California lawmakers want to assist disability insurance claimants
A recent article written by Evan George of the Los Angeles Daily Journal, documents a new bill that would be a great thing for long-term disability claims that are governed by ERISA. If this bill passess, we can only hope that other states across the country would adopt similar legislation. Discretionary clauses do nothing other than tie the hands of judges and increase the profits of disability isnurance companies. A special thanks to Evan for sharing this article with our law firm and for his efforts in independently reporting the actions of long-term disability insurance companies.
Lawmaker Wants to Level Field for Disabled
by Evan George
Spurred by stories of sick and injured policyholders whose disability claims are improperly denied and then tied up in court, a Sacramento lawmaker has introduced legislation that experts say would level the playing field for the disabled.
State assemblyman Dave Jones said his bill, AB 1868, “will help disabled people across California who have suffered from disability insurers’ refusal to make good on their promise.”
The bill seeks a quick fix to what Jones called the “unfair and unequal” legal standing policyholders have suffered in federal courts because of certain clauses that insurance companies insert into the policies, making the companies, and their paid doctors, the sole authority on whether a claimant is disabled.
Under the proposed legislation, those “discretionary clauses” would be null and void.
It would require the state Insurance Commissioner to reject policies that contain those previsions and strike them from existing policies.
The Assembly’s Insurance Committee will hold a hearing on AB 1868 today.
The legislation comes nine months after an investigation by the Daily Journal revealed that hundreds of disabled Californians who are denied benefits face a long and difficult fight on their own, without the aid of government regulators and in an arena that favors insurers.
State and national trade groups for the insurance industry have pledged to fight the bill, saying it removes the insurers’ ability to adjudicate claims and weed out malingering claimants.
“Your bill would turn the claims paying process into chaos,” wrote one lobbyist for the California Association of Health Underwriters in a letter to Jones.
Experts on health law applauded the effort as a strong and necessary consumer protection.
It also has the backing of the Consumer Attorneys of California and individual lawyers who represent policyholders.
Disability insurance, which now covers more than a third of the workforce, typically promises to pay two-thirds of workers’ wages if they become too sick or injured to work.
In most cases, when a worker who has paid for disability benefits files a claim, the insurer will review it and pay.
But some cases – particularly those where the insured reports suffering from complex symptoms like long-term injuries of the back, neck and spine – are denied, even if treating physicians and the Social Security Administration say they can’t work.
The result is that workers who believed they had a safety net find themselves fighting for benefits at the same time they are dealing with health problems and medical bills.
That was the case with Sandra Frost, a former Wells Fargo Bank manager in the East Bay, who plans to testify at today’s hearing.
Frost, 47, has been diagnosed with narcolepsy, chronic pain and another rare condition called Chiari Malformation, which makes working impossible.
She had a group policy with MetLife and received disability coverage in 2002. But by 2004, the insurer and its doctors decided she could return to work, despite what her physicians and the federal government said.
She has been fighting ever since, Frost said.
During a limited bench trial, a district judge found that MetLife did not “abuse its discretion” and dismissed her case. The U.S. 9th Circuit Court of Appeal in 2007 found she should be paid for 3 months of disability, but confirmed that the district court was right to apply a high burden of proof because of that discretionary clause.
MetLife was owed deference in deciding her case, the court found.
“They have no accountability,” Frost said in an interview. “I lost my house, my car, and my good credit rating, and it just wasn’t fair.”
A MetLife spokeswoman on the East Coast could not be reached for comment late Tuesday and a MetLife defense lawyer in California did not return a telephone call seeking comment. The New York-based insurance company has had more than 177 lawsuits like Frost’s brought against it between 2004 and 2009 in California alone.
That legal battle would be made easier for plaintiffs if the bill passes, said Bryan Liang, executive director of the Institute of Health Law Studies at California Western Center School of Law.
“What this bill really does is requires some enforcement,” Liang said.
Brietta Clark, another health law professor at Loyola Law School, said she backed the measure even though she believed it did not go far enough.
“It’s still reactive,” said Clark, because it fails to address the practice of paying a stable of doctors to justify denying legitimate claims. “It doesn’t help patients until they get to trial.”
Both experts said it accomplished the goal of letting judges, not insurers, decide a case based on evidence.
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MetLife for disability? Avoid the surgery unless it's life-threatening
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Answered Questions by Our Lawyers
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Q: Can Metlife reduce my LTD benefit due to SERP payments that were not paid to me (they went directly to FICA taxes)?
A: Jim:If this payment is a form of a retirement or pension payment then it is likely correct for Metlife to of... Read More >
Q: Do I have an option after my appeal is denied?
A: Lauren:If your appeal is denied by MetLife then you have the option to file lawsuit in federal court. Read More >
Q: My daughter died in 2019
A: If your daughter was disabled prior to being terminated then she should have coverage. Read More >
Q: Can I sue Metlife for non payment of approved claim?
A: Unfortunately, the answer is "not liklely." I would assume your MetLife policy is an employer provided policy ... Read More >
Q: How far behind in payments does Metlife have to be to take legal action?
A: Make sure you put all of your requests in writing so there is a record should you end up in court. It’s best... Read More >
Q: Does Metlife pay Disability payments ahead? Example: December payment is for January.
A: Peg, most disability insurers pay monthly disability benefits in arrears, in other words, payments are made fo... Read More >
Q: Would any new disabling conditions be considered by Metlife when considering whether or not to continue my benefits?
A: The change in diagnosis will likely lead to denial so please explain the situation to your treating doctor. Me... Read More >
Q: MetLife: Mental Health and Physical Disabilities
A: If you have physical disabilities that prevent you from working then you have options to get around the mental... Read More >
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Get Your Disability Application Approved
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.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
Submit A Strong Appeal Package
If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
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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98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the little guy against the multi-billion dollar insurance company giants.
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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Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
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Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
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Who are Dell Disability Lawyers?
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.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
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.
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 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.
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 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.
How can I contact you?
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.