Welcome to Season 6, Episode 16 of Winning Isn't Easy. In this episode, we'll dive into When Insurance Companies Get It Wrong (and Sometimes Lose).
Insurance companies often claim they’re just “following the plan” when denying disability benefits. But in many ERISA cases, the real dispute isn’t whether someone is disabled, it’s how the insurer interprets the evidence, which medical opinions it chooses to credit, and how far it will go to defend a denial once it’s made. From surveillance footage that captures only moments of activity to peer reviews that dismiss extensive medical records, disability carriers frequently rely on selective evidence and insurer-retained experts to justify cutting off benefits. In this episode, we examine three real cases where federal courts scrutinized those tactics. We explore how insurers used surveillance to terminate Long-Term Disability payments, rejected claims involving cognitive dysfunction and dysautonomia despite significant documentation, and relied on medical opinions built on assumptions that weren’t supported by the record. Along the way, we break down how ERISA’s deferential standard shapes these disputes, why courts sometimes find insurer decisions arbitrary or inconsistent, and what these rulings reveal about the strategies carriers use during claim reviews. If you’re pursuing Short- or Long-Term Disability benefits, this episode offers a closer look at how denial decisions are defended, and what can happen when a court concludes the insurer got it wrong.
In this episode, we'll cover the following topics:
One - How Physical Therapy Notes Prompted Surveillance and How Hartford Used Surveillance Against a Disability Policyholder Who Suffered Chronic Pain
Two - Cognitive Dysfunction, Fatigue, and Dysautonomic Symptoms as a Result of COVID Vaccination Results in Disability Benefit Litigation
Three - How Appalachian Regional Health Care Wrongfully Denied a Disability Retirement Claim and What One Federal Judge Had to Say
Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.
Listen to Our Sister Podcast:
We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/
Resources Mentioned in This Episode:
LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mind
LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefits
FREE CONSULT LINK: https://caveylaw.com/contact-us/
Need Help Today?:
Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.
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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.
