Discovery in the litigation process has been expanded in various venues and Lincoln could face scrutiny regarding its budgets, goals, or business practices.

As one of the nation’s leading disability insurance law firms, Quadrino Schwartz commonly receives Lincoln Financial disability inquiries. We represent those Lincoln Financial policyholders who have submitted claims and have had their claims either delayed, disputed, denied or terminated. Our disability insurance lawyers can be contacted through the form here or by calling toll-free at 1-800-745-1755 for help regarding your Lincoln Financial disability claim denial.

NOTE:

The Lincoln National Life Insurance company was founded in Fort Wayne, Indiana on June 12, 1905.  Along with life insurance, the company also provides Lincoln Financial disability insurance.  In 1911, Lincoln Life reported $6.5 million of life insurance in force with $250,000 in premium income and $750,000 in assets. During its first 50 years – from 1905 to 1955 – Lincoln Life grew to become the ninth largest life insurance company in the United States. In 2006, Lincoln merged with Jefferson Pilot Financial.

Disability insurers will often approve a claim after a brief initial investigation, but then later cut off the monthly benefits (a claim “termination”).  There are several possible reasons for an “approve and then terminate” scenario, and often the insurer’s reasons appear to be business / profit-motive related.

When a termination happens, the insurer gets to grab a pool of money that had been set aside for a particular claim.  That pool of money is known as a claim reserve.  If the company, such as Metlife, grabs the reserve money and then books it as profit, it can justify spending some money on legal fees toward a fight in court and hope that it can settle the case later date.  Once a lawsuit is filed, however, Metlife needs (by state law) to set aside a new reserve.  In such a scenario, Metlife is simply kicking the can down the road but also hoping that the disabled person will not sue, or, if he /she does, will not hire the right law firm and put up a good fight.

Quadrino Schwartz is one the nation’s leading law firms handling disability insurance clams and lawsuits.  If you or someone you know finds themselves on the wrong end of a Metlife claim denial or termination, contact us for a free claim evaluation by calling 1-800-745-1755 or by filing out a quick and simple form at http://www.disabilityinsurancelawyers.com/contact/ .

Typically, to establish such a claim, a plaintiff must show that the insurance company had no reasonable basis to deny the insurance claim and the company knew or recklessly disregarded the fact that no reasonable basis existed for denying the claim.  An insurance company, however, may challenge claims that are fairly debatable and will be found liable only when the claim was intentionally denied without a reasonable basis. Because insurers may challenge claims that are fairly debatable, if a realistic question of liability exists, an insurer may withhold payment while determining whether there is a reasonable basis for the claim. Insurers will not be liable for good-faith errors in denying or delaying a claim. Accordingly, recovery is possible only if an insurer both errs in denying coverage and does so unreasonably.

In the context of disability bad faith cases, there are many ways in which bad faith can occur.  Claim denials or termination for financial reasons is an obvious act of bad faith.  While difficult to prove, there are ways to build a circumstantial evidence case against many disability insurers.  Another example of bad faith is a deliberately ignoring valid medical findings and then hiring a biased medical examiner to conclude that there is no disability.

Quadrino Schwartz has a track record of success in pursuing bad faith denials or terminations of long term disability insurance claims.  The lawyers at the firm have over 100 years of combined experience and will form a team to vigorously pursue such claims.

To have your claim evaluated, go to www.disabilityinsurancelawyers.com/contact for a free consultation.

Naturally, without understanding your complete financial situation it is not possible to give a straight “yes” or “no” answer, but this post contains some basic considerations and recommendations.

You are far likelier to become disabled for half a year or even more during your working years than you are to die. Even at age thirty you have a one in five likelihood of becoming disabled for a year or longer.

Even one year without revenue could be catastrophic to your financial affairs. At the very best you would need to exhaust your emergency savings. At worst, you will not have enough saved up to cover all of your expenses and have to turn to taking on debt. In some situations, a long term disability can force a person into insolvency.

The best time to get disability coverage is before you are hurt or ill. You want to buy your insurance before anything happens to you, because if you wait, you might not be insurable. Also, the costs are more affordable when you are healthy.

If you have a long term disability and you have filed a disability claim that has been denied, you need to hire highly qualified long term disability lawyers. they can win your case or get you the settlement you deserve. A skilled disability insurance attorney can also help you get through the process of getting your claim approved and avoid a denial in the first instance.

Holmstrom willingly discharged her own lawsuit after MetLife offered to consider her second internal appeal. However, after MetLife declined to change its mind, she re-filed her case. After the district court agreed with MetLife’s decision to terminate her claim, she appealed to the 7th Circuit Court of Appeals.

The appeals court reversed the judge and ruled in Holmstrom’s favor. The appeals court found that MetLife had acted arbitrarily and capriciously. The appeals court reinstated Holmstrom’s disability payments benefits but then left the issue of attorney’s fees for the district court to decide.

The court noted that the U.S. Supreme recently ruled, in a case called Hardt, that ERISA’s legal fee provisions allow fees to be awarded to an ERISA litigant who has achieved “some success” on the merits. The court said that Hardt supplanted the 7th Circuit’s standard for ERISA fee awards. The district court ruled that Holmstrom had achieved more than some quantity of success on the merits since the 7th Circuit had reinstated her disability insurance benefits.

Evan Schwartz and Michail Hack of Quadrino Schwartz published an article in the wake of the Glenn v. Metlife decision arguing that the Supreme Court’s analysis authorized such investigations of insurer claims practices in ERISA cases. Click here for a description of the Schwartz and Hack Article

One of the first considerations for a claimant already receiving benefits is to determine the likelihood of the claim being terminated if the buyout proposal is rejected. Some insurers use the fear of a claim termination as a tactic to convince the claimant to accept a lower than fair amount. If the claim may truly be on the verge of a termination, however, there needs to be an assessment of the potential costs of a lawsuit and the likelihood of winning or losing the lawsuit. Those factors are essential in arriving at a sensible buyout figure. There are tried and true methodologies we use at this stage, in order to provide our clients with the best chance of avoiding a lawsuit and securing their financial future. For more information, visit our website at: http://www.disabilityinsurancelawyers.com/practice_areas/more/negotiating-disability-settlements.

Another important piece of the puzzle is to have a realistic assessment of morbidity and mortality in order to make appropriate adjustments to the total future expected disability payments. Many claimants have missed the opportunity to receive a favorable lump sum by failing to have such an assessment. In addition, the claimant needs a thorough understanding of the “present value” concept in order to calculate the true value of the investment power of a current lump sum of future benefits.

It is also critical to know thine enemy: is the insurer testing the claimant’s mettle or really looking to buy out the claim? Different insurers use different techniques and thus having knowledge of the prior tactics of the insurer is invaluable.

When it comes to a buyout during litigation, the cost and risk factors for further litigation and the potential outcomes are much more prominent factors than in the claim context. Knowing how the litigation will play out under ERISA, for example, is critical, especially since there are land mines at every turn that can cause a claimant’s case to be dismissed entirely.

In summary, buyout strategies are complex and critical, and disability attorneys with years of experience can navigate the claimant to a successful outcome.

In early 2001 Leavey filed his long term disability insurance claim, along with proof that he was receiving appropriate care. His claim had initially been approved and paid on a monthly basis, as required under his disability insurance policy. However, the insurance company, UnumProvident (the parent company handling the disability claim), terminated the benefits.

When Leavey took Unum to court, he obtained a decisive victory. Because Arizona law applied, he was able to seek more than just the monthly disability benefits. The jury ruled in his favor on disability, but he was also awarded “bad faith” damages of $15 million in punitive damages and $4 million in compensatory damages for emotional distress and other harm. Based upon certain legal principles that limit the size of these awards, the trial judge reduced the awards to $3 million in punitive damages and $1.2 million in compensatory damages.

In ruling in Leavey’s favor on the appeal the Court concluded that Unum acted “not only in bad faith but also ‘with an evil mind’”, and that Unum had “sought to influence the opinions of independent medical examiners”. Furthermore, the Court found that Unum and Provident “misrepresented the opinions of those examiners”. In addition, the court found that “Unum. . . . subjected Leavey’s claim to a roundtable review, the sole purpose of which was to close expensive claims; that Unum sought to influence the opinions of independent medical examiners; that Unum misrepresented the opinions of those independent medical examiners in its letter to Leavey announcing the closing of his claim; and that Unum knew that Leavey was a vulnerable individual who suffered from anxiety and depression, was recovering from a serious drug addiction, and was at a high risk of relapse”.

Discretionary clauses have been used by group disability insurers as a way of shielding the insurance company from court scrutiny if a lawsuit is filed challenging the decision on an insurance claim. The clauses say, essentially, that a court must respect and defer to an insurance company’s decision to deny or terminate a disability claim. Disability lawyers have been fighting against the use of these clauses for years, and several States acted to ban the clauses, including New York, after the National Association of Insurance Commissioners urged action. New York pulled back from its original approach and decided to revoke its informal Circulation Letter and proceed instead with formal rulemaking, the process used to issue formal regulations.

Since the shift in approach by the New York State, however, no action was forthcoming. Led by attorney Michail Z. Hack, Quadrino Schwartz forged ahead with an effort to convince the Commissioner that with each passing month, the number of victims of these clauses mounts and thus this matter should be given priority within the Insurance Department. In recent weeks there has been additional momentum after the United States Supreme Court decision in the case of Metlife v. Glenn. It was hoped that the Court would abolish the use of these clauses. While the Court modified some of the rules and allowed disability claimants to obtain additional information in litigation to increases their chances of success, the clauses still remain in use, providing insurers with an effective obstacle to a claimant’s fair hearing on an ERISA governed disability lawsuit.

When Sears Roebuck & Co. employee Wanda Glenn was diagnosed with a heart condition and applied for plan disability benefits, Met Life initially concluded that Glenn’s claim was valid, and encouraged her to also apply for Social Security benefits. However, Metlife later reneged on that decision, claiming that Glenn was indeed able to perform sedentary tasks, and was therefore ineligible for long term disability benefits.

Evan S. Schwartz and Michael Z. Hack of Quadrino Schwartz published an article in the New York Law Journal entitled “’Met Life v. Glenn’: Innovative Worker Benefits Decision. In their article, Schwartz and Hack point out that a prior Supreme Court decision, Firestone Tire and Rubber Co. v. Bruch, actually made it more difficult for employee plan beneficiaries to demonstrate a conflict of interest, or self-interest, in the administrative authority of an insurance company when determining the validity of an employee’s claim. Establishing a conflict allows a court to level the playing field and more closely scrutinize the claims decision of a long term disability insurance company.

Met Life v. Glenn removes much of that difficulty by stating that a court must, at a minimum, take into consideration the following elements, among many others, in determining the severity of the financial conflict of interest:

1. The insurance carrier’s history of biased claims administration;

2. The quality of the firewalls, if any, erected between the claims administrators and those interested in the carrier’s finances;

3. The carrier’s reliance on evidence favorable to it to the exclusion of evidence favorable to the claimant;

4. The carrier’s insistence that the claimant apply for Social Security Disability benefits and, in the same breath, denying the claimant is disabled; and

5. The failure to provide evaluators with all the relevant evidence.

Based upon the existence of evidence as to the scheme of Unum, Unumprovident and its subsidiaries, claimants suing those companies may be placed on a more equal footing. Claimants pursuing benefits against other insurers may now be allowed to investigate further, to uncover biased claim administration and other conduct that would allow more scrutiny of the insurer’s claim decisions.