Colorado District Court overturns denial of benefits by Life Insurance Company of North America
In Johnson v. Life Insurance Company of America, a Colorado District Court ruled in favor of the claimant finding LINA’s decision unsupported by any reasonable basis. The case dealt with a denial of long term disability benefits at the change in definition from own occupation to any occupation. After paying 24 months of benefits to Ms. Johnson, LINA concluded that Ms. Johnson did not qualify for any occupation benefits and ceased payment.
Ms. Johnson had been suffering from a chronic medical condition known as Trigeminal Neuralgia which causes excruciating pain and is often untreatable. She was employed by GEICO for 19 years as an auto damage field supervisor but had to cease working due to pain caused by Trigeminal Neuralgia which had progressed to the point that pain medication made it impossible for her to continue functioning at work and prevented her from driving, a major job requirement. While Trigeminal Neuralgia is often difficult to diagnose, in this case, there was no question as to the existence of Ms. Johnson’s medical condition. However, as is the case in many claims based on chronic pain, LINA challenged the assertion that Ms. Johnson could not work due to her intractable pain.
Following the initial denial of benefits, Ms. Johnson submitted an appeal. Just one month after LINA denied benefits, the Social Security administration awarded disability benefits. During the course of the appeal, LINA obtained records from the Social Security Administration that included an independent examination report. LINA also had Ms. Johnson examined by a physician who described her as “evasive.” The examiner concluded that the pain reports were unsupported, and that Ms. Johnson was significantly exaggerating her symptoms. Unsurprisingly, LINA upheld its decision to deny benefits.
After submitting a second unsuccessful appeal, litigation ensued, leading the court to review LINA’s decision and focus on several issues that had to do with credibility.
First, the court found that LINA’s initial approval of benefits and its failure to discuss that approval raised suspicion about whether its decision was adequately reasoned. After all, it is obvious that the disability due to Trigeminal Neuralgia would have impacted Ms. Johnson’s ability to perform any occupation. The court also found that LINA did not have a legitimate rationale for rejecting the decision of the Social Security Administration and LINA failed to consider the medical evidence that showed Ms. Johnson was receiving extensive treatment.
In reaching its decision, the court concluded that LINA’s doctor’s examination should not be given any evidentiary weight after observing that the examiner’s report “displays a persistently and otherwise unexplained skeptical and impatient tone.” LINA file reviews were equally as questionable given that the reviewer’s opinions were all based on a lack of “objective evidence” even though none of the doctors questioned the Trigeminal Neuralgia diagnosis.
Ultimately, the court concluded there was no reasonable basis for LINA’s determination. This case reminds us that where the diagnosis in question is unchallenged, adverse credibility decisions without any basis are unsupportable.
The case was not handled by our office, but it can provide claimant’s guidance in their pursuit of benefits under their disability insurance policies. If you need assistance with a similar matter please contact any of our lawyers for a free consultation.
Resources to Help You Win Disability Benefits
Get Your Cigna Disability Application Approved
Prevent a Cigna Disability Benefit Denial
Negotiate a Cigna Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Q: Can I add a physical disability claim to my mental health one without seeing a doctor (hard to get an appointment with COVID)?
What Should a Claimant Expect When Suing Cigna or any Other Disability Company for Long Term Disability Benefits?
Is a Claimant's Complaints of Pain Enough to Qualify for Short or Long Term Disability Insurance Benefits?
Is My Insurance Company Allowed to Take An Offset of My Monthly LTD Benefit for Social Security Benefits My Kids Receive As A Result of My Disability?
Is My "No-Fault" Auto Insurance Settlement an Offset Under My Long Term Disability Insurance Policy?
CIGNA Denies Technology Manager under the Own Occupation Provision & Dell Disability Lawyers Wins Appeal
Reviews from Our Clients
Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.