Administrative Appeal by Dell Disability Lawyers forces Principal to Reinstate ERISA Long Term Disability Claim of Former Healthways, Inc. Employee

After being forced to stop working in 2007 due to various disabling conditions, an employee of Healthways, Inc., who was employed as a Member Care Manager, filed for Long Term Disability Benefits under a policy provided by her employer that was through the Principal Life Insurance Company.

Shortly after applying for LTD benefits, by way of an approval letter dated October 23, 2007, Principal agreed that the Member Care Manager satisfied the terms of the policy and found her to be disabled. Principal commenced payment of LTD benefits effectively on October 20, 2007, after the full completion of Short Term Disability benefits, which were also approved by Principal. The Member Care Manager received LTD benefits from that time and until September 24, 2014.

Unfortunately for the former Healthways employee, such benefits were terminated as of September 24, 2014. By way of a denial letter dated September 30, 2014, Principal informed her that it had “determined that (she was) no longer eligible for (LTD) benefits.” In support of its determination, Principal relied upon an Independent Medical Examination it had commissioned and performed on August 27, 2014. Principal also relied upon Attending Physician Forms completed by her own treating physicians. Principal used this information and concluded that the “restrictions provided by (her doctors) and the IME physician would allow you to perform a sedentary level occupation.” Principal also stated that the “IME did not provide any restrictions for fine manipulation or simple grasping. It also noted that you can continuously reach below your shoulder. It goes on to state that you can occasionally keyboard and use a mouse.” Principal then concluded that with “these restrictions, you are capable of performing the Substantial and Material Duties of your Own Occupation.”

After receiving this denial letter, the former Member Care Manager for Healthways found Attorney Alexander Palamara at Dell Disability Lawyers. After listening to her and reviewing the denial letter, Attorney Palamara knew that Principal had made an incorrect decision in denying the claim of a 60 year old woman who had been on claim for the previous 7 years and who was suffering from so many serious health conditions. Her conditions included: Chronic Pain, Diffuse Arthralgias, Fibromyalgia, Chronic Fatigue, Rheumatoid Arthritis, Osteoarthritis of the Right Shoulder Joint, Neck Pain, Cervicalgia, Cervical Spine Degenerative Disc Disease, Scoliosis, Lordosis, Bilateral Shoulder Pain, Left Clavicular Joint Separation, Right Shoulder Tendonitis, Back Pain, Spinal Stenosis, Lumbar Spine Degenerative Disc Disease, Lumbago, Bilateral Knee Pain, Bilateral Hand Pain, Bilateral Hip Pain, Bilateral Paresthesia of both Upper and Lower Extremities, Bilateral Carpal Tunnel Syndrome, Left CMC Joint Effusion, Peripheral Neuropathy, Asthma, Shortness of Breath, Granulomatous Disease in the Lungs, Sinusitis, Pure Hyperglyceridemia, Migraines, Insomnia, Urinary Tract Infections, Esophageal Reflux Disease, Vitamin D Deficiency, Myopia, Anxiety and Attention Deficit Disease. Bilateral Parathesisa of both Upper and Lower Extremetries.

Review of the Claim and the Filing of the Administrative Appeal

Shortly after taking on the case, Attorney Palamara received Principal’s entire file which included the Independent Medical Examination report which Principal heavily relied upon to deny the woman’s claim. A review of this report actually showed that Principal’s hired doctor was very supportive that our now client was actually prevented from working. This doctor clearly stated such when he responded to the Principal’s question as to whether there were “any restrictions/limitations applicable which would prevent her from working currently.” The doctor simply acknowledged “Yes.” This doctor who was paid by Principal went further and stated “It is my opinion that there would be very little if any improvement in her condition and very little recovery over time. The rheumatoid arthritis and her conditions of degenerative disc noted on her lumbar x-ray perhaps maybe progressive in nature and therefore little to no improvement in her current functionality is anticipated.”

Additionally, Attorney Palamara also had a chance to review all of the updated medical records as well as those previously provided to Principal. It quickly became crystal clear that Principal’s decision was blatantly wrong and arbitrary and capricious. A timely and proper appeal was filed before the ERISA imposed 180 day deadline. This appeal showed that Principal was arbitrarily picking one liners from its IME report as well as one liners from our client’s medical records. Unfortunately for Principal, this form of review is very improper and it allowed the appeal to tear into and disprove Principal’s earlier conclusions.

Within 60 days of the filing of the administrative appeal, Principal contacted our office and informed us that it was reinstating our client’s claim for disability benefits. It has since paid all back benefits owed and is continuing to pay all monthly benefits timely. We do not foresee Principal denying this claim yet again and we foresee our client receiving full benefits until the policy ends at age 66, her normal social security retirement age.

It is unfortunate that our client had to suffer months without her rightfully owed benefits. However, we are pleased to have taken on her fight and gotten her back on claim. Our client rests assured that Principal will not again play games with her claim as they know that we continue to represent her and will do whatever it takes to keep her on claim.

If you have been denied disability benefits by Principal Life or any other disability insurance provider, please do not hesitate to contact Attorney Alexander Palamara at Dell Disability Lawyers for a free consultation.


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Principal Reviews
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Showing 8 of 16 Reviews
Principal

Sorry, Principal. My residual and renewal commissions aren't "earned"

Reviewed by Ron on August 24th 2020   Verified Policyholder
(CAPS are added by me for emphasis:) I am a self-employed insurance broker working only on commissions. I was disabled due to surgeries and received some income replacemen... read more >
Reply
Sent on August 24th 2020 by Attorney Rachel Alters

Ron: You certainly can challenge Principal’s interpretation of the various provisions at issue through an appeal, if you have not already.

Principal

Principal will do anything not to pay

Reviewed by George on October 7th 2018   Verified Policyholder
Hello, I’m writing this on behalf of my wife. Her vision has degraded to the point that she no longer is able to see a pc screen without extreme headaches within a few m... read more >
Reply
Sent on October 7th 2018 by Attorney Gregory Dell

George, it sounds like your wife is a victim to the very common 24-month denial. It is unfortunate that Principal will not accept the opinions of the numerous doctors w... read more >

Principal

Principal is absolutely ridiculous. I'm in financial harship after not receibing my full pay from work and exhausting my long term sick

Reviewed by Michelle P. on December 19th 2017   Verified Policyholder
I was placed on medical leave after suffering from vertigo and later diagnosed with Meniere’s Disease. I was put on Meclizine and Klonopin and Prednisone. During these e... read more >
Reply
Sent on December 19th 2017 by Attorney Stephen Jessup

Michelle, will your ENT complete the applicable Attending Physician’s Statement? The APS will allow the doctor to place all restrictions and limitations he/she is imp... read more >

Principal

Principal owes me 60k

Reviewed by Daniel S. on March 15th 2017   Verified Policyholder
I had a lawyer for my long term disability claim but they wouldn’t sue them for me because the company I worked for sent them a letter saying I didn’t work but 3 hrs a... read more >
Reply
Sent on March 15th 2017 by Attorney Stephen Jessup

Daniel, we would need to see copies off your denial letters and your policy to determine how we may be able to assist you.

Principal

I lost everything when Principal terminated my benefits without calling or emailing me

Reviewed by Ray T. on September 22nd 2016   Verified Policyholder
I went on short term disability August 1st of 2013 I had to get my left thumb total reconstructed. After 6 months of short-term I went on long-term. My company told me I h... read more >
Reply
Sent on September 22nd 2016 by Attorney Stephen Jessup

Ray, have you received a formal denial letter denying the benefit? If the initial denial occurred in October 2015, there are concerns as to time expiring to file an adm... read more >

Principal

I cant but feel I am being starved out and given the runaround.

Reviewed by Christopher on June 7th 2016   Verified Policyholder
I went off of work may 29, 2015, with a blood clot in my leg. I have had vein surgeries in the past to alleviate pain and discomfort, all of which I took vacation on a Fri... read more >
Reply
Sent on June 7th 2016 by Attorney Stephen Jessup

Christopher, I am not sure the reason for the proof of good health- was this from a different department? If the claim is already in appeal review then there would be l... read more >

Principal

Principal owes me 4k

Reviewed by Louann W. on April 28th 2016   Verified Policyholder
Purchased short term disability through my employer with this group. I’ve been out of work since 2/29/16. Haven’t received the first pay. Contract is I’m supposed to... read more >
Reply
Sent on April 28th 2016 by Attorney Stephen Jessup

Louann, if they uphold the denial of your claim on appeal please feel free to contact our office to discuss what your rights/next steps are. Hopefully they will not nee... read more >

Principal

I've never worked with people that are so obviously stalling before. Bunch of crooks

Reviewed by Mike on March 2nd 2016   Verified Policyholder
I have been disabled for over 10 weeks and Principle kept saying the forms incomplete so they needed all the medical records from my doctor, including office notes. After ... read more >
Reply
Sent on March 2nd 2016 by Attorney Rachel Alters

Mike, is this a policy you purchased on your own? From what you’re saying it seems that they are investigating to determine whether or not there are grounds to rescin... read more >

Answered Questions by Our Lawyers
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Showing 8 of 25 Answered Questions

Q: Can Principal deduct my social security payment from my monthly Principal disability benefit payment?

Answered on March 30th 2023 by Attorney Gregory Dell
A: Does you disability policy say social security retirement is deductible? If it does then they are allowed to d... Read More >

Q: Why did Principal not back me when Social Security did?

Answered on August 21st 2020 by Attorney Alex Palamara
A: Durron, I am sorry to hear that your LTD claim was denied. While there are different standards for approving L... Read More >

Q: What is the difference between time period of the claim while approved and the time period of the claim while denied?

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A: Jan, I have not experienced retaliatory actions form Principal for refusing a buyout offer. As to your second ... Read More >

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Answered on April 30th 2019 by Attorney Cesar Gavidia
A: APC, it is difficult to know what they courts would do or how they would weigh the opinion of Principal’s co... Read More >

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Answered on October 5th 2017 by Attorney Stephen Jessup
A: Toni, if your policy was an employer provided policy then almost certainly the policy would contain language t... Read More >

Q: Can Principal take away my deceased husband's 3 month survivor benefit? They justified it saying he was eligible for SSDI when he didn't even apply.

Answered on June 1st 2017 by Attorney Stephen Jessup
A: Michele, I am sorry to hear of your loss. We would need to see a copy of the disability policy to determine an... Read More >
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