Fresno, California – August, 2015 – ERISA Law Group, LLP, a California-based law firm representing disability claimants throughout the United States, has uncovered a scheme by Liberty Mutual Insurance Company to cheat claimants of their disability benefits, potentially affecting thousands of disabled employees nationwide.In a case venued in Northern California District Court, ERISA Law Group’s lawyers, Robert Rosati and Thornton Davidson, have sued Liberty and the University of California for denying their client disability benefits on fraudulent and unfair grounds by:
- using a phony “plan description” different from the issued policy as a basis for denying the claim; and
- specifically hiring an “independent” physician who knowingly uses false reporting and significantly mischaracterized
In this case, Liberty issued a policy to cover University of California employees. It then published a plan description for the University which contains criteria to qualify for disability benefits which were materially different from the issued and approved policy. It engaged in this scheme with the cooperation of University of California. Although the law requires that Liberty decide claims based solely on the policy language, the claimant was denied benefits using terms from the plan description in order to support the false conclusion that she was not entitled to benefits. As the suit alleges, Liberty also uses doctors to review records which it knows, in advance, will misrepresent the condition of its claimants and mischaracterize what surveillance shows. Consistent with its use of the unauthorized plan language, Liberty has designed its disability process to ensure denials of valid claims.
In another case, venued in Maryland District Court, ERISA Law Group has again sued Liberty for nearly identical conduct. Similar to the scheme with University of California, a food services and facilities management company hired Liberty to provide long-term disability benefits and then knowingly allowed the carrier to use claims criteria from a “plan description” which was inconsistent with the issued policy. Like University of California, it participated in the scheme by distributing to its employees a series of claims provisions which it knew were inconsistent with the policy’s terms, again allowing a claimant’ s benefits to be denied upon grounds explicitly omitted from the policy.
Also similar to the Liberty-University of California fraud, Liberty used a fraudulent medical review by the same doctor used in the Northern California case, who misreported the claimant’s condition and mischaracterized surveillance, for the sole purpose of unfairly denying the claim.
According to ERISA Law Group attorney, Thornton Davidson, “these two cases are the tip of the iceberg in that they reveal a pervasive strategy by Liberty of gaining approval by State Departments of Insurance to issue policies which are disregarded in the adjustment and management of its claims. Moreover, Liberty knowingly hires physicians who lie about the claimant’s condition in order to fraudulently support denial of benefits.” Mr. Rosati states that it was ERISA Law Group’s goal to stop Liberty’s practices by holding it financially accountable and ensuring that claimants receive benefits according to the terms of the policy “not made-up language and physician quackery designed to frustrate those very terms and the laws which apply to them.”