If you were wrongly denied benefits under an Anthem Life Disability claim, as LTD insurance lawyers we can help you take legal action to get the benefits you need and deserve.
Anthem Life Insurance Company is a subsidiary of Anthem Inc., a billion dollar health care and insurance company. Anthem Inc. merged with WellPoint Health Networks, Inc. According to the AMA, Anthem Inc. is the nation’s largest health insurer in many local markets.
Anthem Life is in the Blue Cross and Blue Shield network of companies. In the disability insurance market, Anthem Life offers
- Group short-term disability insurance
- Group long term disability insurance
- Voluntary short and long term disability (in some regions)
All of Anthem Life’s disability plans are group plans that are employer-sponsored, and therefore governed by federal ERISA law.
ERISA law leans in favor of insurance companies, not the disabled claimant. If Anthem Life unfairly denies your claim, you must go back to Anthem Life to ask them to change their decision.
If your disability insurance claim was denied by Anthem, or if benefits have been terminated, you should consult with a qualified lawyer straight away. You have a short amount of time to appeal a claim denial, and will need an experienced ERISA claim attorney to prepare a rock solid appeal.
Examples of Anthem Life Disability Claim Review and Denial
Like many insurance companies, is not uncommon for Anthem to take maneuvers to avoid paying claims. Here are a few examples.
Own Occupation Changes to Any Occupation:
As with many group disability insurance plans, Anthem Life’s policies are written with a 24 month “own occupation” definition of disability. Once 24 months are up (generally as a short term disability claim) the policy definition changes to “any occupation.” If you are awarded the maximum amount of short term disability benefits (you were disabled from performing your “own occupation”), Anthem ends benefits by denying long term disability benefits, because your condition is not severe enough to keep you from performing any occupation.
This strategy give insurers a way to allege that the medical or vocational evidence submitted in your claim does not support that your impairment is severe enough to justify that you are totally disabled from working at any occupation in the national economy – a claim that is much harder for you to prove.
Third Party Medical Reviews to Override Your Treating Physician’s Opinion
Another course of action routinely taken by Anthem Life is to use third party independent medical reviews of your initial claim or during the appeal process. These third party reviewers frequently conclude or allege that
- there is not enough objective or clinical evidence to support your disability,
- you do not meet the plan’s definition of disability (i.e., you can still do the material and substantial duties of your regular occupation, or
- or simply ignore your treating physician’s medical opinions or only do a limited “paper review” of your disability – hence deciding you are not disabled.
Without just cause, these actions become unfair ways to deny an initial application or an administrative appeal of the denied Anthem Life disability claim.
Abuse of Discretion by Anthem Life
In addition to other judicial decisions, the court has ruled against Anthem Life for denying LTD benefits on such grounds, which – when shown to be unreasonable – come under the standard of the “abuse of discretion.” This means the insurer, by denying a claim, has acted in its own self-interest.
However, it takes a well-developed administrative appeal to prevail in federal court, and for judicial review to find in your favor.
Ask Our Anthem Life Disability Claim Lawyers about Your Options
If you need help in preparing a legally sound disability appeal — or if you just have questions about your claim — please contact our law firm for an informative and free case evaluation.
NOTE: Talk of a merger of Anthem Inc. with powerhouse insurance company Cigna is in the news. Plans are not final, and in July 2016, Attorney General Loretta Lynch announced that U.S. government regulators, focused on antitrust enforcement, have filed lawsuits to block the deals between Anthem–Cigna and also a proposed merger between Humana and Aetna.*
Creation of giant insurance companies through such mergers can make disability insurance issues even more alarming for insureds. Marc Whitehead & Associates will remain on top of this situation, and will keep you informed as the situation develops.