Another Bold Denial by a Disability Insurance Company

Ben Glass

Attorney
(866) 735-1102 Ext 320

0 CommentsPrint ArticleSubscribe

Long term disability insurance claims are tough. The law is terribly weighted in favor of the insurance companies and Congress won't change the law anytime soon since none of its members fall under ERISA (Officially the Employee Retirement Income Security Act of 1974, unofficilally "the Employee Ripoff and Insurance Company Security Act). That's not enough for some insurance companies, though, they try to go the extra mile:

Here's how the Eaton Corporation Long Term Disability Plan got caught:

The plan used a group called Medical Review Institute of America to help deny a claim. This group did an anonymous reviews. That means, they can deny your claim and not tell you who was involved or what their qualifications might (or might not) be.

Here's what a South Carolina federal judge had to say about that:

Further, the MRIoA reviewer is not as credible as Evans' examining physicians. First, the MRIoA reviewer is anonymous. Hence, an anonymous reviewer is not accountable for the findings in their report. Further, it appears to the court that the MRIoA reviewer did not independently evaluate Evans' claims. The reviewer noted that "I will not go into much detail here as to her medical care and evaluations, suffice it to say that every other physician who examined the records over the past two years has determined that she does not meet criteria for permanent disability."

Anonymous reviewers? Who thought that up? The tragedy is that claimants, already strapped for cash, have to hire experienced ERISA disability lawyers (not easy to come by) to battle this junk. To add insult to injury, there are not punitive damages or bad faith damages allowed in ERISA cases. It's no wonder the insurance companies love this stuff. They are laughing all the way to the bank.