An North Carolina District court found that Liberty’s decision in terminating a woman’s long-term disability benefits was wrong and unreasonable. Before her disability, Ms. Rosa Ramirez worked as a financial analyst for Wells Fargo. After suffering a mental breakdown following a confrontation with her immediate supervisor, Ms. Ramirez submitted a claim for LTD benefits with Liberty.
Liberty initially denied her claim, stating she could perform her own occupation. Liberty cited, in part, to the medical records and surveillance to support its decision. During its initial review, Liberty had a psychiatrist review the records and attempt to contact Ms. Ramirez’s attending healthcare providers. Ms. Ramirez appealed Liberty’s decision which included medical records that showed she suffered from depression and anxiety with anhedonia, anger, irritability, insomnia, and suicidal ideation. The records noted Ms. Ramirez was forced to quit her job due to confrontations with her supervisor.
In its consideration of Ms. Ramirez’s appeal request, Liberty had a nurse review the medical records instead of a medical doctor. Based on this nurse’s paper-based review, Liberty denied the appeal. Ms. Ramirez then filed a lawsuit seeking her long-term disability benefits.
This is very typical behavior of insurance companies. This law firm focuses on ERISA and disability insurance claims. We have helped numerous people whose benefits were wrongfully terminated by the insurance company.
The Court’s Review
At the onset, the North Carolina court noted Ms. Ramirez could win her case under either ERISA standard of review. In ERISA disability cases, there is two standards of review the court chooses from when determining a case: arbitrary and capricious or de novo. When an ERISA disability case is decided under the de novo standard, the court does not give deference to the insurance company’s decision. When an ERISA disability case is decided under the arbitrary and capricious standard of review, the court can only rule against the insurance company if acted entirely unreasonable in terminating benefits.
Because Liberty acted so egregious, it reasoned, it did not matter which standard they used because Ms. Ramirez would still win even if the court gave deference to Liberty’s decision to deny her long-term disability benefits.
Her policy did not contain this discretionary language. Thus, Ms. Clark only needed to prove to the court that she was disabled. The court noted that the substantial weight of the evidence supported Ms. Ramirez’s total disability under the insurance contract.
Liberty claimed Ms. Ramirez left her job because of work stress, however, the medical record showed she had severe mental health issues. During her claim, Ms. Ramirez showed symptoms of anxiety and major depressive disorder and was later diagnosed with bipolar disorder, PTSD, and character disorder. The court held that Liberty’s review of Ms. Ramirez’s claim and appeal violated the language in the insurance contract.
As a result, Ms. Ramirez was awarded past benefits as well as prejudgment and post-judgment interest.
Having an Experienced Disability Attorney Matters
Disability insurance law is complicated. If your claim for long term disability benefits was denied or being delayed by an insurance company, it is important to get legal help from a lawyer who focuses on disability law.
As a law firm built to focus disability insurance, all our long term disability lawyers spend every day working to get our clients disability benefits from insurance companies.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.
Dabdoub Law Firm represents clients nationwide with:
- submitting a disability insurance claim;
- appealing a long-term disability denial;
- negotiating a lump-sum settlement; or
- filing a lawsuit against your disability insurance company.