Do you know if you can bring a Bad Faith claim against an insurer with an ERISA governed disability insurance policy? As of September 2004, the answer to this question is: No. Chief Judge Anthony Scirica, writing for the United States Court of Appeals for the Third Circuit last fall, in Barber v. UNUM, ended years of judicial debate about whether ERISA preempted Pennsylvania’s Bad Faith Statute under it’s broadly interpreted preemption clause. The Court held that Bad Faith is preempted under ERISA, under both the doctrine of conflict preemption and under express preemption. This decision effectively put to rest […]

The fact is that disability insurance companies are becoming more aggressive in attempting to find ways to deny claims. All provisions of your disability insurance contract must be satisfied in order to make the company obligated to pay you benefits. The definition of either total or residual disability typically contains a second condition, which not only has to be met in order for you to receive your disability income, but which is fast becoming a weapon in the company’s arsenal of ways to attack claims. I am referring to the physician’s care provision, or the issue of “appropriate care.” You must […]

Do you have group long-term disability coverage that pays you if you become disabled? If you get sick or hurt, are you relying on that group LTD policy to pay you benefits? If so, don’t count on it. There are three primary reasons for this: (1) inferior contract language, (2) ERISA, and (3) relevant court decisions. If you become disabled, you may be in for the fight of your life. Unfortunately, when you are disabled and at your most vulnerable is the worst time to mount a fight against a big insurance company. As you read this article, think how […]

Since my last article appeared in this publication in March 2001, there has been even more press, in this publication and others, about difficulties related to payment of disability benefits. This is just not anecdotal; more physicians call me now, and call earlier in the claims process, for assistance with their disability insurance claims. Although many claims are paid, the insurance industry has become more restrictive in its acceptance of liability of a claim. For instance, several disability carriers have required that the insured provide objective evidence of disability, notwithstanding the fact that such a provision or requirement does not […]

As an attorney representing physicians and health care professionals with disability insurance claims, I often find what appears to be a trend: many disability insurance companies are taking a more “hard line” approach when it comes to paying out benefits on their disability insurance policies. This position applies to the full gamut of claims that I see in the course of my practice, including claims for drug and alcohol dependency, psychological and psychiatric conditions, cardiac conditions, orthopedic claims as well as other mental/nervous and physiologic conditions. Back in the 1980’s physicians were the favorite “target market” of the numerous insurance […]