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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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.

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Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

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