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Blog | ERISA and Disability Rights and Benefits | Alabama | The Martin Law Firm, LLC

“Old Reliable” Insurance Company

Posted by David P. Martin | May 13, 2019 | 0 Comments

What happens when the “old reliable” insurance company you've paid premiums to for 30 years denies your claim for long-term disability benefits? We gather all the evidence and research the many claim violations. Then, we present a lengthy, detailed, and effective appeal. Watch this client's story to find out more.

Mrs. Gregory worked as a nurse for 30 years at a major hospital. One of her benefits was a disability policy. She paid premiums on it during her employment, which turned out to be a good thing. Moving and lifting patients and being on her feet for 12-hour shifts took a toll on her back. She became worried when she began experiencing back problems because she was a widow and depended on her salary.

She moved into a supervisory role thinking that would help. It didn't. The repeated standing and sitting caused chronic pain. She had a laminectomy. But her problems continued. She had a discectomy. It afforded some relief. But then one night while working, her leg gave out. She landed on her face, chest and abdomen. She was taken to the emergency room. X-rays showed significant degenerative changes and fractured ribs. She was hospitalized.

Mrs. Gregory was in constant pain. She had paralysis in her left leg, which would go numb after sitting for 30 minutes. She had many more falls suffering fractures in her feet as well as her shoulder. She was a risk to herself and her patients. She realized she could not go back to work. Her employer agreed.

She filed a claim for long-term disability benefits. After all, she had paid premiums all those years and now it was going to pay off. She thought the insurance company was an old reliable company so she assumed it would be no big deal. She was clearly disabled, so they would simply begin making payments, right?

Her claim was denied. Despite the clear evidence, the claim of this hard-working widow, who had paid premiums for decades, who was in chronic pain, and who had fallen at work and many times thereafter due to her disabling condition, was denied with absolutely no good reason.

Heartbroken, Mrs. Gregory came to us for help. We gathered all the evidence and researched the many claim violations. We presented a lengthy, detailed, and effective appeal. The insurer reversed its position and agreed to pay her claim.

We represented Mrs. Gregory on a contingent fee basis (no fee unless they pay). We could be paid when the claim was approved or paid over time. If we were paid over time, her monthly payments would be more, and we'd still be on hand to make sure that Old Reliable continued paying. We offered to spread the payment of our fee over ten years. She asked us to stay on board. It proved a wise decision.

After paying this claim for over five years, a cranky old nurse at the insurance company decided Mrs. Gregory's claim should be terminated. This in spite of the fact that Mrs. Gregory had four more surgeries and was even less mobile than she had been when her claim was approved. The nurse made argument upon argument, but we were able to refute every one. Not to be deterred, she finally simply ignored all the evidence and terminated Mrs. Gregory's benefits. Insurance companies often do that to force the claimant to file a lawsuit, which many never do. Mrs. Gregory was hospitalized when her benefits were terminated.

After Old Reliable summarily denied our appeal, we filed a lawsuit. But lawsuits take time. By now, Mrs. Gregory was receiving a Social Security disability benefit. However, it was not enough to make ends meet. Mrs. Gregory had to sell her house and her car. Not long thereafter, a few of those more level-headed within this ruthless insurance company recognized the risks posed by this litigation. We were able to negotiate a favorable resolution.

Shock and surprise turned to bitter disappointment and resentment for Mrs. Gregory, who reasonably believed that Old Reliable would act in good faith in its dealings with her. Unfortunately, we were not surprised. While we see it all the time, the facts of this case stand out. While Mrs. Gregory's faith in Old Reliable was not restored, justice was. And for that, Mrs. Gregory was most grateful. That's why we do what we do.

About the Author

David P. Martin

Senior & Managing Attorney


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