A few years ago someone close to me became disabled. She had purchased a long-term disability (LTD) policy with CNA insurance and felt fortunate to have the policy.
She was brought up with a strong work ethic, this, coupled with the fact that she immensely enjoyed her job, only increased the emotional pain of not working. Regardless of how much she wanted to return to work, the physical pain was too great to overcome. Eventually her injury required surgery which, unfortunately, only made matters worse.
For the first 3 months of her disability, she had short term disability insurance through her employer’s insurance. For the balance of the first year, CNA’s LTD policy co-paid with the State of California’s Disability Insurance (SDI) benefits. At the end of the year, when California’s State Disability Insurance was about to run out, she received a letter from CNA saying that they were denying her any future payments because they felt she should be better. It was odd that they said that because all 6 of her medical doctors said she was 100% disabled. Even odder still is that she was never examined by any represenative of CNA insurance.
She was not getting any better and, if anything, her situation was deteriorating under the stress of not knowing how she was going to be able to pay the rent and day-to-day bills. Fortunately, her car was paid for. Unfortunately, like so many others faced with medical expenses she was using credit cards to live and eventually was forced into bankruptcy.
Like so many disabled individuals who find it difficult to muster the energy to fight a deep pocket insurance company, she needed help in working through the insurance company’s labyrinth of mythical proportions.
I tried to find an attorney who would be able to help her. Phone call after phone call to attorneys who handle insurance claims were met with the same response after telling them of my friend’s denial by the LTD insurance company—laughter. After a half-dozen phone calls, I found an attorney who didn’t laugh after explaining to him about her situation. I asked him why no one seemed interested in a case that was obviously a miscarriage of her legal rights.
He explained that chances are her LTD policy fell under the Employee Retirement Income Security Act (ERISA) and there wasn’t much that could be done. The only chance she would ever have of collecting any money was if the claim did not fall under ERISA guidelines and could be heard in California State Court. Even then, he was not in the position of mounting that kind of lawsuit against a deep pocket insurance company.
That happened several years ago. I was finally able to locate a law firm familiar with ERISA and after reviewing her case was willing to take on CNA. At first, after wading through the contracts, it seemed clear that her claim against CNA insurance actually did not fall under ERISA guidelines and that the case could and should be heard in a California state court. Unfortunately, the plaintiff’s lawyer’s were out maneuvered by CNA’s attorneys. Apparently, somewhere along the line, CNA provided new material that made references to ERISA. Though not the orignial contract which she possessed (which indicated that she, not the company, had purchased the LTD insurance from CNA) , the new material made references to ERISA.
This new material, and a case elevated to the 9th Circuit Court that was ‘similar’ to my friend’s and which had just been denied the right to litigate in State Court, meant to her attornies, that the chances of recovery were slim to none. The law firm had forewarned her that they would not be able to handle the case if it was deemed to fall within ERISA’s guidelines because it would then fall under Federal Court which made no provisions for attorney’s fees.
Fortunately, after being turned down the first time (common practice) and obtaining a social security attorney, SSDI approved her claim for 100% disability. After filing for bankruptcy, and moving to a lower income area she was then able to keep from having to live in her car.
As Ray Bourhis says in his book, Insult to Injury, the last thing you want to think about is your long-term disability insurance. That is until you are permanently disabled, then it is the only thing you can think about.
The book tells the story of Dr. Joan Hangarter’s legal nightmare dealing with UnumProvident. Unlike my friend’s LTD, her policy was not subject to ERISA guidelines.
UnumProvident initially paid on Dr. Hangarter’s LTD claim, but after 2 years sent her a denial letter informing her that in the insurance company’s eyes she was better and was able to return to work. It didn’t matter that Dr. Hangarter was forced to sell her chiropractic office, that she would have to lose her car and be forced into bankruptcy. It didn’t matter that she no longer could perform the one thing that she loved 2nd only to her children–that is ability to help people heal as a chiropractor.
Penniless, on welfare, and with little hope, Dr. Hangarter sought out legal help. She was fortunate to find Ray Bourhis and partners. Through Bourhis’ often sardonic wit he provides a real life example of how a non-ERISA LTD insurance claim is denied and why the insurance company is seldom forced to pay. Those who have policies that fall under ERISA have little hope of ever seeing a dime of benefits from their policy once it has been denied. It will not matter if they are parapalegic, suffering from Parkinson’s disease, even unable to walk across the room without assistance.
The reason you do not often hear about the problems with LTD claims being denied is that the insurance companies know that someone disabled, penniless and on welfare, is rarely going to pose a problem either legally or through bad press. Those that do make noise are sometimes offered a settlement. The policy might be worth over $500,000 over time, but the claimant is offered $50,000 and told to sign the agreement and not to discuss their settlement with anyone. They are told if they do not accept the $50,000 they risk getting nothing because, even if they do prevail in court, it will be appealed and they promise it will be a long time before they will see any money.
For those few lucky souls who do take their LTD insurance company to court on a bad-faith claim and prevail, they are often told to sign a non-disclosure form or the insurance company will appeal the case. Most people sign—and that is why you do not hear about these cases.
The insurance companies refute much of what is documented in Bourhis’ book. The claim they make most often is that they pay out billions in disability claims. For the most part they do, but those payouts are mainly for short-term disability; like broken arms and legs. What they refuse to share publicly is the percentage of long-term disability claims that they deny. Although it cannot be documented, it appears that if your income is around $50,000 or above you are likely to be targeted for denial of a LTD claim. It is estimated that denying just 10% of those claims amounts to billions over a decade.
If you have a LTD policy you really need to read this book. If you have recently become disabled and are counting on a LTD policy you would be a fool not to read this book immediately.
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i was working as an key data operator and got injuried on my job i had to have surgery on my shoulders and hands for carpal tunnel as it turned out i woke up in a lot o pain to later find out i have fibromylgia and it is also work related state fund accepted the claim but told me that they would pay for medical and thats it. i have no attorney and have to go to court on my own i am limited range an motion due to not having a bursa sac in either shoulder and i have arthritis bad in my neck and back plus hernited disc in neck and back
i was working as an key data operator and got injuried on my job i had to have surgery on my shoulders and hands for carpal tunnel as it turned out i woke up in a lot of pain to later find out i have fibromylgia and it is also work related state fund accepted the claim but told me that they would pay for medical and thats it i have no attorney and have to go to court on my own i am limited range an motion due to not having a bursa sac in either shoulder and i have arthritis bad in my neck and back plus hernited disc in neck and back
i was on hartford LTD for 3 years,they did surveillance and had me going to the grocery store,and i never had told them that i couldn`t.they came to my house and grilled me for 3 hours and their investigator changed the statements that i made,not knowing anything about this process.this investigator had a laptop and a printer.he asked me all kinds of questions,related to what they had me on video doing,to see if i`d lie and i did not,the funny thing is i saw the dumb ass PI following me i knew something was up 2 months before and then they call and write me set up this interview.they sent the video to my doctor and then “cherry-picked” the sypnosis that they also sent my doctor.i told the guy i can use a computer and write and they told my doctor that i am an experienced typist and had computer skills like someone that has been trained for such work.i said i could do some household chores and some light yard work,but that i would pay for it and i took extra pain medication when i did these.they didn`t tell my doctor nothing about the pain meds.i `ve had a 3 level fusion in my neck.(c5-c7) and my surgeon says thatc3-c5 needs to be fused (i have terrible pain that radiculates down my left arm) he wants to go in and take the hardware out and re-do it all and then put in more hardware.at t1-t2-bone spurs.i have l4-l5 fused.t6-t10 all are herniated.i have scheurman`s(sp) disease with smorl`s nodes and some scoliosis,degenerative disc disease and spondylosis of the cervical,thoracic,and lumbar spines.there are numerous places in my spine that the herniations are causing pressure on the spinal cord according the mri`s,myeleograms,ct scan s and x-rays.folks do not take on these LTD people by yourself. i`ve had to increase the strenght of my pain meds 3 times in the last year.it seems they totally ignore your health problems.they will use dirt-ball tactics to keep from paying you.i hope to be approved for ssdi soon.i can`t tell other people what to do,but as far as i`m concerned hartford can take their money and stick it where the sun don`t shine. BIG WARNING TO FOLKS –do your home work when dealing with LTD insurance,they do not want to pay you and will look for every way out they can!
People who take out LTD policies, dont take the time to read there policies, simply becasue the dont expect to ever have to use them! I paid into a LTD policy through MetLife for 27 years! I just recently had to file fot LTD for the first time in 27 year. I severed the nerves in my c-spine and out of the clear blue, became totally disabled do to an injury on the job. I then filed for Workmans Comensation And SSDI! Met Life put me through a living HELL asking for dotors NOTES! WE WANT DOCTORS NOTES!!!!! Then after I send them my doctors notes, they told me they couldnt understand them and accually told me to have my doctors to type them! MetLife has been paying me the 50% of my income. But I feel so sick, just waiting for the next letter from them asking me for something else, that is going to put me through another living hell! I just won an award from workmans compensation. MetLife wants it all! People do not realize that there LTD policies only alow them to earn anything other then what MetLife pays them! If you become permenantly disabled at 47 years old. If you sratch off a lottery ticket thatis given to you for your birthday and win $10,000.00 You better put that ticket in someone elses name, or good’ole MetLife will want it ALL! So, that $400.00 I paid towards a LTD policy for 27 years, has accually made me more ill then I already am.
It’s not only the disability companies who are the problem. I have suffered a few ruptured discs and have undergone a 3 level lumbar fusion. Although I can probably perform most of my duties from home, my employer will not allow me to work. The will not allow me either from home or part time in the office. Yes Met-Life was a royal PIA in the beginning of all this mess, but they have been civil thus far. I am waiting for the day that some investigator shows up at my house taking video of me tossing a ball around with my son on one of my good days. Ya see, the thing with me is I don’t care anymore. I have lost a nice 6 figure job, I have filed for BK and almost lost my house. Thank God I still have my family. Now if the ongoing situation worsens and the stress from dealing with it causes too many problems for my family via my employer or the Ins. Co., I can shoot 3″ group from 800 yards. And I will have no problem in making a statement for those people who’s lives are effected by the decisions made in the higher ups. I’m be damned if I will sit back and suffer and watch others suffer while some CEO walks away with a 25 million dollar severance package. So, do your homework and know your rights. Read the book and save the ammo.
I sued MetLife and lost and then appealed and it was upheld. This was in 2009 and you can still see the case online today. If you read it, you must know that it is full of lies starting with the claim that MetLife was not provided with a list of tender points from my fibromyalgia doctor and on and on. There are so many inaccuracies in the ML statements made in court that I am convinced they will do anything to prevail. I’m not sure that anyone should purchase disability insurance unless you understand that (in my opinion), it will not pay benefits beyond one year no matter what your illness or doctors, or skills at documentation. I have boxes and boxes of documentation that I sent them, but they denied they received it (like the tender points graph from my rheumatologist that I have stamped with THEIR FILE NUMBER ON TOP). They received it all right, but it did not stop them from claiming in court that I had not Their doctors will not review the entire file, and they never see you or talk to you, so their conclusions are preset. This is just one inaccuracy in my court case.
My advice…do not buy this insurance.
I’m getting the same run around from my LTD co. saying that they never got paperwork, etc. What is the case filed under? I’d like to read the case.