When it comes to disability insurance claims, it seems like all claimants are subject to the same hassles regardless of their financial status or social class. Long term disability insurance companies are billion dollar giants that really don't care much about what individual policy holders think about them or about the negative effects that bad publicity can have against their businesses. Take the example of Haruki Nakamura, an Ex-NFL player who was recently denied long term disability benefits.
Nakamura, a former safety for the Baltimore Ravens and the Carolina Panthers, purchased a 1 million dollar long term disability policy from Lloyd's of London that provided benefits in the event that, due to illness or injury, he became unable to "participate ever again in his occupation of football player". In August 2013, during a Carolina Panthers pre-season game against the Pittsburgh Steelers, Nakamura suffered a hit to the head and was diagnosed with a concussion a few days later. Nakamura was placed on the injured list in September 2013 and two days later was released from his Carolina Panthers contract due to his “concussion.”
In October 2014, Kakamura's treating doctor wrote a report stating that his patient would not be able to play professional football again due to the disabling effects of his concussion. Despite the well documented evidence of the effects of concussions in football and the medical evidence on record, the insurance company chose not follow the recommendation of Mr, Nakamura's doctor. Instead, the insurance company invoked its right to conduct its own medical examination by a doctor hired by them.
After unnecessarily prolonging the application for benfits for more than 18 months, the insurance company denied the claim. In many ways the actions by the insurance company in Nakamura's claim, resemble many other denials that I see on a regular basis. The company's decision to deny benefits is typical of the insurance industry's arrogance. For example, the insurance company claimed that Nakamura could return to play, however their own doctor cautioned Nakamura to consider the “probable long-term effects of repetitive concussions” before making the decision to go back to football. This leads me to believe that the insurance company knows that it doesn't have a strong case but it denied the claim merely to force Mr. Nakamura to compromise his claim.
Another aspect of Nakamura's claim that resembles some of the issues faced by my clients is that the insurance company seems to be preying on the highly subjective aspects of disabilities claims caused by concussions. Nakamura has alleged that due to the concussion he suffers from headaches, vision problems, fatigue, depression and suicidal thoughts. Unlike usual orthopedic injuries suffered by football players, the subjective effects of head trauma are a lot harder to assess with objective tests.
Nakamura has filed his complaint in the North Carolina Superior Court. To read a copy of the complain click here. Since Nakamura purchased his policy individually, his lawsuit is not covered by ERISA. As you can see from the complaint, he is entitled to a jury trial and damages for unfair and deceptive practices. If his claim had been governed by ERISA, such legal remedies would not have been available to him