Using a variety of surveillance and investigation techniques, disability insurance companies often try to gather information about claimants’ daily activities. Then, they use the information to say the claimants are not disabled – and not eligible for disability...
appeal denied insurance
State law remedies for denied individual insurance policy claims
Different laws apply to each of two types of disability insurance policies. The first kind of policy is governed by the federal law ERISA, short for the Employee Retirement Income Security Act of 1974, which applies to almost all policies offered through employment....
Nurse anesthetist with drug addiction could not work because he put patients at risk
A federal appeals court on April 5, 2021, agreed with the trial court that the insurer had denied the short- and long-term disability insurance claimant’s applications wrongly and without the required substantial evidence to do so. Last year, we talked in this space...
Pre-existing condition and disability need substantial link to deny claim
Most disability insurance policies contain clauses that provide for the denial of disability claims for the first policy year if the disabling impairment was a pre-existing condition during a period of time immediately before the policy took effect – called the...
Common Delay or Denial Tactics Utilized by Life Insurance Companies
Life insurance is often purchased to protect the surviving beneficiary or beneficiaries financially, especially if the insured was a breadwinner. Because of this, it is important that insurance companies timely pay life insurance benefits. The last thing a grieving...
Patterns in long-term care insurance denials, part 2
After paying the premiums for long-term care insurance coverage for years, it can be emotionally upsetting and financially devastating when the insurance company denies a claim for benefits. Unfortunately, this scenario is not uncommon. Long-Term Care insurers utilize...
Long-term disability claimant’s debilitating pain had subjective and objective support
The U.S. Court of Appeals for the Sixth Circuit recently held in favor of a long-term disability (LTD) claimant whose insurance company denied his claim based largely on severe, chronic back pain. Disability insurance companies often improperly discount credible...
Unum wrongly denied Long Term Disability as pre-existing condition
Disability insurance policies often ban coverage for disability that stems from pre-existing conditions. In other words, if someone had a medical problem within a specified time frame prior to their effective date of coverage and they became disabled within the first...
Legal remedies for private disability insurance claim denials
People acquire disability insurance as a safety net to provide financial support should they become disabled from working. Short- and long-term disability insurance policies fall into two buckets. On one hand, group policies such as those available through employers...
LTD insurer’s failure to disclose key report triggers de novo review
On January 21, an Alabama federal court decided that the proper standard of judicial review in an appeal of a long-term disability insurance benefit termination was “de novo” review. In an appeal of a federal disability insurance denial or termination, the court must...