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Thursday, July 21, 2016

Large Insurers Accused of Fraud in Denying Disability Claim

When can a policyholder sue an insurer for its tactics in refusing to pay disability benefits?

Obtaining disability payments is difficult even in the best of circumstances. Applicants must meet countless medical requirements, obtain letters and test results from doctors, and file reams of paperwork. But the task is especially difficult when an insurer may be committing fraud.

Plaintiff Seeks Damages for Breach of Contract and Bad Faith

That is the allegation at the heart of recent disability lawsuit against Unum Group, The Paul Revere Life Insurance Company, and New York Life Insurance Company. The plaintiff in the case has accused the companies of committing breach of contract and violating the implied covenant of good faith and fair dealing. The suit seeks contractual and consequential damages, punitive damages, recompense for emotional and mental distress, attorneys’ fees and more.

In court filings, the plaintiff says he had two separate disability policies issued by New York Life which, combined, would pay him $2150 monthly for 24 months in the event of a disability. The plaintiff was suffering from two disabling conditions, one involving his heart, the other his right knee. He alleges that the defendants, acting on their own, retroactively approved a 2007 disability claim he had made for depression. This approval made him ineligible for disability payments for a new 24-month period. He is seeking payment of the disability benefit and other damages.

Insurers Have History of Trying to Avoid Paying Disability Claims

This would not be the first time Unum has faced allegations that it acted improperly at the expense of beneficiaries. In 2016 the company paid  $46 million to settle a class action alleging improper calculation of long-term care benefits. Over a decade ago, the Department of Labor ordered Unum to cease bad faith insurance practices, but many policyholders still say that the company alters the terms of policies after claims are filed, fails to investigate claims properly, and misconstrues medical records in order to deny a claim of disability.

If you are fighting an insurer or government entity that refuses to pay benefits you are owed, an experienced disability attorney can help. With forceful representation, you can level the playing field and overcome the stratagems insurers may use to deny claims.


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