may face serious financial consequences. One veteran is fighting USAA, a major insurer for American military forces, in court after the company refused to pay out $1 million in life insurance benefits following the death of her husband.

Both the woman who filed suit and her husband were members of the Air Force and had banking and insurance policies with USAA. The woman's 52-year-old husband was an electrical engineer, a former Air Force captain and the family breadwinner after their military retirement. However, he suddenly passed away in 2016 after an aortic aneurysm. While the family relied on his income, they believed they would be protected under his USAA life insurance policy.

The reason why short-term policies cost less

Individuals in Florida and throughout the country are eligible to buy health insurance through the Affordable Care Act (ACA). About 80 percent of those who buy policies through the ACA receive subsidies to make their policies more affordable. As part of changes to the system announced in August 2018, it is now possible to buy short-term policies that last for up to 364 days.

However, these plans generally offer less coverage and may not be available for those who have pre-existing conditions. According to research from the Kaiser Family Foundation, 71 percent of these plans don't cover prescription drugs. In the past, they have not been considered to be qualified health plans. This means that those who've purchased them have been subject to a financial penalty. With the elimination of the individual mandate, this is generally no longer the case.

Why might an insurer deny a life insurance claim?

You may think that purchasing a life insurance policy is the safest way to provide for your loved ones after your death. It is a simple transaction with you paying your premiums and your loved one receiving a payout after your death.

Unfortunately, if it were that easy, not many life insurance companies would remain in business for long. In fact, most policies contain language that can provide numerous ways for insurance companies to avoid paying your loved one's claim.

Researchers criticize retroactive denial policy of major insurer

People in Florida typically seek out medical care at emergency rooms for acute and worrisome conditions and injuries. To discourage the use of emergency care, the insurance company Anthem launched a policy of reviewing emergency charges and denying coverage if the company deemed the emergency care inappropriate. Researchers who analyzed the outcomes of this policy determined that the insurer could not reliably identify nonessential emergency visits.

The researchers looked at a national database that documented over 100,000 emergency room visits during a four-year period. They applied the rules of the Anthem policy to the cases and found that one in six patients could have been denied coverage. Over 85 percent of the patients in this sample presented symptoms that met Anthem's criteria for payment denial. Large percentages of these patients went on to receive necessary emergency care. The researchers concluded that a policy that allows an insurer to retroactively deny care that might be covered under certain conditions burdened people with fears of high medical bills when they needed urgent medical care.

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.

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