Disability Lawyer, Marc Whitehead has filed suit on behalf of a disabled 53 year old worker and a resident of Texas, who became severely disabled while covered under a long term disability insurance policy issued and administered by Met Life.
Plaintiff is a 53 year old worker and was formerly employed as an Administrative Project Manager. Plaintiff is a resident of Texas and is currently disabled due to pancreatitis, gastrointestinal bleeding, osteoarthritis, Hepatitis C, lupus, PTSD, and fibromyalgia. Met Life is an insurance company doing business in Texas.
Venue & Jurisdiction of Long Term Disability Lawsuit
Suit was filed in federal court in Texas pursuant to 28 U.S.C. § 1331. Specifically, Plaintiff brings this action to enforce plaintiff’s rights under the Employee Retirement Income Security Act (ERISA), as allowed by 29 U.S.C. §§ 1132, 1133, & 1140
Allegations of Wrongful Denial of Disability Benefits Under ERISA:
Plaintiff brings this action to secure all long term disability insurance benefits, to which Plaintiff is entitled under a disability insurance policy underwritten and administered by Met Life. Plaintiff is covered under the policy by virtue of plaintiff’s employment.
The Social Security Administration issued a fully favorable decision on Plaintiff’s claim for social security disability benefits under Title II and Title XVI of the Social Security Act, finding that Plaintiff is “disabled” during the relevant time period, a fact that Met Life was aware of.
On November 09, 2010 Met Life notified Plaintiff that Defendant affirmed its original decision to deny Plaintiff’s claim for long term disability benefits, totally ignoring the findings of the Social Security Administration.
Met Life also notified Plaintiff on November 09, 2010 that Plaintiff had exhausted all administrative remedies and they would consider no further claims or evidence. Met Life, in its final denial, discounted the opinions of Plaintiff’s treating physicians, among others, and the documented limitations from which Plaintiff suffers including the effects of Plaintiff’s impairments on plaintiff’s ability to engage in work activities. Plaintiff has now exhausted all available administrative remedies, and plaintiff is forced to file a lawsuit to obtain plaintiff’s rightfully owed disability benefits.
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Claimants must prove the insurance company “Abused its Discretion”
In a disability insurance claim brought under state law, the disabled claimant only has to prove it is “more likely than not” that they are disabled. This generally only applies to individually purchased policies. Most policies however are obtained through a worker’s “Employee Benefit Plan.” Employee Benefit Plans are usually governed under ERISA. In most claims brought under ERISA, the claimant must prove that the insurance carrier “Abused its Discretion” when it denied your claim. This is a very tough standard requiring you to show the insurance company had “No Reasonable Basis” for denying your claim. An example might be if you had three doctors that said you were disabled and the insurance company only had one that said you were not. The insurance company could legally argue that they had a “reasonable basis” to deny your claim based on their one doctor, in spite of your three.
Disability Insurance companies such as Unum, Cigna, Aetna and Prudential often write their policies so to take full advantage of ERISA rules and regulations to make it difficult for a disabled person to get receive benefits or to keep them for the entire length of the term of their insurance policy. Other insurance companies with a large share of the disability market include The Hartford, Standard Insurance, SunLife, MetLife and Liberty Mutual, Provident, CNA, John Hancock, Colonial, AXA Equitable, New York Life, Guardian, Penn Mutual.
If you have questions, ask disability attorney, Marc Whitehead by visiting disabilitydenials.com or you can download Marc Whitehead’s free E-book, Disability Insurance Policies-How to Unravel the Mystery and Prove Your Claim.
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