From the Insurance Company’s Point of View

Hi, I’m Nick Ortiz. I’m a board-certified disability insurance attorney. Today I’m here to talk to you about an insurance company’s point of view as laid out by an experienced defense attorney. Right now we’re in October of 2017, and just yesterday I received an email from a defense attorney, announcing his involvement in a webinar. The title of the webinar is “ERISA Wrongful Denial of Benefit Claims: Procedural Prerequisites and Key Defenses”. So here they lay out the issues that they’re going to cover, and this gives you insight into how an insurance company’s going to be looking at your claim.

From the very beginning of the email that I received, it says, “We will review these and other key issues:” and the top two are one, “How can plans preserve and maximize their procedural and substantive defenses through plan design?” A plan is the insurance policy, and what that means is, from that phrase that I just read, they are laying out how you can design the insurance policy in a way that will maximize the insurance company’s ability to deny your claim. Two is, “What has been the impact of recent case law on the review of claim administrators’ determinations?” Again, what they’re saying here is, “How can you incorporate recent court decisions into your plans and policies to maximize your opportunity of denying future claims?”

The very next paragraph is also very insightful into how they’re looking at these cases. It says, “ERISA litigation remains steady, including cases brought by plan participants, beneficiaries and providers challenging denials of benefits. Defending benefits denial cases involves several procedural and substantive tactics.” So again, they’re laying out all the different ways and strategies that they can use to deny legitimate claims.

The next paragraph says, “Counsel must be vigilant in leveraging effective defense approaches.” To go on, it says, “Potential tools in the defense attorney’s arsenal include include lack of standing, preemption, failure to exhaust administrative remedies, expiration of the statute of limitations and claims-based limitations defenses.” Again, they’re laying out all the different strategies that can be used to deny claims.

The next paragraph: “Effective plan design, careful structuring of the administrative process, and informed guidance to those who administer claims can greatly increase the precision of claims administration and maximize the likelihood and success in benefits denial litigation.” So it says straight out in that sentence that their whole goal is to maximize the denial of benefit. And they conclude by saying, “Our panel will provide guidance to employee benefits counsel for defending against wrongful denial of benefits claims involving ERISA plans.”

I’m pointing this out to you because this is from a defense attorney, granted, but what they’re doing is they’re directing this webinar towards defense attorneys who defend these insurance companies in LTD denial claims, and also to insurance companies themselves, in trying to educate them into how they can structure their plans and insurance policies to maximize the opportunity of a future denial of benefits. That’s why it’s so important to fight back hard against these insurance company tactics, and one of the best ways of doing that is to hire an experienced long-term disability attorney to help you in your claim.

If you’d like to talk to our office, we do have a lot of experience in handling these types of claims. You can give us a call at (850) 898-9904. Thanks for watching. We look forward to hearing from you.