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by “One who wants to see laws change” 

The worst insurance policy to have is a long-term disability (LTD) policy because it usually falls under the guidelines of Employee Retirement Income Security Act (ERISA). If you make a claim on an ERISA covered LTD policy and have been denied benefits, you will be unlikely to find an attorney to pursue the matter. The major obstacles to finding an attorney to handle your lawsuit are that you must sue in Federal court, you are unable to collect attorney fees if you do prevail, punitive damages cannot be awarded, and it cannot stop the insurance company from just doing it again after time has passed.

You will not have much luck with your state’s Department of Insurance (DOI) either. Of all the state DOI’s, California is probably the most effective one, and even it is powerless when it comes to a LTD policy covered by ERISA. In fact, no state regulates ERISA insurance policies. The state DOI’s only regulate how the insurance company conducts business in the state-not the policy itself.

I purchased a long-term disability (LTD) policy with CNA insurance thinking I would probably never use it but if something should happen to me, this policy would take care of me as it so stated. I didn’t think about it again, just made my payments each month, until my life turned upside down and I wasn’t able to work.

I was brought up with a strong work ethic, and I loved my work. I would have done it without pay if I could have lived without an income. This only increased the emotional pain of not working. Regardless of how much I wanted to return to work, the physical pain and was too great to overcome. Eventually my injury required surgery which was supposed to make me as “good as new” but unfortunately took away one physical problem and created others.

For the first 3 months of my disability, I had short term disability insurance through my employer’s insurance. For the balance of the first year, CNA made LTD payments to me but subtracted from their payments the full amount of the State of California’s Disability Insurance (SDI) benefits. CNA’s contact rep assured me I was lucky and had a good policy and I would be taken care of. Actually that was the first rep I had, (She was the one who said don’t bother with workers comp because you have us and the policy clearly indicates you’re covered!) As the months went by, I was passed on to new reps. The kind and compassionate attitude diminished with each rep change. At the end of the year, when California’s State Disability Insurance was about to run out, I received a letter from my newest rep stating CNA was denying any future benefits because they felt I ‘should’ be better. My LTD income immediately stopped. I later found out that this was typical…to stop paying when they would have to pay the first complete benefit payment. First make you feel safe, then kick you in the stomach when you are the most vunerable.

It didn’t matter to CNA that all 6 of my very reputable medical doctors said I was 100% disabled nor did CNA think I had a right to be examined by one of their physicians. I asked to see their doctor. I had nothing to hide. But I was refused. I was never examined by a doctor or representative of CNA insurance.  Our only communication was over the phone with an assigned rep. Yet, I had one of the “good” policies that said CNA would cover me if I could not go back to the kind of work I had been doing when I was injured, and that I would be covered as long as I was disabled. They cut me off, and I was told the only thing I could do was to file a petition for a grievance and wait 90 days before I had an answer. If I continued to be turned down, I would then have to appeal to Federal Court.  Since they wouldn’t even send me to a doctor, it was pretty clear what the answer would be. It was also clear that this would be dragged out.  I had to find an attorney.

I was not getting any better and, if anything, my situation was deteriorating under the stress of not knowing how I was going to be able to pay the rent and day-to-day bills and my COBRA $300 a month health insurance. I hadn’t filed for worker’s comp because the CNA Rep told me not to bother because they would take care of me. Also, I thought I would be going back to work soon.  Like so many others faced with medical expenses I was forced to use credit cards to live while waiting for resolution. Eventually, I was forced into bankruptcy. Which was humiliating after a lifetime of good credit.

Like so many disabled individuals who find it difficult to muster the energy to fight a deep pocket insurance company, I needed help in working through the insurance company’s labyrinth of mythical proportions. I wouldn’t have been able to do it without the help of a friend.

Phone call after phone call to attorneys who handle insurance claims were met with the same response after telling them of my denial by the LTD insurance company-laughter.With the help of my friend he found an attorney who would see to me.

We located a law firm familiar with ERISA, and one that wasn’t on the side of insurance companies. At first, after wading through the contracts, it seemed clear that my claim against CNA insurance clearly DID NOT fall under ERISA guidelines and that the case could and should be heard in a California state court. Unfortunately, over a period of time, and several meetings,  my attorneys were out maneuvered by CNA’s attorneys. CNA provided NEW material that made references to ERISA–(surprise…surprise). Though not the original contract which I possessed (which indicated that I, not the company, had purchased the LTD insurance from CNA and I not the company paid for it without any reference to ERISA) , the new material made references to ERISA.

This new material, and a similar case elevated to the 9th Circuit Court which had just been denied the right to litigate in State Court, meant to my attorneys, that this made my chances of recovery slim. My case now referred back to Federal Court and I was left SOL. However, I was told that if I tried to go after CNA through Federal court, CNA would charge me their attorney fees for what they had already spent on the case while I was trying to be heard in state court. They strongarmed me into signing a statement that said I wouldn’t pursue it further. They forced me to stop. What else could I do. I couldn’t risk losing in Federal Court and then oweing their attorney fees. I maintain they defrauded me. To date, about $500,000 worth. This is just the monthly benefits I didn’t get. Since I am still disabled and the policy was for my lifetime…the backpay keeps growing. 

Fortunately, after being turned down the first time (common practice) and obtaining a social security attorney, SSDI approved my claim for 100% disability. I was able to start receiving Social Security Disability income. I also found a great Workers Comp attorney. After filing for bankruptcy, and moving to a lower income area I was able to just barely live on social security disability income. It took another 5 years to finally settle my workers comp claim. If it had not been for social security, I would have been destitute.  As it was I was left with 7-10 years of bad credit and the humiliation of how it effects all aspects of ones life. 

Long term disability insurance policies are worthless. The stats I found said that only 5% of the insured fight back when they are denied their rightful benefits–5%. That means I am in the 5% who fought and look what happened to me. I had all the reputable doctors, all the documentation, a signed contract that stated that the policy was between me and the insurance company, but when it came down to using it, they ‘found’ bogus “company” documentation that I had never been privy to, dated after my contract, that placed me “under ERISA guidelines. They defrauded me and there was nothing I could do about it. Nothing. No laws to protect me.

My only way to fight this injustice was through State Court and for a while I believed I might actually achieve justice. But the laws are set up for the insurance companies not people who are disabled. The judges side with the insurance companies a majority of the time. I get angry when I hear misinformed people making comments about ‘those people’ who collect disability income and spend leisure time water skiing or laying around pretending to be injured…stealing the federal or state money…you’ve heard the comments. I mean, after all, who do YOU believe,  individuals who ask for disability income or insurance companies?

Most people who ask for help, are legitimate, the insurance companies lobby in Washington and State Capitols, sell commercials on tv and radio, insert lies as public service announcements to make us believe that “those people pretending to be disabled” are causing “your taxes or insurance payments to go up”. The truth is their greed is causing the insurance policies to go up. I have learned a lot in the last 8 years. I hope this will help others who might be going through this. Get Attorneys, and fight for your life. Maybe you’ll be the one. The one to win in court. The one to change the laws to protect yourself and others in need. Maybe you’re feeling great today…no one expects to be injured and unable to work. When we feel well we all think we’re invincible, but we’re not. Contact your representatives…ask about your rights. Protect your future and the future of your family.       

{ 16 comments… add one }

  • James March 27, 2012, 2:23 pm

    I too have gotten screwed by a Long term disability company. And they have no intention of paying you for the long term. Even though I`m declared 100% disabled by SSD.These companies are protected by the law they call ERISA. They will committ fraud against you anyway they can. And if you can find an attorney to take your case, you are wasting your time and effort..In the court process, you are guilty with no way of proving your innocense..You don`t have the right to even stand in court and face a judge. Nor do you have the right to bring witnesses or your doctor or anything..There is no lengths of how low they will go to commit fraud. There is no justice in this country. Why do these companies need lobbyists in Washington if they are not trying to cheat people. And I think that the judges get pretty nice gratuities from these companies. And eventhough your doctors will say your condition will only get worse. They never ask you to go to another doctor or to take other tests. If I would have robbed someone, I would have had theright to face my accusers and tell my side t rebutt what is said about me. But not in these cases. I wouldn`t even know what the judge looks like if I stepped on his toes in an elevator. And I have tried to get other jobs and can`t pass a physical. The Hartford. I call them dirty rotten SOBS. And some day I will see them all. Because there is a Judge that we will all stand before someday.

  • Jack January 3, 2013, 4:28 pm

    Okay,

    So I work for an insurance company. I’m a LTD claims specialist. Meaning I am directly responsible for managing your claim, approving, denying, etc. I can honestly say Insurance Companies are not out to destroy you. Long Term Disability Insurance is just that. Insurance. As long as you remain disabled from your own occupation (this means your occupation LEVEL… not your job) you can receive benefits. Usually after a period of 24 months (or for the REALLY good policies until your normal retirement age (usually 65)) you are then investigated to see if you can work ANY OCCUPATION (which means that based off your former salary and work history if you can make a gainful amount. This is unfortunately MUCH LESS then your salary from before) Now I can’t speak for companies like CNA but ALL of the decisions at my company are based off of medical documentation from your providers. We have medical professionals that I see EVERY DAY, who basically make our decisions for us. Benefit Specialists only RARELY can make a decision to cancel your benefits without medical documentation, and this is usually for things like failing to provide documentation or requested forms (there is usually a 60 day policy from the date you are first contacted for you to get this information to our company)

    Now, I’ll admit I’ve cut off a lot of people, but it’s because they tried to cheat the company by claiming disability and not being disabled (Yes, this DOES happen), working while also collecting a disability check (happens a lot too, and its illegal), and not turning in requested forms or not being disabled for their own occupation (again NOT job, look up occupation levels on google it will give you a description). Yet, I like to try and tell people that the best thing to do once you start on LTD is to GET OFF IT. LTD is a crutch, and a weak one at that.. If you do feel like you are totally disabled… Most people hope to hold out for Social Security because once you’re approved for that, benefits are rarely canceled.

    As for the loan thinking I can address that as well. When you start LTD it is written in your contract (most contracts) that if you receive social security it will be considered an offset of your LTD policy. Meaning…. when you are awarded social security you are usually given a very large lump sum check at the beginning which is retroactive to the date your disability began. The law states that insurance companies, who were paying you since before the award of Social Security are due the money that they were paying you for that time. Guess what… you don’t just get to keep a $25,000 dollar check! (How is that fair for you to get paid a lot more just because you’re disabled?) So after that you have to pay the company a large chunk of that back. But guess what? Insurance worked for you! (this happens a lot) Insurance was around long enough to guarentee that you received SOME income during your disability. Even after your award of Social Security as long as you remain disabled according to the company policy the company will make up the difference from your social security checks (meaning if you receive 100 from social security and you were receiving 200 from LTD, LTD will now pay 100 to make up the difference).

    So my advice? Read your policy. Know the dates of your own occupational period and your any occupational period. AND know that you can be cut off at ANY TIME. And return to work as soon as you can, or if you feel like you’ll never be able to return to work EVER then wait for social security which can take up to two years to get.

    That being said I hope this helps people. Please know that if you try to cheat insurance companies, it’s against the law and you could go to jail. If you are an honest person, and a hardworking person then it should work out for you. As for LTD, its a huge money loss for most insurance companies meaning THEY DON”T MAKE A PROFIT FROM LTD (I’ve seen the numbers in accounting. I’m not lying) Return to work as soon as possible if possible, and get social security as soon as possible if possible (if you’re COMPLETELY disabled) otherwise your best option is to work again. I’m sorry if you have to work through the pain, but a job is MUCH more secure then insurance. May not be what you want to hear but don’t shoot the messenger shoot the laws that prop these rules up.

    Thanks

    -LTD Benefit Person

  • Storyman January 3, 2013, 7:59 pm

    LTD Benefit Person,

    Thank you for sharing your experience from working within an insurance company that sells LTD. It is interesting that you never mentioned ERISA, which is the Federal laws governing LTD. What ERISA allows insurance companies to behave in a capricious manner mainly because when there is malfeasance by the insurance company the complainant is unable to sue for punitive damages.

    However, if the case falls under the purview of the state punitive claims can be awarded. I personally know of one LTD claimant who was denied his claim after a couple of years. The insurance company claimed it fell under ERISA because an office worker mistakenly paid his monthly LTD insurance fee by a company check.

    Being aware of how many LTD insurance companies will deny high wage earners after a year or two this gentleman cancelled the payment and reissued the payment from his personal checking account. That one lone error would have been enough to prevent him from filling in his state’s Superior Court.

    The outcome was that the LTD insurance company was slapped silly with punitive damages.

    I’ll agree with you that backdated SSDI payments should be used to reimburse the insurance company. It’s like how auto insurance and medical insurance would cover the same claim giving the claimant a double payment. That is no longer allowed.

    When it comes to profit/loss, I’ll beg to differ. There are a lot of ways to make it look like there is little profit or even a loss. Movie studios wrote the book on it and the insurance companies appear to have read it. Insurance companies reward their CEOs with yearly benefits that exceed what the average worker will earn in a lifetime. Do you really believe that these captains of insurance are going to allow a loss?

    Finally, you don’t really understand what a LTD claimant experiences. Sure, there are some bad apples in every barrel, but it is not as rampant as the insurance companies want you to believe. The fact is that most people hate being disabled. Given a choice they would LOVE to return to work. Talk with someone who has followed the rules their entire life and then suddenly find themselves disabled and you’ll find someone who can’t understand why the insurance company is treating them like a thief. It’s a walloping blow to be in physical pain, then have some faceless LTD claims adjuster suggest you’re faking it and should get back to work.

  • Loretta January 22, 2014, 5:49 pm

    I have to argue with Mr. Jack. I pay for my SSDI with my wages, every paycheck. This is the same as paying for my S/LTD insurance. Therefore I’m entitled to both insurances. It’s not fair to me to pay a premium and not get a benefit just because I have multiple policies. I have followed the rules my entire life and would say I’ve been over insured. It’s high time I get my benefits now that I need them. I paid my dues.

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