Once a Long Term Disability Claim is Paid, It Stays Paid, Right?
Many people think so, but under ERISA, that is not true. A recent example proved that again. Mr. Brian McConnell filed a claim for benefits in 2009. “The defendant and its predecessor paid benefits without interruption from 2009 to June 2018, when the defendant terminated benefits. ” McConnell v. Am. Gen. Life Ins. Co., CIVIL ACTION 19-0174-WS-MU, at *2 (S.D. Ala. Jan. 21, 2020) This happens too often … on claim many years and then “out of the blue” the claim was terminated. I know of a lady who was on claim over 20 years!
Does that only happen when someone’s condition suddenly improves? Is there material change for the better? That would be rare. Most people with problems only see them get worse as they age, so that is almost never happens. So, what gives? Insurers do this because they think they will get away with it. A new adjustor takes over, or the company is sold and they want to show their boss how wonderful they are to save money. Or there is a concentrated effort by the director of the department telling the adjuster to deny claims to increase profits.
Insurers don’t worry about whether decision-making was inconsistent or not. They don’t worry about what a court might think of them. After all what can a court applying ERISA do? Only make them pay the benefits they should have been paid to begin with. No punitive damages are allowed. No mental anguish damages are allowed. It doesn’t matter how much grief they put anyone through. I see clients in tears, very frustrated, upset and angry to have their benefit pulled out from under them. They cannot work a job and have not been able to do so for many years. ERISA allows attorney’s fees so they hope maybe there’s a chance the insurer might be liable for the plaintiff’s attorney’s fees. Maybe, but look at how many opinions there are awarding fees. Not very many.
Mr. McConnell was very fortunate to find an experienced ERISA attorney. Many clients are not so fortunate. And what happens if a company like American General decides to terminate benefits when there is only 1 or 2 years left of the claim? Not much to pursue. It can be really hard to get an attorney to help on a contingent fee basis at that point.
That is why we offer creative fee agreements for our clients. We agree to stay with the client for 5 to 10 years and sometimes longer. We spread our contingent fee out over that time to make it a little bit easier on the client, and then we stay in place to defend the claim. We diligently protect the right to continue to receive benefits. Does that mean we have to file a lawsuit twice if necessary? Yes, and we have! Does that mean we have to file an appeal two times and fend off a claim termination repeatedly? Yes, and we have many times.
We understand all too well the games that insurers play. Companies like American General (aka AIG) also know all too well how the ERISA game is played. Do not let a big insurance company run over you! You need an experienced ERISA disability lawyer on your side to put some fairness back on your side. We have handled these claims since 1992, and we have seen quite a few tricks during that time.
Contact one of our experienced ERISA disability attorneys today for a free claim evaluation.