Anthem Disability Denials

With nearly 40 million members, Anthem is one of the largest health insurance providers in the United States. Anthem sells various health insurance products, including disability insurance, often as a group benefit plan available to employers. Employees mistakenly believe that they will receive benefits if they ever need to file a claim, but Anthem disability denials are much more common.

At the Ortiz Law Firm, our disability attorneys help disabled workers fight for the disability insurance benefits they deserve. We offer a free consultation after a claim is wrongfully denied or terminated so claimants can discuss the reasons for their disability denials with an attorney.

Anthem Blue Cross and Anthem Life Insurance Company

Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Empire BlueCross BlueShield, and Anthem Life are part of one parent company, Anthem, Inc. Anthem is an independent licensee of the Blue Cross and Blue Shield Association. According to Anthem’s website, Anthem Blue Cross and Blue Shield is the brand name of: 

• In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc.
• In Connecticut: Anthem Health Plans, Inc.
• In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.
• In Indiana and Ohio: Anthem Insurance Companies, Inc.; Community Insurance Company 
• In Kentucky: Anthem Health Plans of Kentucky, Inc.
• In Maine: Anthem Health Plans of Maine, Inc.
• In Missouri (excluding 30 counties in the Kansas City metropolitan area): Healthy Alliance® Life Insurance Company (HALIC); Anthem Insurance Companies, Inc. (AICI) 
• In New Hampshire: Anthem Health Plans of New Hampshire, Inc.
• In Virginia: Anthem Health Plans of Virginia, Inc. and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. and its affiliated HMOs, HealthKeepers, Inc., Peninsula Health Care, Inc., and Priority Health Care, Inc.
• In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), Anthem Insurance Companies, Inc. (AICI) or, for former Atrium Health Plan members, Compcare Health Services Insurance Company. 

In California, Anthem Blue Cross is the brand name of Blue Cross of California and is offers short- and long-term disability insurance benefits. While California does have a State Disability Plan (CA SDI), the State Plan replaces only 55 percent of an employee’s income for up to 52 weeks.

Anthem Disability Insurance

Disability insurance protects policyholders against the loss of income resulting from a prolonged inability to work due to an accident, injury, or illness for an extended period. Anthem Life offers a variety of disability insurance plans to companies across the country, all of which are part of an employer-sponsored group benefit plan and are governed by the Employee Retirement Income Security Act (ERISA). ERISA law is a federal law that strongly favors insurance companies over disabled individuals.

Anthem Short-Term Disability

As the name implies, Anthem short-term disability benefits are only available for a short period of time. Many policies have a maximum benefit period of only six months, if not less. We have seen short-term policies that only pay benefits for as little as nine weeks. An Anthem short-term disability plan would provide benefits in addition to any state disability plan; however, many states do not have a disability plan.

Anthem Long-Term Disability

Anthem’s long-term disability plan extends short-term disability coverage for more complicated and longer-term claims. Anthem typically replaces 60-66% of your income, and the length of time you receive benefits depends on the plan you choose. Depending on the coverage you choose, a long-term disability insurance claim could last until you reach retirement age.

Anthem Long-Term Disability Lawyer

Many people who file a disability claim are shocked and dismayed by the hurdles Anthem Life puts in front of them. The insurance adjuster requests more and more paperwork as part of the insurance company’s investigation of your claim. Just when you think you’ve filled out the last form, you get another one.

Your doctor may start to get annoyed with Anthem’s phone calls to the doctor’s office and numerous requests for the doctor to fill out paperwork as well. Then, after the claim investigation is finally complete, Anthem denies your disability insurance claim.

Policyholders are devastated when they are denied the very benefits they thought were there to protect them if they ever became unable to work due to an injury or illness. Most are downright angry at their insurance company for their delaying tactics and denials. That’s why it’s important to have an experienced disability insurance attorney help you by explaining to you the reasons for the disability insurance claim denial and what you can do to fight back and win your claim.

At the Ortiz Law Firm, our experienced attorneys know how difficult it can be to deal with Anthem Life’s bad faith practices when you are fighting for long-term disability insurance benefits. Bad faith is a big problem that you may not even realize is affecting your claim. You have enough to worry about with the treatment of your injury or illness. We also understand how important these benefits are to you and your family when you are unable to work and earn an income.

Let us take on the burden of fighting the insurance company off your shoulders. With experience in dealing with Anthem Life and many other major insurance companies, our Anthem Life disability claim lawyers have the skills and knowledge needed to help you understand your rights under your policy and pursue the disability benefits you deserve.

Important Information About Anthem Disability Claims

Definition of “Disability” in an Anthem Insurance Policy

To qualify for disability benefits, you must meet the policy’s definition of disability. Disability is defined in each policy. Your definition may be different from the example below. You should always check your specific policy to see exactly how it defines disability for your long-term disability claim.

Here is an example of how the term is defined in a previous policy to give you with some insight into how Anthem defines disability:

“Disabled and Disability mean during the Elimination Period and the next 36 months because of Your Injury or Illness, all of the following are true:

You are unable to do the Material and Substantial Duties of Your Own-Occupation, and You are receiving Regular Care from a Physician for that Injury or Illness, and Your Disability Work Earnings, if any, are less than or equal to 80% of Your Indexed Monthly Earnings.

Thereafter, Disabled and Disability mean because of Your Injury or Illness all of the following are true:

You are unable to do the duties of any Gainful Occupation for which You are or may become reasonably qualified by education, training, or experience, and You are receiving Regular Care from a Physician for that Injury or Illness, and Your Disability Work Earnings, if any, are less than or equal to 60% of Your Indexed Monthly Earnings.”

Pre-Existing Conditions and Anthem Disability Insurance

Even if you meet the definition of disability, Anthem Life will not approve your application for disability insurance if it determines that your disabling medical condition is pre-existing. The term “pre-existing” is also defined in each policy. However, the following policy excerpt will help you to understand how the insurance carrier may define “pre-existing”. Here is an example from one of their policies:

“A pre-existing condition is an illness or injury for which you received treatment or where symptoms were present within 3 months prior to your effective date of coverage. A disability that begins in the first 12 months after your effective date will not be covered if it results from a pre-existing condition.”

Appealing Anthem Disability Denials

At the end of the day, your insurance company is in business to make money. For an insurance company, that means collecting more in premiums than it pays out in claims. Understanding this basic premise will help you understand why even the most well-supported disability claims can be denied.

Most importantly, do not despair and give up just because you have received a claim denial. ERISA gives disability insurance claimants the right to appeal an unfavorable decision directly to the insurer through its internal appeals review process. Only after you have “exhausted” your appeals do you have the right to file an ERISA lawsuit.

Note: If you have an individual disability insurance policy that you purchased on your own (not through a group plan) or if you are a government employee or a member of a church plan, you may be exempt from ERISA regulations. If so, you may file your lawsuit in state court.

State law gives the consumer greater protection in disability claims than an ERISA claim in federal court. This is one of the many reasons it is important to hire an attorney. At the very least, you should schedule a free case evaluation so an expert can explain your legal options.

A Disability Attorney Can Help with Your Claim

When filing a claim for LTD benefits or appealing a denial under an Anthem disability plan, the guidance of an experienced Anthem disability attorney can be extremely helpful and may even increase your chances of receiving the benefits to which you are entitled. We have experience with Anthem LTD claims and understand the difficulties of pursuing a claim for benefits.

We have helped countless clients with their disability insurance claims, and we would welcome the opportunity to put that experience to work for you. We primarily represent clients during the administrative review appeal process but can also assist with state and federal court litigation. Most of the claims we handle are for long-term disability insurance benefits.

Legal Help Getting Your Anthem Disability Claim Approved

Unfortunately, even claimants with the most severe disabilities and the best prepared claims can receive a claim denial from Anthem. If you receive a claim denial, you should know that you have the right to file an appeal. If you have exhausted your appeals with the insurance company, you may have the right to file a lawsuit under the ERISA Act.

When appealing a denied claim for short-term disability or long-term disability benefits under a disability insurance plan, it can be helpful to have the assistance of an experienced attorney. The Ortiz Law Firm has experienced disability attorneys and can help you obtain the benefits you deserve. Our firm provides detailed advice on the many issues involved in the claims and appeals process, including:

• Helping you understand the reasons for your claim denial;
• Obtaining additional evidence, including medical records and other supporting documents to supplement the appeal;
• Completing the appeal paperwork;
• Preparing a legal argument to challenge the carrier’s decision to deny your claim
• Filing your appeal within the time limits allowed by applicable law;
• Filing an ERISA lawsuit in federal court and/or
• Briefing your case for consideration by a federal judge during the ERISA litigation process.

You don’t have to face your battle against one of the largest health and disability insurance companies alone. The Ortiz Law Firm is here to help you through the appeals process. We will not give up on your claim until the denial is overturned and the insurer agrees to pay out your claim.

If Anthem has wrongly denied you or if your claim has been prematurely terminated, call our office today at (888) 321-8131 to schedule a free consultation with an experienced Anthem disability claims attorney. We would welcome the opportunity to discuss why your claim was denied and what we can do to help reverse the denial.