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.
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Answered Questions by Our Lawyers
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Q: I filed an appeal and lost. Is it worth pursuing?
A: Kim, in my opinion, yes. If you are still within your timeframe to file a lawsuit you have little to lose in t... Read More >
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A: Frank, we would need to see a copy of the denial letter and the policy. Please feel free to contact our office... Read More >
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A: Tret, Cigna will be required by law to provide you with a written denial letter setting forth its reason for t... Read More >
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A: SB, ERISA provides 45 days to render a decision on appeal with the possibility of a 45 day extension- basicall... Read More >
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Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
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Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
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We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
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We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
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Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
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Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
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Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
Do I have to come to your office to work with your law firm?
No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
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When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.