Support Lindsay's Battle Against MS

Illness can strike unexpectedly, disrupting lives and dreams. Your support will help cover essential expenses and mounting medical bills as I work to stabilize my health while battling MS. We promise that once we’re through this storm, we’ll pay it forward, giving back to the world in meaningful ways.

Although we believed we had a safety net with paid long-term disability coverage through Unum (a company with a known track record of issues, including losing a prior class-action lawsuit), they unfortunately decided in May that I was not “sick enough” to qualify—despite letters from all my doctors supporting my condition. We’re challenging their decision, but the legal process is expected to take at least a year and then the laywer takes there percentage.

Why they do not automatically have to pay the legal fees if they lose, baffles me!

Under most employer-sponsored long-term disability (LTD) insurance plans, which are governed by the Employee Retirement Income Security Act (ERISA), the rules are designed to limit the types of damages and remedies claimants can pursue. Here’s why suffering and lawyer fees are generally not recoverable in these cases:

1. ERISA Limitations: ERISA is a federal law that preempts state laws and restricts remedies available to claimants. Under ERISA, if you sue an insurance company for wrongful denial of benefits, you’re primarily limited to recovering only the benefits you should have received under the plan, plus interest and, in some cases, attorney’s fees. The law doesn’t allow for damages for emotional distress, pain and suffering, or punitive damages.

2. Compensatory Nature of ERISA: ERISA is structured to compensate claimants solely for the economic loss tied to the denial of benefits. It aims to make claimants whole only by awarding the benefits they were originally owed. This focus on economic recovery excludes non-economic damages, such as pain and suffering.

3. Attorney's Fees Are Not Automatic: ERISA allows courts the discretion to award attorney’s fees in some cases, but it’s not a guarantee. Courts weigh factors, such as whether the insurance company acted in bad faith or whether awarding fees would benefit other plan participants. However, even when awarded, these fees are typically just to cover the legal costs, not any additional compensation.

4. Limited Punitive Actions: ERISA’s purpose is to provide uniform standards across employee benefit plans, which means it limits the possibility of punitive damages. The law is not designed to punish insurers but rather to ensure claimants receive the benefits to which they’re entitled under the terms of their plans.

In some cases, if your LTD insurance is a private policy or an employer plan not covered by ERISA, you might have more options to seek damages, including those for suffering and attorney’s fees, under state laws. However, for most employer-sponsored LTD plans governed by ERISA, the remedies are unfortunately quite limited.