ProPublica recently filed a very well sourced article on the lengths health insurers will take to deny coverage in order to preserve profits. https://www.propublica.org/article/priority-health-michigan-cart-insurance-vanpatten-denials When a claim is denied you as the claimant have certain rights. https://www.propublica.org/article/find-out-why-health-insurance-claim-denied As the article explains this includes the right to obtain a copy of the…
SMDA was recently able to get Long Term Disability insurance benefits reinstated for a client who had developed significant orthopedic spine problems. The client had last worked at a sedentary job for an engineering firm. The Disability insurance company (Reliance Standard) had initially approved and paid benefits for more than…
The attorneys at SMDA recently convinced long term disability insurer, Cigna to reverse its decision to deny an Oakwood Hospital employee disability insurance benefits when the claim transitioned to the “any occupation” standard. As with most LTD insurance policies this Cigna policy paid benefits for 24 months if the claimant…
The team at SMDA recently obtained a favorable administrative decision reversing Cigna’s (Life Insurance Company of North America) decision denying disability insurance benefits for a Registered Nurse who had been disabled by her treating physicians as a result of her significant orthopedic (back and shoulder) problems. The original denial was…
Almost every Long Term Disability Insurance Policy I have ever reviewed contains a limited period (usually 24 months) of time that it will pay benefits if a claimant is unable to perform the duties of his/her “Own” (see prior post on how “Own” occupation is misleading) occupation. The plans most…
In this recent case out of Louisiana the court rejected Cigna’s (Life Insurance Company of North America) efforts to deny a claim by a man who was permanently paralyzed and wheelchair bound. The claimant, Mr. Hughes, had been employed as an electrician when he was forced to stop working as…
Anyone familiar with LTD Insurance claims and ERISA knows that you must first exhaust your administrative remedies before filing suit. In other words, you have to try and convince the LTD insurer to reverse its decision to deny the claim for benefits. While this may seem like an difficult task…
In Rochow v. Life Ins. Co. of N. Am., 2015 U.S. App. LEXIS 3532 (6th Cir. 2015), the Sixth Circuit Court of Appeals (the Court) en banc overturned a previous decision of a 3 judge panel that had allowed plaintiff’s claim for the disgorgement of profits earned by the disability…
The 6th Circuit recently granted a request for en banc review of the Rochow v Life Insurance of North America case where a three judge panel determined that the claimant could recover for unjust enrichment the profits the insurance company had earned on the wrongfully denied LTD benefits. As most…
SMDA filed a lawsuit against Liberty Life Assurance Company of Boston (LLAC) after it denied a claim for LTD benefits filed by an employee of DTE energy who had significant orthopedic back problems. The claim was governed by ERISA since it was a group plan provided through the employer. Despite…