Can I sue my long term disabilty insurance company for bad faith or punitive damages?
Disability attorney Gregory Dell discusses your ability to sue your disability insurance carrier for bad faith or punitive damages.
Well, the answer to this question depends upon whether or not you have a claim governed by ERISA or you have an individual disability policy. Let’s start with the easy one and probably the most unfair one. If you have a policy governed by ERISA, the answer is that you absolutely cannot sue your disability insurance carrier for either bad faith or punitive damages. I didn’t make the law, I don’t agree with it. I think the ERISA laws are very unfair, and there’s no indication that those laws are going to change any time soon.
With regard to individual disability policies, in some states, you can sue your disability carrier for bad faith and punitive damages, and obviously in others, you can’t. The facts of the case in order to qualify for a bad faith claim have to be very specific. There are only a few states that allow you to sue for bad faith or punitive damages, so if you have any facts in your case that you believe would warrant a claim for bad faith or punitive damages, we encourage you to contact us at your convenience.
Was told by my employer amazon.com that due to my preexisting condition, I would have to take a LOA or, use vacation time/personal time. I opened a claim with the disability company Liberty Mutual. After approximately a month of nothing happening I contacted my claims examiner and was told that my healthcare providers hadn’t returned the requested information.
I contacted my doctor’s office personally and was informed by their office manager that they had never received any such request from the examiner. I requested a copy of the official request that she sent which was stalling the processing of my claim.
I found that the letter requesting my medical info, in addition to another letter informing me (from the examiner’s office) that she hadn’t been given the information from my doctor’s office was conflicting in their dating.
The letter that was dated informing me that she was not given the information was one dated, and it was postmarked as sent six days later. In addition, I requested a copy of the letter that she sent to my doctor and it was the same dated two one day after the letter that she sent to me. How could they have possibly have received it and answered a letter from Arizona?
Most recently, during my pre-surgical examination, the surgeon discovered a lesion that she wanted to have tested for cancer. She refused to perform the surgery until I had the test conducted by another specialist. After scheduling the ordered biopsy, I was contacted by my insurance provider BCBS, and informed that they required me to see my primary care physician for an examination, to be cleared to see the specialist for the biopsy, which was required for the surgery which was all that I expected to have done originally.
In addition, I can’t even return to work if I wanted to because I need to have my surgeon document that the surgery was indeed done. My job forced me to take this LOA as part of their employee policy. As I explained to the examiner, I did not choose to stay away from work. I can’t return per their LOA policy. Also, I have co-pays for these office visitis, medications, treatments and I won;t even mention the copay of the surgery itself.
She left mew a message last week and informed me that things were still being processed. This is two months later.
Please help.
Best,
CB
CB,
Liberty Mutual can be very slow with their claim handling but you need to call them daily and demand a decision. It sounds like things should be resolved for you very shortly.
My disability company, CIGNA, approved my short term disability. They then paid me for 4 months, after which I applied for Long Term to prevent a lapse in coverage. I’m still in a wheelchair and cannot walk, climb stairs, or drive and all of these were a significant part of my job. My doctor wrote them a letter indicating that I could not return to work because of my condition and won’t be able to work in the future. They still denied me.
In addition, they didn’t complete the short term disability payments that were already approved. They still owe me for 2 months of short term disability. Can they do this? What can I do about it? Do I need an attorney?
Cransheka,
I am sorry to hear about your experience. As each claim is unique please feel free to contact our office for a free consultation to discuss how we may be able to assist you.
Under my long term disibility the policy it is said that if I can’t return to my regular job, that they will pay for retraining perdentual offed me a 50 dollar settlement. I am a CNA and they will not pay for anything else and they said I should just go to the public library and take a free computer course. I want to sue.
They also want me to apply for social security disibility and use the money to pay them back! For a policy I purchased.
Josepgb,
Please feel free to contact our office to discuss the status of your claim as it is somewhat unclear from your post. With respect to the SSDI offset-such provisions are found in almost all ERISA governed policies, and are legal and enforceable.
I have a policy with unium ins. Company for a long term disability. They have paid up until I received ssd. Now they want all the money back that they have paid me and also they are to be paying me the difference in the amt. to makeup what I don’t receive in ssd.
Linda, if you have an employer provided policy it is almost guaranteed that SSDI benefits are an offset under the policy, and as such, Unum would be entitled to repayment of any overpayment and reduction of monthly benefits by the amount of the SSDI award.
I had a massive stroke in 2006, I had ltd with Genworth through employer. Genworth paid 2 months then sent letter stating I owed them money. My husband lost his business due to my disability due to lack of income utilities were shut off house forclosed. We became homeless so I did not have forwarding address because of this I did not appeal their decision until much later when I found copy of polo.
maria v
254/413/8153
Maria, I am sorry to hear about your troubles. Was your claim denied in 2006, or did they only request a repayment of an overpayment? If your claim was denied in 2006 then there stands a very real chance that the statute of limitations to bring a lawsuit on your claim has passed.
I also have Unum as my ltd company. I have the ltd policy through my employer. I read the answer you gave Linda C, but how is that legal when the company I worked for doesn’t even take out social security? I earned social security from previous jobs I worked. Now because of Unum’s offset I am about to be homeless because trying to live on ssdi alone is impossible. I am blind and I was told by social security that I can make up to $1820 per month more if I want to go back to work. Unum benefits are $1824 total. If I could receive both this would at least keep me from being destitute. There has to be some law that polices these companies in order to keep them from causing undue hardship on ppl. It seems the laws are only for the companies and ppl have no rights at all. It’s a felony to harm an animal but to cause someone to become homeless or live in sub-standard conditions (which would also be cruelty to animals) is ok according to the United States Inc. This is really sad that ppl have absolutely no rights. Nothing was disclosed to me about the offset situation when I signed up for s/ltd. To my knowledge any contract without full disclosure is void from its inception but I’m sure they are all exempt from the law!
Wondra, although I fully sympathize with your position, unfortunately, courts have held that the provisions of the policy allowing for offsets are enforceable and legal.
My name is Troy. Got hurt on my job grion pull rib contusion back and neck injury picked up 365 lbs paralize man by myself at work long term disability suppose to kick in after six month and now it’s going online months and they keep telling me they have to review it.
Thankyou for your advice, need help haven’t had any kinda pay in eight months my doctor has put me out on totally disable do to the injuries I suffered at work.
Troy, please feel free to contact our office to discuss your claim. Do you also have a worker’s compensation claim pending?
I also have Unum as my LTD insurance through my company. I have been out of work for almost a year. Unum paid my STD for 6 months but when it came to switch over to LTD they denied it saying I wasn’t doing enough to help my situation. I had a moderate disc herniation from L5 to S1. I was following all the dr orders and most of them were saying that surgery would be out of the question due to my size. Finally my chiropractor referred me to a surgeon and on June 7 had a multi-level laminectomy. I have appealed their denial but I just cannot understand what is taking them so long to decide. I mean I DID have surgery!
Dawn, how long ago did you appeal the denial? Unum will have 45 days under the law to render a decision, with the possibility of a 45 day extension (for a total of 90 days).
What is the statue of limitation to file a law suit against unimportant bad faith practices.
Jackey, Statute of limitations can depend on the jurisdiction the action arose in.
I worked at st Luke’s hospital for 25 years. In 2014 had knee arthroscopic surgery, I had STD which I used. In Jan 2015 I also took out LTD for the future, in feb I had a total knee replacement surgery. Our insurance company is PRUDENTIAL. When I enrolled in LTD I was I guess to fill out a EOI form, which even the hospital says it fell threw the cracks. I have been paying for the coverage since enrolling 2015, but to PRUDENTIAL I never had coverage. St Luke’s worked to try to get them to honor claim, they made me fill out the EOI form few days ago, PRUDENTIAL looked at it and denied coverage and hence my claim. My knee is bent and I walk with a limp and cane a lot and have been going to p,t. Since feb. Since my knee wasn’t straight I was terminated aug when MY STD ran out. St Luke’s is reimbursing me the premium I paid in this year which I’m not cashing as I feel they are just trying to get out of their mistake. So by myself I need to appeal PRUDENTIAL for coverage/claim, why st Luke’s can’t help me do that is beyond me. I don’t know first steps to appealing, I just know that now our home is close to foreclosure. Just wanted to know what you think is best options or what to do. I’m frustrated with st Luke’s for not fighting more for me. People tell me cut your losses and move on. This is my life, not only am I in pain from knee but the situation. Any advice
Colleen, if St. Luke’s did not provide the proper paperwork to Prudential your action may be against them. We would need to see a copy of the denial letter to determine what, if anything, we can do to assist you.
My LTD company UNUM, has demanded me to send them my tax returns and W2’s for 2011-2013, saying I worked during that time! I tried to start a small home business but didn’t make a dime, and have the proof from that company that i made a whopping $38 commision which didn’t even cover the cost of the products. Here is the problem, since I don’t make enough money to file taxes, I haven’t since I stopped working in 2010. UNUM says if they don’t recieve them by 1-3-2017 they will stop my benefits. This all started after I wrote a negative review of how they troll people and try to get them so disgusted trying to jump through hoops to keep their own earned check, that they either walk away disgusted, (which is their goal)or can’t comply with their ridiculous demands on people that are already challenged by making them go to the Dr’s and making you do their work for them. I don’t mind recertifying once a year but they make you go multiple times and don’t document it so you look like a liar. I am about to lose my benefits to these thieves, any advice would be greatly appreciated.
Jeff, if you have not filed taxes the most I can suggest you do is advise them of such in writing. You can’t give them something that doesn’t exist.
I enrolled in a union backed plan in 1999 and have paying premiums for both short term and long term policies. It required a 30 day waiting period. I was injured at work which qualifies me for injury comp payments. The company has reduced my payments for $1300 monthly to $100 monthly. A coworker has a different company policy, was injured on the same job, her company lowered her payments by half. Can I file a complaint/sue my insurance company?
Cheryl, if your policy allows the insurance company to offset your monthly benefit by the amount you receive from worker’s compensation, then no – you would not have an actionable claim against the carrier.
Hello:
I had a long term disability plan through Cigna. Cigna helped me get on SSDI and as stipulated through my policy would pay me the difference between my SSDI monthly payments and my salary until I turned 65. For over a year they paid me $667 per month to go along with my Social Security. Cigna then had nurses on their staff review my claim and decided I was no longer disabled. Social Security decided I am disabled. My doctors claim I am disabled. I see the top orthopedic surgeon in the country and he has stated that I will always be disabled.
How can I determine if I can take any action against Cigna? My fear is the statute of limitations have expired.
Thank you.
Anna, first and foremost, did you file an administrative appeal of the denial of benefits? The appeal has to be filed with 180 days of the deadline. If you did file your appeal and Cigna denied same, you would typically have three years from the date proof of loss was required (commonly determined to be from the date of the initial denial) to file a lawsuit. Please feel free to contact our office to discuss what options you may still have.
I had a brain tumor on brain stem in 2013. I had a stroke in surgery which as left partial paralasis on right side, hearing loss on left side and facial paralysis on left with eye damage. My ltd is Metlife and now they say I am able to work again after all doctors say no. What should I do?
Robin, if they have denied your claim you would have the right to file an administrative appeal of the denial. MetLife only provides one level of appeal so it is imperative that it be as complete and thorough as possible. Please feel free to contact our office to discuss how we may be able to assist you in restoring your benefits.
I have insurance with MetLife through my work (ERISA). I wrote a letter requesting an appeal to MetLife regarding the rate paid within the first 180 days. MetLife determined that my condition is pre-existing since I saw my doctor Dec 27, 2013 which was 3 days before the change in LTD when into effect. MetLife called me on the phone to explain but, I do not think they actually appealed the decision. Can I file you a law sue if the Contract statute of limitation is 6 years in Minnesota? It has been 4 years since the initial rate denial.
Bernard, most employer provided policies require legal action within 3 years of a claim rising, which could be a potential roadblock. Without seeing the denial letter from MetLife we would not be able to properly assess. Furthermore, I am not sure if this is a complete denial of benefits (as in not disabled) or a denial of an increase in your monthly benefit amount (for example during open enrollment). That would also have an impact on your situation. Please feel free to contact our office to discuss your situation further.
If my LTD policy is governed by ERISA what are my options for escalation? I have an attorney and have been in an appeal/denial cycle for three years.
Anonymous, if your ERISA benefits are denied, pursuing and exhausting the administrative appeal process with the disability insurer is mandatory before filing suit. ERISA requires that your disability insurance plan require at least one level of mandatory appeal; however, no more than two. If you have been in the appeal / denial cycle for more than three years then it is likely that you are exercising voluntary appeals offered by the disability insurer. You should speak with your attorney about when the appropriate time to file suit is.
Thank you for responding. This has been going on so long. It’s very discouraging. I am a transvaginal mesh victim. I’ve been seen by some of our nations specialists. Unfortunately, the surgeons don’t want to fight insurance companies. I have many TVM side effects. I’m on Social Security Disability but, the LTD keeps denying my appeals. They’ve even claimed that my problems are mental health related. I just don’t know what to do. My records are not enough for the LTD company. They put me through so much. Surveillance, etc. It feels like bad faith but, it’s ERISA. Would contacting an elected official help?
Anonymous, if you have a denied LTD claim you should contact our office to speak with one of the attorneys about the specific facts and circumstances of your claim.
My (government) H.R. Dept. paid the premium for all employees LTD policy. I became disabled and was paid benefits for years. Then the latest disability insurer spent a year threatening, intimidating, withholding and finally discontinuing payment of benefit. The things they did during the year and the results are so terrible that I want to sue them for Bad Faith. The policy is in CA. I know my benefits are taxable. My questions are: would the attorneys fees be taxable, and would any bad faith winning be taxable? Because in CA, and with any lump sum, I don’t want to pursue only to end up in the red! ?!
Steph, I am sorry to hear all of the issues you are dealing with due to your disability insurance carrier. As your claim has been denied, please call us so that we can offer you a free consultation regarding your denied claim. We would love to review your denial letter to see if we can assist you. Whether your claim arises to the level of bad faith depends on many factors which we can discuss once we speak with you. Regarding the taxability questions, the best to answer such would be a tax professional (tax attorney or an accountant).
I paid for ltd l. It came out of my check. Offered through my employer, but not paid for by them. Does that fall under erisa?
Lindsey, paying the premium does not dictate whether the coverage is governed by ERISA. There are five requirements in order for a group disability policy to fall under ERISA: (1) A “plan, fund, or program”; (2) established or maintained; (3) by an employer or employee organization, or both; (4) for the purpose of providing medical, surgical, hospital care, sickness, accident, disability, death, unemployment or vacation benefits; (5) to participants or their beneficiaries. An ERISA governed disability policy is one that is sponsored by an employer. Generally, these policies are part of a benefits package, and may or may not require a portion of the premium be paid by the employee while a portion is paid by the employer. I suggest you contact our office and speak with one of the attorneys to address your specific questions regarding your situation.
Would you be open to a class-action lawsuit against Wells Fargo? Wells Fargo is not in compliance with their 2007 EXPRO (PTE 96-62) reinsurance of long-term disabity. All fact based. No opinion.
270,000 Wells Fargo employees are underinsured. I’m a registered whistleblower. I have interviewed with the EBSA.
I have Liberty Mutual’s underwriting statistics. Not comparable to the competition. Not in the best interest of customers. Wells Fargo 2007 EXPRO (PTE 96-62) plus Liberty Mutual DOES NOT meet impartial conduct standards.
Impartial Conduct Standards
Impartial conduct standards require fiduciaries to adhere to basic fiduciary norms and standards of fair dealing (act in the best interest of customers, charge no more than reasonable compensation, and not make misleading statements).
Jonathan, with the recent purchase of Liberty’s group disability and life insurance departments by Lincoln it will be interesting to see how the claims administration proceeds going forward.
I receive LTD benefits under my employer group plan (ERISA). However, I had to hire a LTD attorney to receive these benefits as Custom Disability Solutions denied benefits for not meeting the policy criteria, twice. The attorney gets 1/3 of my monthly benefits. Can I sue Custom Disability Solutions in Federal court for legal fees? I should be receiving all the benefits owed to me! When we are at our weakest point due to health issues this whole process feels wrong.
Jab, under the circumstances you describe you cannot take legal action against the LTD insurer to cover the costs of your legal fees.
These wrongful denials of long term disability claims are exactly why people act out and get Justice on their own. You say that there is nothing that will be done in the near future about erisa laws… maybe if somebody shows up and forcibly demands that their disability benefits be reinstated, All Insurance Companies will think twice about wrongfully denying them in the future. THAT is where we are at if employees don’t have any legal recourse to ensure that this insurance is made available to them, it will cost more lives than the life it is already cost and THAT will change ERISA! I WILL CHANGE ERISA!!!
Troy, we encourage people to contact their congressional representatives to push for legislative changes to ERISA be made. Our office has pushed for changes with lawmakers at the state and federal levels in an attempt to effect same.
My wife was disabled in 2016, went on social security disability and long term disability. She was diagnosed with a TBI and after month after month of harassment by met life they finally decided to terminate her in March 2019. We got an attorney and within one week of his filing they re enstated her. I asked why so quick and the attorney explained that met life had made a mistake. The policy reads that you only have to show you are on social security disability and no further questions should be asked. I find it incomprehensible that you cannot go after attorneys fees as well as all the anguish they have put my wife thru.
Thank you, Don