What Does This Mean for Your Valid Group Disability Claim?
Competition between private businesses theoretically drives better services as companies vie for your business. Aetna and The Hartford were two such corporations. They specialize in insurance, including long-term disability insurance, and were major competitors in the industry.
In late 2017, The Hartford bought Aetna’s group disability insurance business for $1.45 billion. This means The Hartford is now the second largest group disability insurer in the nation. It also has the right to the approximately $5 billion in premiums it expects to earn from Aetna’s group disability business. Many of Aetna’s group disability policyholders will transfer to The Hartford, and the companies will work together as Aetna’s group disability business changes hands. So if you’re an Aetna group disability policyholder, does this transition affect your valid claim?
If you’re concerned about the transition of your long-term individual or group disability insurance policy, America’s top-rated long-term individual disability lawyers and award winning ERISA attorneys at DarrasLaw are here to answer your questions. To schedule your free disability policy analysis and free claim consultation, call us today at 800-898-7299 or contact us online.
Transitioning Your Individual or Group Long-Term Disability Policy
No matter the individual or group long-term disability insurer, your carrier may start the claims process by assuming you’re not disabled. Even if the diagnosis is serious, such as a traumatic brain injury, paralysis, multiple sclerosis, or cancer, you must submit compelling medical evidence and proof showing how your specific symptoms prevent you from performing the important duties of your occupation.
For example, if your occupation requires constant typing, carpel tunnel syndrome might render you disabled. The same may not be true, however, if you’re diagnosed with early stage breast cancer. The measure is how your current symptoms directly affect your ability to work in your occupation.
You or your company paid dearly for your individual or group long-term disability benefits, and if you are currently on claim you probably fought hard to obtain your benefits. You don’t want to face a revaluation of your valid claim if your policy transitions to The Hartford.
The Hartford may subject you to:
- Changes in the nature and frequency of your independent medical examinations or functional anxiety capacity evaluations
- Changes to monthly disability forms and physician submission requirements
- Different technological platforms
- Changes in mailing addresses, phone numbers and claims adjusters
- Different administrative appeal procedures or claim hurdles
Interestingly, a primary reason cited for the purchase was The Hartford’s desire to improve its group disability processing system. Aetna’s digital assets and technology apparently far exceeded that of The Hartford. This means The Hartford has acquired a more advanced claims processing system, which theoretically may benefit its current policyholders by hopefully expediting the disability claims process.
“Assigning” Your Disability Policy
When you enroll in a long-term disability policy through your union or employer, you’re signing a contract with the insurance carrier. Even if the rights to administer and receive premiums from that policy change hands, the new carrier is still bound by the terms of the original contract. Accordingly, when The Hartford bought Aetna’s group disability business, it had no legal right to automatically change the terms of your long-term disability policy, including:
- The definition of disability
- Your premium
- The date your policy expires
- The standard by which your occupation’s duties are measured, whether individual or national
- The amount of group disability benefits you’re owed
- The means by which your group disability benefits are calculated
- The nature and length of your eligibility period
- Your policy’s exclusions and limitations
However, your new carrier does control discretionary determinations left open by your long-term group disability plan. This means The Hartford will decide whether you how/have submitted sufficient medical records and how often it will require you to attend independent medical examinations (IMEs), functional capacity evaluations or attend a mandatory field visit.
If your individual or group long-term disability contract states only that your carrier has the right to send you for periodic IMEs, the frequency of these IMEs is left to the discretion of your disability insurer. If Aetna only sent you for an IME every other year, The Hartford may have the right to send you every six months.
Every long-term disability contract is different, and some group plans may grant insurers more discretion than others. You can expect your individual or group long-term disability insurance company to ask you to submit documentation through a new online system or provide medical documentation of your disability more frequently. It may reassign your claim to a new adjuster. However, your new individual or group long-term disability insurance carrier may breach your contract if it changes your benefit amount, asks you to resubmit your valid claim, or tries to increase your premium before the next renewal.
Group Disability Policies and ERISA
Just because your long-term disability policy changes hands doesn’t mean the law governing the plan changes, too. Whether you’re with Aetna or The Hartford, the Employee Retirement Income Security Act (ERISA) generally controls your group long-term disability policy. Under ERISA, you have the following basic legal rights, no matter the carrier:
- Your insurer must grant or deny your claim within the statutory time period.
- You’re entitled to a detailed explanation as to why your carrier denied your valid claim, including the exact areas in which the insurance company-paid doctor disagreed with your treating physician’s findings.
- The insurance company must explain your administrative appeal rights and assign different adjusters and doctors to your administrative appeal.
- Your insurer company cannot retaliate against claims adjusters and doctors who support, grant, or reinstate your group disability benefits.
- Your insurance company cannot incentivize or promote adjusters and company on-site doctors if they deny claims or minimize injuries or illnesses.
ERISA is an extremely complex area of law, but it helps standardize group disability insurance throughout the industry. If you’re unhappy with the transition from Aetna to The Hartford because you’ve experienced a breach of contract or potential ERISA violation, call the nationally renowned disability lawyers and ERISA attorneys at DarrasLaw today at 800-898-7299 or contact us online.
Protecting Your Legal Right to Individual and Group Long-Term Disability Benefits Around the Nation
It’s not uncommon to have your individual or group long-term disability policy assigned to a new carrier as insurance companies get bought and sold. However, your new individual or group disability insurance carrier cannot use this as an excuse to wrongfully delay, deny, or terminate payment of your benefits.
If you experienced difficulty during a disability insurance carrier transition, consult an award-winning individual disability attorney or nationally respected group ERISA lawyer at DarrasLaw today. Frank N. Darras and his firms have recovered nearly $1 billion in wrongfully delayed, denied, and terminated insurance benefits, and we may be able to help. To schedule your free policy analysis and free claim consultation, call DarrasLaw now at 800-898-7299 or contact us online.
