In general, when a person with a disability qualifies for Social Security Disability, he or she should easily qualify for private long-term disability insurance, and vice versa. Eligibility for both programs usually depends on similar or even identical factors, revolving around the diagnosis of a long-term disabling condition that prevents the applicant from maintaining substantial gainful employment, with sufficient medical evidence and testimony to back up that claim. Because of this seeming no-brainer, a Pennsylvania woman who was deemed eligible for SSD recently filed a lawsuit against an insurance company based on its denial of her claim for long-term disability following a brain injury.
According to the lawsuit, the woman has been disabled and unable to work since June of 2001 after suffering an undisclosed brain injury that causes short-term memory loss. Because she received both short- and long-term disability benefits as part of a compensation package from her employer, the woman initially filed for and received short-term disability while she determined her medical and employment future.
After it was determined that the woman would not be able to maintain future employment, she filed for Social Security Disability from the Social Security Administration and long-term disability from Unum Life Insurance Co. According to the lawsuit, Unum denied the woman’s claim in early 2002, despite earlier approval of her short-term disability claim and approval for SSD.
The woman subsequently filed a lawsuit against Unum, claiming that the insurer repeatedly displayed bad faith by denying her claim, dragging out its investigation of her disability, and by making unreasonable demands such as addition medical exams. The lawsuit seeks payment of benefits from the woman’s date of eligibility to the date of the judgment with interest.
Source: Tribune-Democrat, “Boswell woman sues insurer over disability benefits”, Bernie Hornick, 11 January 2011