The relevance of a Social Security disability determination to the outcome of a long-term disability claim has become a hot topic with the courts and insurance regulators. CIGNA and its subsidiary, the Life Insurance Company of North America have been the subject of numerous court rulings as well as a recent regulatory settlement with state insurance departments, as exemplified by our discussion of the ruling issued in Melech v. Life Ins.Co. of North America, 739 F.3d 663 (11th Cir. January 6, 2014). There, the plaintiff, Diane Melech, worked for Hertz Corporation as a station manager until she became disabled in 2007 due to degenerative disk disease in her cervical spine and tendonitis in her right shoulder. After becoming disabled, Melech submitted a claim for disability benefits to the Life Insurance Company of North America (LINA), which denied her claim. Shortly after the denial, Melech was approved by the Social Security Administration to receive Social Security Disability Insurance Benefits; and she notified LINA of the approval. However, LINA denied Melech's claim appeal without asking her to supply the SSA decision or any of the evidence submitted to Social Security.
Long-term disability insurance cases involving fibromyalgia present special difficulties because there are no objective tests for the condition other than a clinical "trigger-point" test. A recent ruling from California handled by attorney Michael McKuin and decided by Judge Dolly Gee presents an interesting and thorough discussion of such a claim that stands out in noting where the insurer, Liberty Life Assurance Company of Boston, a subsidiary of the Liberty Mutual Insurance Company, was found to have thwarted a legitimate claim by not sharing the evidence it developed while reviewing the claim denial.