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When Can an Insurance Company Stop Paying Long-Term Benefits?

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Attorney Tom MetierThe United States District Court for the District of Colorado answers that question in Johnson v. Life Insurance Company of North America (Civil Action No. 15-cv-0699-WJM-MEH, March 28, 2017).

Julie Johnson (“Johnson”) took a job with UBS Financial Services (“UBS”) as a “Vice President Financial Advisor/Consultant” at a salary of $10,833.33 per month. Johnson became eligible for long-term disability benefits that would pay her some 80% of her salary. Life Insurance Company of North America (“LINA”) administered claims under the plan.

Johnson became sick and could not work. She applied for short-term disability benefits, which would then become long-term. As part of the protocol, LINA required beneficiaries to apply for Social Security Disability Benefits as well. Johnson’s doctors claimed she could not work. LINA’s doctor claimed she could, with accommodations, and LINA denied the claim. Social Security determined Johnson to be disabled and awarded her SSDI benefits. Johnson appealed the claim denial from LINA and began receiving benefits. LINA asked Johnson’s doctors for updated medical information and was getting conflicting reports. (Her claim was based in her lack of ability to work because of an auto-immune disorder resulting in migraines whereby she couldn’t walk or stand for a long time, and she had fainting spells.) LINA decided to hire a Private Investigator to follow Johnson.

The PI found that Johnson was going for walks with her baby stroller and two dogs as well as standing for more than an hour at her child’s soccer game. The next day she drove around, went to the movies, shopped, and ate lunch with friends, and visited a tire store. Throughout this, LINA was having Johnson examined by various doctors and experts, and there continued to be conflicting reports from doctors and experts as to whether she was actually disabled. LINA eventually terminated the benefits. Johnson appealed again.

The court did extensive analysis of the ERISA laws, the classification of Johnson’s job, and her potential to work in another field. LINA was praised for using third party analysts to look at this case. The court affirmed LINA’s termination of Johnson’s benefits.

The Metier Law Firm is committed to assisting people with personal injury claims throughout Colorado, Wyoming and Nebraska, and we frequently serve as co-counsel to law firms nationwide. Tom Metier recently secured the largest personal injury verdict in Colorado.