Oftentimes employees in Illinois and around the country have to engage in fierce battles with an insurance company in order to pursue their long term disability benefits under an employer-sponsored long term disability plan. With the help of an experienced disability attorney, sometimes these battles for benefits end quickly, and you never have to step foot in a courtroom. Other times, for one reason or another, people are forced to pursue their long term disability benefits in federal court or give up.
In a recent case, an aerospace engineer had to obtain two important court orders to enable her to receive an award of benefits. Yancy v. United of Omaha Life Ins. Co., No. CV14-9803 PSG (PJWx), 2015 U.S. Dist. LEXIS 172233 (C.D. Cal. Dec. 18, 2015). During her first round in court, Ms. Yancy had to fight for a court to order that she be allowed to submit additional information into her Administrative Record, because she was unable to address the insurance company’s neuropsychologist’s harmful report and respond to it during her administrative review. Yancy v. United of Omaha Life Ins. Co., No. CV 14-9803 PSG (PJWx), 2015 U.S. Dist. LEXIS 118595 (C.D. Cal. Aug. 25, 2015). After successfully augmenting her Administrative Record, she returned to court so that her claim for long term disability benefits could be properly reviewed.
Ms. Yancy became disabled shortly after the summer of 2012, when she began to suffer from migraines, body aches, weakness, fatigue, and memory loss, which were later attributed to migraines, major depression, fibromyalgia, and possible systemic lupus erythematosus. Ms. Yancy had provided the insurer with ample medical records as to all of her conditions. The Court found that there were several problems with the insurer’s denial of Ms. Yancy’s benefits under the long term disability plan. First, the insurer was operating under a structural conflict of interest, which appeared to have influenced the handling of Ms. Yancy’s claim. Second, the insurer committed a procedural error in denying Ms. Yancy the opportunity to respond to one of its doctor’s reports before administering its decision. Third, the insurer construed the plan in a way that conflicted with the plain language of the plan provisions. Fourth, the insurer failed to develop facts necessary to its determination, even going so far as to rely substantially on clearly false findings of fact by its file-reviewing doctors in making its benefit determination. Ultimately, the Court found that when considering all of the evidence and circumstances of Ms. Yancy’s case, there was no evidence that would provide the insurance company a reasonable basis for denying her claim for long term disability benefits. The court ordered the insurer to pay Ms. Yancy all of her back benefits.
An experienced ERISA long term disability attorney can help you fight the insurance company and identify if its decision making process will hold up in court. If your claim for long term disability insurance has been denied–do not give up! Call an ERISA lawyer right away.