| There is a very disturbing trend going on in Michigan in | | | | review by a doctor chosen by the insurance company. |
| which persons approved for a long-term disability claim | | | | ERISA law, augmented by federal court rulings, does |
| out of the blue six months later gets their benefits | | | | allow workers denied benefits to seek a limited bench |
| cancelled by the insurance company. You can just | | | | trial – a mere review of the administrative record, |
| imagine the havoc that causes in that person's life. | | | | no new evidence, no witnesses, no jury. But federal |
| The reason is that the Employee Retirement and | | | | law only allows the plaintiff to sue for the original |
| Income Security Act of 1974 (ERISA) was rigged by | | | | benefits. There are no payments for damages or pain |
| Congress and further rigged by the Courts to be | | | | and suffering. |
| strongly biased against in favor of the insurance | | | | One study of 576 lawsuits filed in federal court against |
| company paying Long Term Disability (LTD) benefits to | | | | the seven largest disability insurers (MetLife, Unum, |
| an individual. | | | | Prudential Financial Inc., CIGNA Corporation, Standard |
| Insurance companies sell group policies that some | | | | Insurance Co. and Aetna Inc.) found that insurance |
| courts have ruled provide little or no coverage. | | | | companies: |
| Congress approved ERISA to "protect" employees' | | | | - Regularly deny or terminate benefits to individuals |
| pensions but in doing so unwittingly gave disability | | | | even after they determined to be disabled by the |
| insurance companies a free pass to play the game on | | | | federal government and approved for Social Security |
| a field that is not level. | | | | Disability payments. |
| That practice has been challenged by a lawsuit against | | | | - Hire contract doctors who routinely reject the opinion |
| insurance giant UnumProvident (Unum) charging that | | | | of treating physicians without ever having seen the |
| the insurance carrier devised a scheme to illegally deny | | | | patients. |
| or terminate the long-term disability claims of | | | | - Provide incentives to employees to deny and |
| thousands of people in violation of ERISA. The lawsuit | | | | terminate claims, typing performance evaluations to |
| charges that Unum cut costs by terminating claims by: | | | | meeting money-saving goals. |
| - providing financial incentives to in-house physicians | | | | - Force plaintiffs to wait two years and eight months |
| who would rubber-stamp previously made business | | | | on average form the time they are disabled to the |
| decisions | | | | time their cases are resolved. |
| - authorizing more senior in-house doctors to change | | | | - Face no peril for repeatedly denying or terminating |
| the written reports of other "uncooperative" in-house | | | | legitimate claims because federal law does not allow |
| doctors in order to justify a claim denial or termination | | | | for any damages. |
| - stopping payments to policy holders without any | | | | Many of the denials or terminations involve long-lasting |
| explanation given for termination | | | | illnesses that are hard to prove, such as chronic pain, |
| In recent settlements Unum has agreed to reconsider | | | | back problems, closed head injuries or fibromyalgia. But |
| some 200,000 denied disability claims. The company is | | | | some claims involve heart disease, blindness, migraines, |
| facing a potential $145 million fine in Maine alone. And | | | | or cancer – diseases which are easier to establish. |
| this is only one insurance company; there are others | | | | The rush to denial by insurance companies also is a |
| engaged in the same kind of deceptive practices. | | | | practice followed for government benefits such as |
| The fact that insurance companies without good | | | | SSD and SSI: Social Security denies almost 70 percent |
| reason are terminating LTD claims previously | | | | of its initial disability claims while 60 percent of those |
| approved is one more attack made to rob | | | | who appeal eventually win. |
| well-intentioned, honest citizens of the benefits they | | | | Because the deck is stacked against disability |
| have coming. I find this to be absolutely horrible. It is bad | | | | claimants form day one, and all through the process, |
| enough that insurance companies, without good cause, | | | | there is no question in my mind that the injured person |
| will routinely deny disability claims when first submitted | | | | early on in the process should contact an attorney |
| and force applicants to appeal or resubmit claims. This | | | | who specializes in personal injury litigation, especially in |
| is a long-standing ruse of LTD insurance companies, | | | | the fields of long term disability and/or workman's |
| and it's wrong! | | | | comp. An applicant living in Michigan who is denied |
| Disabled workers how are denied benefits must | | | | LTD, SSD, SSI or workman's comp needs an attorney |
| appeal not once but twice to the insurance company, | | | | from Michigan because of how Michigan No Fault Law |
| a process that takes at least six months and requires | | | | and other Michigan laws impact these areas. |
| patients to track down all their medical records and | | | | The permanently injured person soon learns that the |
| submit every document that they might later want to | | | | only ones looking after their best interests are |
| use in a lawsuit. After a second denial, the insurer | | | | themselves and their attorney. |
| might send a case for an "independent" medical | | | | |