Anthem is one of the world’s largest health benefit companies, with a primary focus on health insurance benefits. While revenues for Anthem top 17 billion annually, short and long term disability benefits is a small portion of their revenues. Anthem is an independent licensee of Blue Cross and Blue Shield Association, but they sell most of their disability, life and AD&D insurance products under the name Anthem Life or Anthem Insurance Companies throughout the United States. Anthem has a very small stake in the disability insurance market, but with the talks of buying CIGNA corporation they could quickly become one of the largest in the US. Anthem has business relationships with numerous other entities and we have seen Anthem disability claims handled by a third party company called Custom Disability Solutions or their former parent company Wellpoint. We have also seen Anthem act as the third party disability administrator for large companies such as Eli Lilly and Company. After the Merger of Wellpoint and Anthem in 2004, some of the disability products were converted to the Anthem name.
Most Anthem Long Term Disability Policies Have Restrictive Language
Anthem’s disability products are only sold as Group plans, which means that most people covered by an Anthem disability policy are subject to ERISA regulations. From our experience, most of the Anthem disability policies contain a 24 month “own occupation” definition of disability and then they change to an “any occupation” definition of disability. We also commonly see Anthem disability policies which have a 24 month mental nervous limitation and a self reported symptoms limitation. One of the most restrictive items in an Anthem long term disability policy is that they will commonly require “objective medical evidence” of disability. There are frequent disputes as to what “objective evidence” constitutes and this frequently results in benefit denials. Some Anthem policies define “Objective Medical Evidence” as:
“medical signs” (including psychiatric signs) and “laboratory findings,” as documented by a Licensed Physician regarding disability status… Medical signs are anatomical, physiological, or psychological abnormalities that can be observed, apart from subjective statements of symptoms… Psychiatric signs are medically demonstrable phenomena that indicate specific abnormalities of behavior, affect, thought, memory, orientation, and contact with reality. They must also be shown by observable facts that can be medically described and evaluated. Laboratory findings are anatomical, physiological, or psychological phenomena that can be shown by the use of medically acceptable laboratory diagnostic techniques.
If you have a disability claim with Anthem, any of our disability insurance lawyers are available nationwide to assist you at any stage of your claim. We welcome you to contact us for a free lawyer consultation. We regularly track disability insurance claim denials and lawsuits throughout the country against Anthem. We also welcome your comments, complaints and feedback about your experience with Anthem so that other claimants can learn from your experience.