Pleasant Law Blog (Insurance Claims, Medical Misakes, and Nursing Home Claims)

Long Term Disability Insurance Benefits Denied Unjustly?

By Thomas W. Pleasant, North Carolina Insurance Attorney. 888.435.7156 | 910.509.7106. I had a call from a potential client the other day. This person had worked in healthcare for many years, and developed back problems. She subjected herself to orthopedic surgery in order to try to solve the problem so that she could keep working. The surgery made things worth (possibly due to medical malpractice, but that's another story). She made a legitimate claim on her Liberty Mutual disability insurance policy, provided through her employer. For the first two years (the period where the insurance benefit is paid regardless of whether you can do any other job -- as long as you cannot do the job you were doing at the time of your disability), Liberty Mutual paid, and held up its end of the bargain. As soon as the two years expired, the aggressive attempt to unfairly terminate this person's disability insurance started. Unfair evaluations by insurance company doctors, etc. Despite that this person spends 75% or more of the time unable to do anything, the insurance company has determined that this person can do "sedentary" type work. The claims handling in this case is almost certainly in bad faith and unfair, but the insurance policy is probably governed by ERISA (a federal statute) simply because it was provided through an employer. This means, effectively, that this person will have no remedy in state courts (i.e., inability to pursue state remedies for unfair claims practices/unfair and deceptive trade practices, bad faith, etc.). If most people understood what ERISA does to their rights as to their insurance companies and claims, they would be completely outraged. Every person to whom I have explained how ERISA guts their ability to get justice in cases like this is totally dumbfounded. There are some other stories of complaints against Liberty Mutual regarding disability insurance at this consumeraffairs.org website.