Happy New Year to all.  So off we go into 2012.  Seems that rust and Unum (or Met Life, or CIGNA, or AETNA, or Sun Life etc.) never sleep.  Challenges right out of the gate include many of the usual suspects. 

Pre-existing condition denials, although entirely new medical conditions lead to disability post employment.  How pre-existing condition denials such as the ones on which I am currently working unfold will be reported in 2012.

Lack of objective medical evidence of disability.  It may be a New Year, but long term disability insurers (most specifically in ERISA cases) never tire of this one. There is perhaps some gathering light in the long, dark night of this LTD denial favorite as more federal courts find "lack of objective medical evidence" is simply a decision to ignore the findings of treating doctors and statements of the actual insured person.  Many courts are growing increasingly skeptical of cursory denial of long term disability insurance claims based on captive medical reviewers.  I'll try to report more on this trend based on my own cases throughout this year.

Here's a thought-to-be-extinct basis for denial brought back in 2012 from the past:  You were able to work on the last day of your employment, and your LTD insurance coverage ended on the day you left work, therefore your claim for disability technically begins the day after you stopped working when you were no longer covered under group LTD insurance.  Gotcha.  We'll see if one particular court in Northern California agrees with Sun Life.

Hope for 2012?  Or the end of the world.  I'll go with the positive viewpoint.  I do see increasing skepticism by the courts at the perfunctory and cursory denials of long term disabiity insurance.  I'll keep trying to fertilize this skepticism and see if it grows any real fruit.

2011 saw some growth in the infant long term disability insurer/administrator as fiduciary reasoning.  There were a few plaintiff-insured victories in court based on this theory, which is a complicated legal theory.  I'll try to monitor the progress of this line of reasoning in 2012, and try to boil the hard to understand theory into a plain language paragraph in a blog post.  It's hopeful, but too early to accurately say if the fiduciary theory is going to improve the odds getting denied long term disability insurance claims reversed and reinstated. 

All in all, 2012 should be a year of steady progress in bringing fair and just results back to long term disability insurance claims.

Where's the snow?  Where's winter?  Not at Lake Tahoe.  I'll post some pictures of a very brown winter wonderland later this month.  One bonus is very rare, thick, glass like ice on the lakes at high elevation in the Sierra Nevadas.  Makes for a unique ice fishing experience.  Regards, Randy Noah