Insurance Companies Still Allegedly Denying Legitimate Claims

Washington, DCNo matter how many lawsuits are filed, it seems insurance companies are still accused of improperly denying legitimate long term disability insurance claims. New lawsuits are constantly being filed claiming despite policyholders having proper medical evidence to confirm disability claims, insurance companies violate ERISA and other laws by denying or delaying payment of such claims. Although there are situations in which insurance companies legitimately deny false claims, policyholders say there are still too many instances in which valid claims are denied.

Recently, a lawsuit was filed against American United Life Insurance Company by Rhonda Carter (according to Pennsylvania Record; 8/22/16). Carter reportedly suffered joint pain, migraines and benign brain tumors that prevented her from working as a document processing tagger. She filed for short-term disability benefits but was denied despite, according to her lawsuit, having a policy that covered her disability and having medical evidence of her disability.

Policyholders have filed lawsuits against many insurance companies, alleging that their claims have been unfairly denied or delayed to protect company profits or meet quotas. They say companies will claim the policyholder has a condition that is preexisting or is not covered by the policy to get out of making payments. Or they will claim the policyholder has not provided sufficient evidence of disability, even in cases where medical evaluations from independent doctors have been provided or where Social Security disability benefits have been awarded.

Worse, they allege that because of the failure to properly pay out legitimate claims, insurance companies put policyholders in financially precarious positions. They are unable to work so often they cannot afford to pay their bills. They may also not be able to afford to pay out of pocket for vital medical care that could help them.

In August of this year, Haruki Nakamura, a former NFL player, filed a lawsuit against his insurance company alleging his disability claim was wrongly denied. Nakamura alleges his company subjected him to "interminable delays in its 'investigations' of [his] claim" and "virtually impossible, hair-trigger notice procedures." The company also allegedly used unscientific and unverified reports of Nakamura's response to waiting room lights when it decided not to approve his benefits. In all, it reportedly took the insurance company two years to deny his claim, even though the NFL's player retirement plan awarded him total disability benefits.

Carter's lawsuit alleges violations of the Employee Retirement Income Security Act (ERISA). The lawsuit is case number 3:16-cv-00177-KRG, US District Court, Western District of Pennsylvania.