Lake Tahoe Bad Faith Insurance Law Blog

Half way through March, 2012, already.  St. Paddy's just a few days away, and one of the wonderful marriages of Saturday with a Holiday dedicated to the serious study of Guiness.  Not much can improve on that thought, but I'll try anyway.

In the ongoing day to day litigation of long term disability insurance claims more of the usual suspects themes from the purveyors of LTD insurance.  Pre-existing condition exclusion is still alive and well.  Currently battling the insurance carrier's general pre-existing categories of medical conditions or symptoms, such as headaches, as opposed to really looking at a new medical diagnosis.  This particular claim will help to better understand how far an insurance company can go to claim pre-existing condition exclusion for rather general symptoms, as opposed to a closer examination of the diagnosed condition giving rise to the symptom.  As the claim goes forward from the admistrative LTD appeal to the lawsuit, I will update the findings and conclusions to this important aspect of long term disability insurance claims (pre-existing condition exclusions, that is).

Here's one I haven't seen in quite a long time, "contract recision."  It goes like this.  LTD insurance applicant with severely disabling renal disease cannot realistically be denied benefits, although the record requests go on and on for about six months.  Finally, being forced to make a decision on the case the insurer cancels the entire policy, claiming the applicant did not list a hospitalization in the year prior to his qualification for the insurance policy (this in not a pre-existing condition case).  Therefore, the insurance company has the legal right to rescind (cancel) the policy for failure to disclose material information that may have led their underwriting department to reject the insurance application.  Contract law does actually allow for this in certain situations, and as long as the recision occurs within a certain period of time, for example within two years of the issuance of the policy.  The interesting part of this particular case is that the applicant never filled out or signed the application.  It was done following a brief phone call by the sales agent.  The applicant never saw the application and has no memory of even being asked about past hospitalization.  I'll update the progression of this claim.

What else?  As always, more and more "no (or insufficient) objective medical evidence of limitiations and restrictions."  What can you do about this most common reason for denial of long term disability insurance claims?  Do all you can to have your medical providers document your condition, your limitations and your need to be off work due to your medical condition.  All medical records should be sent to the insurance company that have any bearing on your disabling condition.  This is tricky, but anything your employer may be willing to submit to the insurer, noting that with your medical condition you are not able to perform all of the required duties of your job, will be of immense value to your claim.  Employers, however, are extremely reluctant to have any involvement for fear of some type of violation of a myriad of state and federal employment laws.

Otherwise, the year marches forward, although it seems we have traveled back from a very early spring to winter (photo attached of the so much delayed snow at Tahoe).  The work on the highly anticipated (by me) conference room at the Tahoe office (the construction zone also visible in the attached photo) View image continues.  I am ever hopeful that by mid-summer all work will be done, which will include the video conference/phone capability in the new conference room.  It will be nice to be able to video conference with clients and potential clients (and anybody with questions) from the new facilities.  Soon.  Don't hesitate to contact me with any questions, comments or critique.  Happy St. Patrick's Day, Randy Noah

The law practice focusing on long term disability insurance benefits denials continues every day, but it's also rewarding to take a look outside every now and then.  While the Lake Tahoe region is a natural wonder in every season, this winter is remarkable for the extraordinary lack of snow, shown in these several photos.  While my photography is anything but remarkable, it's worth capturing the scenery, given that this site has seldom been seen in mid-January in the Northern Sierra Nevada mountains.  Almost a complete lack of snow.  However, as this is being written, winter snowfall has finally begun.  If the forecasted feet of snow is realized, it should make for fun, contrasting photos. 

More to report with long term disability insurance denials and ERISA in the next update

The forest near the Angora Ridge, site of the Angora fire.  View image.

Lake Tahoe uncovered in January.  View image.

Glass like ice and brown mountains at 7000 feet.  View image.

Wishing everybody the happiest holidays and a wonderful New Year!  Randy NoahView image

Belated happy Thanksgiving.  Always a refuge of feast, family and festivity in the rush to the end of the year work and celebrations.  In Northern California and Lake Tahoe it's been a long extended Fall season, with winter reluctant to arrive.  Lots of sun, some cool, some cold, some mild, but little rain or snow.  Not even sure if the bears at Tahoe have seriously thought of hibernation yet. The coyotes have been a bit more visible, probably taking advantage of easier hunting of various rodents.  They know it'll get considerably more challenging when several hundred inches of snow blankets the forests and mountains.  Best to fatten up now. 

Unfortunately, this time of year serves to underscore the hardship of so many individuals with work disabilities who have been denied long term disability insurance benefits.  Anecdotal evidence from my practice suggests an ever increasing number of disabled and uninsured are at critical risk for losing their housing, along with health care.  And even more unfortunately, little can be done to lessen the extreme hardships many are enduring.  What I  can do is respond quickly to every client concern, and always be available to talk to clients and explain the claims and federal court appeal process for a long term disability insurance (erisa) case.  A realistic understanding and knowledge of the legal process provides a basis for making many of hard decisions required when  facing a work disability and income crisis. 

Those of you currently involved in a long term disability insurance claim, where benefits have been denied, are gaining an understanding of the grossly uneven playing field on which you find yourself with the insurance company or large corporation.  I have focused on this area of law for some years now, and have wondered how extreme can it get.  Just how far will an insurance company push the very forgiving limits of ERISA?  The blind individual should be able to learn brail within 12 months and be fully fit for sedentary employment.  Really?  How about someone who is dead?  Are they also fit for sedentary employment?  I'll find out and let you know in future posts.  My client, very ill with numerous serious conditions, was on long term disability benefits for some years, and then cut off, since it was reasonsed that she was actually malingering so she could stay home and take care of her children.  Sedentary employment would be well within in her capacity according to the insurance company doctors.  So big insurance company sends her their final benefits denied letter and she dies just days later of medical complications.  More to come on this later. 

If you have any useful advice or resources for disabled people facing eviction or forclosure, please feel free to contact me so I can pass it along to disabled individuals I work with.  Regards, Randy Noah