What is Liberty Life Assurance Company of Boston trying to hide in denial of disability benefits?

This disability insurance case against Liberty Life Assurance is an example of the type of fight that a disability insurance company will engage in once a disability lawsuit is filed. It is often surprising that disability insurance companies will claim they are acting fairly, yet when you ask them to provide claims handling information they will aggressively object.

Disability Attorney Sues Liberty Mutual

Antonio Prado filed a lawsuit against Liberty Life Assurance Company of Boston (“Liberty Life”), administrator of the Allied Domecq Spirits and Wine Group Disability Income Policy, in the United States District Court for the Northern District of California. As an employee of Allied Domecq Spirits and Wine (“Allied”), Prado was a qualified participant of his employer’s disability insurance plan with Liberty Life.

Prado was injured on September 2, 2003 while employed and subsequently applied for long-term disability under Allied’s disability plan. Under the plan, claimants receive funds for up to twenty-four months if an injury renders them unable to work in their “own occupation,” and receive payments beyond that time period if they are unable to work in “any occupation” for which they are reasonably qualified.

Liberty denied Prado’s claim and in 2005, Prado filed a disability insurance lawsuit.

Court finds that because Liberty acted both as the plan administrator and the funding source for benefits, it operated under a structural conflict of interest.

The court found that Liberty’s conflict of interest, in addition to other factors, supported its finding that Liberty abused its discretion in denying Prado’s claim. However, despite the courts conclusion that Prado was unable to perform his “own occupation” for the first 24 months of his injury, Liberty Life again denied Prado’s claim, finding insufficient objective evidence of a disability.

Prado brought a second suit alleging three causes of action:

  1. review of denial of ERISA benefits;
  2. violation of California Insurance Code Section 10111.2; and
  3. failure to produce records under 29 U.S.C. § 1332.

Court holds that Plaintiff is entitled to conduct limited discovery into the nature, extent, and effect of Liberty’s conflict of interest on its decision-making process.

During Liberty’s assessment of Prado’s appeal, Prado made several requests for additional information from Liberty to “prepare an appropriate appeal.” Liberty denied Prado’s request arguing Prado was requesting “private, trade secret, proprietary and/or confidential commercial information regarding [Liberty’s] processes, operations, work, or apparatus which has not been made public and may have the effect of causing harm to [Liberty’s] competitive position. A second request by Prado was also denied.

Prado’s requests for additional documents were aimed at obtaining information relevant to show the nature, extent and effect of Liberty’s conflict of interest. The court was not convinced by Liberty’s claims and allowed Prado to conduct a limited discovery into the Liberty’s conflict of interest on its decision-making process.

Plaintiff argues Liberty was obligated to produce certain documents during its claim assessment.

In addition to documents evidencing the effect of Liberty’s conflict of interest, Prado argued that he was entitled to receive certain documents during the claim determination process under Department of Labor regulations. Among the requested documents were: The Long Term Disability Plan and amendments thereto; The insurance policy issued by Liberty Mutual to insure the Plan; All writings which establish that the Plan has complied with 29 C.F.R. § 2560.503(b)(5); etc.

The court concluded that it needed the requested documents and all relevant information to determine if Liberty abused its discretion in denying Prado’s claims and for that reason granted Prado’s requests.

Conclusion

The court granted Prado’s Motion for Order Directing Liberty to Augment the Administrative Record and for Leave to Conduct Discovery.

Generally, claims denials reviewed by a court are limited to the administrative record available to the administrator at the time it rendered its decision when the administrator is found to have been granted discretion to interpret the policy. However, a court may allow limited discovery when it deems appropriate.

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FAQ

Do you help Liberty Mutual claimants nationwide?

We represent Liberty Mutual clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Liberty Mutual disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Liberty Mutual. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Liberty Mutual.

How do you help Liberty Mutual claimants?

Our lawyers help individuals that have either purchased a Liberty Mutual long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Liberty Mutual:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

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 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.

What are your fees?

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 telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. 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.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer 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.

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Paul D., MD

Mr. Dell has represented me in my dealings with Unum Provident for over four years. When Unum tried to deny my claim he was able to make Unum understand that I was still disabled and unable to do my job. He has been most effective and honest. I recommend him unequivocally.

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