Principal wrongly denied long-term disability insurance benefits to a Texas insurance agent with Ehlers-Danlos Syndrome.
A federal court in Dallas, Texas found that Principal Life Insurance Company (“Principal”) relied on inconsistent and unpersuasive evidence when it terminated Angela Haynes’ long-term disability (“LTD”) benefits.
Background
Ms. Haynes was employed by an insurance agency when she began experiencing severe weakness, pain, and fatigue. Forced to stop working due to her debilitating symptoms, she applied for and was paid all her short-term disability benefits.
The LTD Claim
Initially, Principal approved Ms. Haynes’ claim for LTD benefits. However, Principal then initiated a review of Ms. Haynes’ file, determined that she could perform her job duties as an insurance agent despite her condition, and terminated her benefits. Ms. Haynes appealed and submitted additional documentation regarding her medical conditions and work restrictions.
After requiring Ms. Haynes to undergo an independent medical evaluation (“IME”) by one of its hired consultants, Principal denied her claim on appeal. Ms. Haynes then exercised her right under the Employee Retirement Income Security Act of 1974 (“ERISA”) to file a lawsuit against Principal in federal court.
The Lawsuit & Court’s Decision
Principal denied Ms. Haynes’ benefits because it determined that she did not meet the LTD Policy’s definition of Disabled, which requires the inability to perform the majority of the substantial and material duties of one’s own occupation. In holding that the preponderance of the evidence supports the conclusion that Ms. Haynes is disabled under the Policy’s definition, the Court explained that:
- The reports of Ms. Haynes’ doctors support the finding that she is disabled;
- Ms. Haynes’ subjective reports of pain and related symptoms support the finding that she is disabled; and
- The Social Security Administration’s conclusions and approval of Ms. Haynes’ SSDI benefits support the finding that she is disabled.
The Court’s decision is a good reminder to not let your insurance company get away with denying you the benefits you deserve on the basis that the company and its paid doctors should have the final say as to whether your disability prevents you from working.
Lawyers Specializing in Disability Insurance Claims
Because disability insurance law is complicated, it is important to get legal help from a lawyer who focuses on this specialized area of law as early as possible.
As a law firm built to focus on disability insurance, our lawyers have developed an expertise in disability insurance. We spend every day working to get our clients long term disability benefits approved.
Since federal law applies to most disability insurance claims, we do not have to be located in your state to help.
If your claim for long term disability benefits was denied or is being delayed by an insurance company, call us for a free consultation.
Our disability insurance attorneys represent clients across the U.S. with:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
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- Filing a lawsuit against your disability insurance company.
Call (800) 969-0488 or contact us online to speak with an experienced disability attorney. Consultations are free.
