Anthem Life Insurance Company Wrongly Denies Employee Benefits

The O’Ryan Law Firm, on behalf of Plaintiff Sherry M., recently filed a federal lawsuit against Anthem Life Insurance Company (“Anthem”). The Plaintiff was employed with Anthem Life as an Operations Expert, which made her eligible for disability benefits under the Anthem Life Long Term Disability (LTD) Plan (the “Plan”).  Anthem was both her employer as well as the insurance company for her long term disability benefits.  It always is particularly troubling to see an employee, who has worked hard for a number of years for an insurance company, be mistreated when they become disabled by their own employer.

Facts of the Case

The Plaintiff was employed by Anthem Life until she became disabled in 2015 due to the disabling effects of lupus erythematosus.  According to WEB MD, lupus is an autoimmune disease, which means that the immune system mistakes the body’s own tissues as foreign invaders and attacks them. Some people with lupus suffer only minor inconvenience. Others suffer significant lifelong disability. Nine out of 10 people with lupus are women. The disease usually strikes between age 15 and 44, although it can occur in older individuals. There are two kinds of lupus:

  • Discoid lupus erythematosus (DLE)
  • Systemic lupus erythematosus (SLE)

SLE is more serious: It affects the skin and other vital organs, and can cause a raised, scaly, butterfly-shaped rash across the bridge of the nose and cheeks that can leave scars if untreated. SLE can also affect other parts of the skin on other parts of the body.

Besides the visible effects of systemic lupus, the disease may also inflame or damage the connective tissue in the joints, muscles, and skin, along with the membranes surrounding or within the lungs, heart, kidneys, and brain causing extensive damage. SLE can also cause kidney disease. Brain involvement is rare, but for some, lupus can cause confusion, depression, seizures, and strokes.  All of which make it very difficult to work in any type of regular capacity.

Additionally, blood vessels may come under attack with systemic lupus. This can cause sores to develop on the skin, especially the fingers. Some lupus patients get Raynaud’s syndrome, which makes the small blood vessels in the skin contract, preventing blood from getting to the hands and feet — especially in response to cold. Most attacks last only a few minutes, can be painful, and often turn the hands and feet white or a bluish color. Lupus patients with Raynaud’s syndrome should keep their hands warm with gloves during cold weather.  As shown by these symptoms, individuals suffering from the symptoms of lupus face great challenges in remaining able to work a 40 hour work week on a sustained basis.

 After her lupus symptoms became severe, the plaintiff submitted a claim for long term disability benefits with Anthem after receiving the maximum amount of short term disability benefits.  Anthem denied her claim contending that her medical records did not support a condition severe enough to take her out of work.  The Plaintiff filed an internal appeal with Anthem with further supportive evidence of her claim; however, Anthem denied her appeal.

Having no alternative, the plaintiff hired the O’Ryan Law Firm to represent her in court.  The O’Ryan Law Firm filed a lawsuit against Anthem for their wrongful denial of the plaintiff’s disability benefits.  We are seeking the following from the Court:

A judgment that requires Anthem  to pay all long-term disability and life waiver of premium benefits that are due, along with accrued interest

A judgment that the Plaintiff’s eligibility for future long-term disability and life waiver of premium payments e reinstated

A judgment that the Plaintiff will continue to receive future long-term disability and life waiver of premium payments for as long as Plaintiff remains eligible under the terms of the Plan

A judgment that Anthem will pay for the plaintiff’s attorney fees

A judgment that Anthem will pay for all associated court costs

If you have a disability claim with Anthem that has been denied, please contact the O’Ryan Law Firm so that we may take immediate action to obtain payment of your disability benefits.  We understand that the loss of this income can cause severe financial difficulties for you and your family and therefore seek to obtain the best results possible for your claim.