Life Insurance Company of North America (LINA) Disability Claims

No one who is unable to work because of a disabling injury or illness should be denied the benefits they rightfully deserve under the terms of their Life Insurance Company of North America long-term disability (LTD) policy. Life Insurance Company of North America may be referred to as LINA for short.

LINA Long-Term Disability Insurance

LINA sells short-term disability and long-term disability insurance plans to individuals. However, the majority of its long-term disability insurance sales are sold as group plans to large corporations, unions, and associations.

What Is Long-Term Disability Insurance?

According to some estimates, the average employee misses as much as two and a half (2.5) years of work due to a disability.

Long-term disability insurance is designed to protect an employee from the loss of income if he or she is unable to work for an extended period of time due to a disabling illness, injury, or accident. A LINA long-term disability plan provides for a portion of covered income is replaced and paid directly to the disabled employee.

Most policies will pay 60 percent of your insured pre-disability covered earnings (reduced by deductible income from other sources such as Social Security or worker’s compensation) while you are out of work due to an approved disability. Most LTD policies do not take effect until after an “elimination period,” which is typically a six-month waiting period.

LINA offers two main types of disability benefits:

• Short-Term Disability: STD benefits help employees who suffer a temporary illness that prevents them from working for a short period of time (typically up to 6 months);
• Long-Term Disability: LTD benefits offer employees protection if they are unable to work for an extended period of time. LTD benefits usually kick in after a six-month waiting period and are usually (but not always) payable until the claimant’s retirement age.

How to Choose the Right Disability Coverage and Benefit Amount

Selecting the best disability coverage for your needs can feel overwhelming, but breaking the process down into simple steps can make it a lot easier. Here’s how employees can confidently identify the coverage and benefit amount that makes the most sense for their specific situation:

• Understand Your Policy Options: Start by carefully reviewing the summary or brochure for your employer’s disability insurance plan. This should outline the key details, from elimination periods (how long you need to be disabled before benefits begin) to the percentage of your income that will be replaced.
• Assess Your Finances: Consider your ongoing expenses like rent or mortgage, utilities, groceries, healthcare costs, and family needs. Use the plan’s coverage chart—often found toward the end of the brochure—to compare benefit amounts available for different elimination periods or coverage levels.
• Determine the Right Elimination Period: The elimination period is the waiting time before benefits kick in. While a longer elimination period may reduce your premiums, make sure you have enough emergency savings to cover you until benefits start. Weigh this period carefully against your financial situation.
• Calculate Your Ideal Benefit: Most long-term disability policies replace up to 60% of your pre-disability income. Review whether this amount, especially after accounting for any offsets like Social Security Disability Insurance (SSDI) or worker’s compensation, will be sufficient for your needs.
• Speak with an Expert: It’s never a bad idea to consult a licensed insurance agent or benefits specialist. They can answer your questions and help clarify how different options fit your unique financial circumstances.

By following these steps, you can choose a disability coverage amount and benefit period that best matches your needs, providing greater peace of mind during life’s uncertainties.

Why Combine Long-Term and Short-Term Disability Coverage?

Pairing a long-term disability (LTD) plan with a short-term disability (STD) plan offers broader protection if an illness or injury keeps you off the job. While your LTD benefits typically begin after the elimination period—often around six months—STD coverage steps in right away and provides income replacement during that initial period when you are unable to work.

Here’s how combining both can benefit you:

• Immediate Support: Short-term disability can cover your income during the waiting period before LTD benefits kick in, so you’re not left without a paycheck.
• Seamless Protection: Together, these plans help ensure you have financial security from day one of your disability through your recovery or transition to long-term support.
• Less Financial Stress: By filling the gap between the onset of your condition and the start of LTD payments, this combination reduces the risk of falling behind on bills or dipping into savings.

In summary, having both plans in place means you won’t have to worry about an interruption in income if you need to take time off work due to a covered illness or injury. Combining STD and LTD coverage is one of the most effective ways to protect your financial well-being throughout the duration of a disability.

How LTD Insurance Works with Sick Leave and Annual Leave

Many employees wonder how long-term disability insurance fits in with their existing sick leave or annual leave benefits. Here’s how they typically work together:

• Bridge the Gap: When you become unable to work, you may first use your employer-provided sick days or accrued annual leave. These benefits usually last for a limited time and provide your full salary during those days.
• Extended Coverage: Once you’ve exhausted your sick and annual leave—and met your policy’s elimination period—long-term disability insurance can step in. This ensures you continue to receive a portion of your income even after your regular paid leave runs out.
• Financial Security: By picking up where your leave benefits stop, LTD coverage provides ongoing income replacement, so you aren’t left without financial support due to an extended illness or injury.

This layered approach helps employees maintain greater financial stability during lengthy periods when they’re unable to earn their usual paycheck.

How to File a Disability Claim

If you need to file a claim for disability benefits with LINA, the process typically begins by notifying your employer as soon as possible about your medical condition. You’ll then need to complete the necessary claim forms, which are usually provided by your employer’s human resources department.

Here’s a general overview of what to expect:

• Step 1: Obtain the Claim Forms: Request the appropriate claim forms from your HR representative or benefits coordinator.
• Step 2: Complete Your Portion: Fill out all required sections of the claim form, providing detailed information about your disabling condition.
• Step 3: Physician’s Statement: Ask your doctor to complete the attending physician’s statement, outlining your diagnosis, treatment plan, and restrictions or limitations.
• Step 4: Submit Supporting Documents: Gather relevant medical records, test results, and any additional information that demonstrates the nature and extent of your disability.
• Step 5: Employer’s Statement: Your employer may also need to fill out a section that confirms your job duties, salary, and when you last worked.

Once you’ve gathered all the necessary paperwork, return it to your HR department (or follow any instructions provided for direct submission). LINA will then review your application and may reach out to request additional documentation if needed.

It’s important to respond promptly to any requests for more information, as delays can slow down the review process. Keep copies of all documents you submit for your own records.

Common Conditions Typically Covered by Long-Term Disability Insurance

Long-term disability insurance is intended to provide coverage for a wide range of serious health challenges that prevent an employee from working for an extended period. Typical conditions that may qualify for LTD benefits include:

• Complications related to pregnancy and childbirth that result in prolonged recovery times
• Injuries stemming from accidents, such as broken bones or severe fractures
• Major illnesses like cancer, which often require ongoing treatment or recovery
• Cardiac events, including heart attacks, as well as other cardiovascular issues such as strokes
• Musculoskeletal problems, such as chronic back pain or significant joint disorders

These are just a few examples, but policies generally cover serious medical conditions that inhibit your ability to perform the duties of your occupation. If you’re facing a situation where your diagnosis may limit your ability to work, it’s important to review your policy or consult with your HR department to determine whether your specific medical condition is covered.

Limited Coverage Under “Own Occupation” Definition of Disability

Most LINA group plan policies define the term “disability” as the inability to perform one’s “own occupation”; however, the period for such coverage is typically very short. Most “own occupation” periods are limited to a six months, one year, or two years. Once the short “own occupation” period expires, the definition of disability changes to whether the claimant can perform “any occupation.” Even if a claim is approved under the “own occupation” definition of disability, many claims are “cut off” or terminated once the definition changes to “any occupation”. In other words, many claims are cut off at the two-year mark.

LINA Has a History of Denying or Terminating Legitimate Claims

In recent years, LINA has gained a reputation for denying large numbers of claims for long-term disability benefits by requesting additional “objective information,” and then denying the claims when claimants fail to provide such documentation.

In 2013, LINA’s parent company, Cigna, entered into a multi-state settlement with the insurance commissioners of five U.S. states for improper long-term disability claims handling practices. The settlement followed investigations by the insurance departments into Cigna’s improper denial of long-term disability claims and wrongful termination of existing benefit claims.

As further detailed below, the settlement required Cigna to improve its claims handling processes and establish a program to review long-term disability claims that have been improperly denied or terminated.

The insurance departments of California, Connecticut, Maine, Massachusetts, and Pennsylvania conducted individual claims examinations of Cigna’s disability claims handling practices. Some of the specific allegations against Cigna include:

1. Failing to adopt and implement reasonable standards for the prompt investigation and processing of disability insurance claims;
2. Failing to disclose to claimants pertinent facts or insurance policy provisions relating to coverage issues;
3. Unreasonably denying claims when it knew that the information it needed to approve disability benefits existed, but it did not obtain or review the information before making the denial decision;
4. Failing to conduct its own functional testing or peer review of medical records on file;
5. Failing to consult with health care professionals with appropriate training and experience in the field of medicine related to the underlying disabling condition;
6. Wrongly terminating claims during the “any occupation” period of the definition of disability without conducting a transferable skills analysis and labor market survey to identify alternate occupations suitable for the respective claimants based on their restrictions, limitations, education, training, and experience;
7. Failing to provide complete information from the claim file to the medical expert conducting a medical review of the record;
8. Failing to clarify a claimant’s restrictions and limitations when appropriate with the treating physician who supported the disability, when appropriate.

During the claims reviews, Insurance Department officials found irregularities in the claim process, including:

• Failing to give due consideration to the medical findings of independent physicians;
• Disregarding information from Social Security disability decisions; and
• Failing to give proper consideration to worker’s compensation records.

The California Insurance Commissioner Dave Jones issued this statement following the settlement:

“This case involves long-term disability claims and is an important win for California consumers. … When people are injured or disabled, it is particularly important that their claims are handled quickly and fairly. The agreement with Cigna puts into place more effective claim handling procedures, which will ensure consumer protection for policyholders.”

Under the settlement agreement, Cigna Group is required to:

• Enhance claims procedures to improve the claims handling process for the benefit of current and future policyholders.
• Establish a remediation program in which the companies’ improved claims procedures will be applied to certain previously denied or adversely terminated claims for residents of states whose insurance commissioners also signed the settlement agreement.
• Participate in a 24-month monitoring program conducted by the insurance departments of the five lead states in the action, which includes random sampling and ongoing consultation.
• Submit to a re-examination at the conclusion of the monitoring period.
• Pay fines and administrative costs totaling $1,675,000 to the five lead state states, which are California, Connecticut, Maine, Massachusetts, and Pennsylvania.

The “enhanced” claims procedures that Cigna agreed to adopt include the following:

• Giving more appropriate consideration to awards of Social Security Disability Insurance (SSDI) benefit awards;
• Collecting and analyzing medical records for a claimant’s complete medical history;
• Increased use and selection of External Medical Resources; and
• Provide full and complete documentation to its various vocational and medical examiners.

The Cigna companies set aside $77 million for projected payments to policyholders across the nation whose claims were not handled properly and began reevaluating certain claims. Cigna also paid a $500,000 penalty directly to the California Department of Insurance in addition to $150,000 to reimburse the Department for the cost of ongoing monitoring required by the settlement agreement.

LINA Federal Court Case Summaries

• Evans v. LINA – LINA Denies Disability Benefits to Wireline Operator with Severe Back Pain
• Brown v. LINA – Can a Peer Review Physician Outweigh the Opinion of My Doctor?
• Harrison v. LINA – Claim Denied Based on Pre-existing Condition Exclusion
• Mayer v. Mercy and LINA – Court Unable to Determine Whether Plan Is Church Plan or Not
• Shaw v. LINA – Claimant Refused to Follow Recommended Treatment Plan
• Graham v. LINA – Court Rules LINA Must Review Claim Under “Medium-Occupation” Standard
• Gailey v. LINA – Court Upholds Denial of Long-Term Disability Benefits
• Esbensen v. LINA – Insurer Acted Arbitrarily and Capriciously
• Dawson v. LINA – Court Rules Claimant Didn’t Provide Enough Objective Evidence
• Calhoun v. LINA – LINA Acted Arbitrarily and Capriciously in Denying Claim

Work with a LINA Long-Term Disability Insurance Appeal Lawyer

Attorney Nick Ortiz is a LINA disability lawyer with over a decade of experience handling disability insurance claims. Mr. Ortiz has the skill and insight needed to help you address a wide range of issues related to your Life Insurance Company of North America disability benefits claim, including:

• Appealing a Denied Claim: Unfortunately, a large number of LINA disability claims are denied or terminated (cut off after having previously being approved). A denial letter is not the end of your claim rights. You have the right to file at least one internal appeal with LINA. We will help you understand the reasoning behind your denial, work with you to gather the appropriate evidence and documentation to satisfy your “proof of loss”, and otherwise work diligently to address any alleged deficiencies LINA has found in your documentation and paperwork before perfecting your appeal. Our goal is to demonstrate your limitations in such a way that the insurer cannot deny that you are entitled to benefits.
• Taking Your Case to Court: In some cases, we successfully work with LINA to reinstate the claimant’s benefits without the need for legal action. However, there are times when LINA may persist in denying your claim. If internal appeals don’t yield a positive result, you have the right to file an ERISA lawsuit for review by a federal judge. We’re here to help you initiate the ERISA lawsuit and ensure that all documentation is ready for the court’s evaluation.

It’s important to recognize that not every LTD claim falls under ERISA regulations. We’ll evaluate whether your claim is exempt from ERISA, which may allow you to file your case in state court, where policyholders often receive more robust protections.

Get Help with Your Long-Term Disability Claim

We have successfully represented numerous LINA disability insurance policyholders in their claims for long-term disability benefits. If you have had your LTD claim denied or terminated by LINA, you need the skilled guidance of disability insurance attorneys experienced in representing LINA claimants. Call our office today at (888) 321-8131 for a free case evaluation.