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.

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There are 11 comments

  • Cindy, I am sorry to hear of your denial of benefits and unfortunate, sometimes that seems to be the MO of the insurance companies. If you would like any assistance with your appeal, please do not hesitate to contact us. We offer a free consultation.

    Alex PalamaraAug 14, 2019  #11

  • Wow, I feel for all of these folks. I am currently appealing my denial of continuation of LTD benefits. I was approved for SSD first time out. And yet Anthem believes I can work. I have multiple health issues: fibromyalgia, RA, OA, Scleroderma, and they all affect every joint I would need to perform any job. I worked for Anthem close to 24 years and also paid into this benefit. It seems rather than review “all” the facts, they try to find just one minut reason to deny and hope no one will fight them. I wish the best for all of these folks and hope that things turn out for the best with them… and myself.

    Cindy C.Aug 14, 2019  #10

  • I was an Anthem employee placed on first short and then long term disability.. I didn’t have much trouble with initial processing. At their command I applied for SSD which took a couple of years to be determined. Upon SSD concluding I was disabled, My benefit (50% of my salary) was re-figured and my SSD benefit was subtracted leaving a monthly benefit of $400. I’ve repeatedly been told that there is nothing legally wrong with this. I can’t understand how my contributions into SSA along with my many employers, somehow reduce my insurance policy’s value or benefits. Basically I paid Anthem, the federal government both for this money. The government is paying me and Anthem is repaying themselves for offering me a policy rather than following through on payment. If anyone can rip off the government and get a pass Anthem usually falls into that mob.

    zannaSuJun 17, 2019  #9

  • Michael, please contact us directly to discuss your options with one of our disability insurance attorneys. Anthem may have exceeded the time period allowed under ERISA to make a decision on your claim.

    Cesar GavidiaJun 16, 2019  #8

  • I took out a short and long term disability policy with Anthem when I started a job on October 1, 2018. On January 28, 2019 I was ordered off work by both my doctor and the place where I was working due to developing a lightheaded, off-balance sensation following what I thought was a 3 day cold. I work in an industrial plant with lots of moving machinery.

    Initially it was thought this was due to high blood pressure and cardiac problems. It took almost 3 months to go through all the tests only to find out my heart, circulation and blood pressure were not the cause. I was then sent to a neurologist who determined I had an acute onset of severe peripheral neuropathy. The neurologist believes I didn’t have a cold but instead, one of a number of viruses that cause Mercer inflammation. I’ve now seen 4 doctors who believe the neurologist is correct.

    Anthem did pay one month of benefits for February but not until mid April. Since then there has been no payments from them and every time I call I’m told my claim is still under medical review. As a result I cannot pay the bulk of my debts and am facing collections.

    My doctors have turned over my records to Anthem and those records show I’ve never had sever neuropathy, have never been advised of having that condition and that I’ve never had the vertigo like sensations I’ve experienced since January.

    I’ve followed all procedures I was asked to follow and complied with every request made by Anthem. Now I’m broke and can’t afford the only neuropathy therapy that could get me back to work. Per Anthem’s policy this is not a preexisting condition. They owe me over $9,000 in benefits for March through today’s date. With those funds I can get the therapy I need and eventually get back to work.

    I need advice.

    Michael S.Jun 16, 2019  #7

  • Pam: I’m not sure what you’re asking here. It looks as though you’re asking about a buy out but much of what is written is jumbled. I suggest you contact our office and speak with one of the attorneys to address questions you have regarding your specific situation.

    Jay SymondsDec 17, 2018  #6

  • Does Anthem ever agree to buy out lump sums while I’m receiving monthly payments instead, plus I paid in both yet I worked for them, they sweet talked me in to going with them, and never told me anything that happened until it happened. I still trying to figure out how they came to the amount they came to and why the judge backed up my applications two years further back when then they told me I had to pay back every penny, despite my paying Ltd most of my life.

    Paid in two life times of credits for social security for two life times according to the judge and etc… now they are saying it. Is mandatory I fill out all the information since this is the first time received a Ss raise in years & my plan said at the time that they and I agreed to a certain amount and they could not come after my Ss raises. Ddid the law change? I rember getting the ketter stating the supe e court won and made Ss to use my points and my payment to pay them back. Plus my dr of 16 years has retired. I need a doctor and mine can’t even get an mri and I gave primary I pay or er 600 monthly just to add me and secondary full office for a and b just in case, yet they say they won’t pay anything the primary refuses. Now the primary has begun refusing everything including an mri so. Can go see a specialist. So I pay for two full major medical insurances, Ss use to pick up what primary wouldn’t, nit any longer. I was going back to school after all these years, accepted avd fed g out the osier for my PhD in nursing to finish my degrees after and while working many hours when this got so bad I couldn’t stand it. What can Do, I used all my savings, 401k.

    PamDec 17, 2018  #5

  • Anita, please contact our office to discuss your claim so we can determine what rights you may have under your disability insurance policies.

    Stephen JessupDec 4, 2018  #4

  • I have been approved by the SSDI for diability benefits and have filed several claims with Anthem Blue Cross for long term disability since this happened at my work. I have been denied several times now and just recently denied again after finally getting approval from a judge for SSDI. Can you please tell me what I can do?

    Anita J.Dec 3, 2018  #3

  • Beverly, I am sorry to hear that your Anthem claim was denied. It sounds like you have a valid claim which should have been approved. I am not sure if you have an another opportunity to appeal the determination as I would need to see the denial letter. If not, your only option is to sue them in federal court. If you would like assistance I would be happy to review your denial letter an policy for you free of charge. Please contact my office and ask for Rachel Alters.

    Rachel AltersSep 12, 2018  #2

  • I was an Anthem employee who discovered I had an Abdominal Aortic Aneurysm after having abdominal pain & going to ER in August 2015. I was on short-term disability, then LTD from Feb 2016-Feb 2018. Received letter March 1, 2018, I no longer qualified & lost all benefits. I was also was seeing a therapist for depression d/t diagnosis. I also have sleep apnea, palpitations, degenerative joint disease, chronic low back pain, DeQuarvain’s in dominant hand, trigger finger, psoriasis, bilateral knee pain & the abdominal pain had continued. Filed for S.S. disability had hearing 3/16/18. Filed appeal with Anthem that was supposed to be addressed within 45 days, took them over ,60 days, received letter stating they were waiting for documentation from 3:providers I had never seen or heard of & who did not even practice in my state! Of course, my appeal was denied, even though my abdominal pain, depression and joint pains continued. I was paying for LTD & medical benefits monthly yet they want subrogation if benefits from SS are awarded. That is what I was paying premiums for. I was an employee and was treated like this, I can only imagine how others are treated.

    BeverlySep 11, 2018  #1

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