We have previously discussed the importance of appealing when insurance providers deny long-term disability benefits. People feeling like they’re not equipped to handle a lengthy court battle while they’re sick or injured aside, there’s a persistent myth that insurance providers can crush applicants under the weight of their high-priced lawyers and teams of medical professionals.

In truth, these people have a powerful motivation to save the company as much money as possible. This mandate often leads them to make questionable decisions and, occasionally, absurd decisions.

Desperately twisting reality

In Rosenberg v. Reliance Standard Life Ins. Co., the plaintiff, a doctor with a private practice, became permanently disabled and unable to perform her job. She applied for long-term disability benefits, which Reliance denied.

Normally, insurance providers deny (or attempt to deny) applicants for vague or creative reasons. Sometimes they deny people for no reason at all. These denials often revolve around medical nuances or a questionable interpretation of the plan. In this case, the medical evidence was so ironclad that Reliance went in a different direction.

Seeing that the plaintiff’s business structure involved payments for her work going to her corporation, rather than a standard salary, Reliance argued that she had no “covered monthly earnings,” rendering her ineligible for her own plan.

Cue the magic words

In the world of long-term disability appeals, the words “arbitrary and capricious” usually precede good news for plaintiffs. Both the district court and the circuit court agreed that Reliance’s reading of the policy “borders on the absurd.” They went on to add “the only reasonable interpretation of the Policy is that Rosenberg’s ‘Covered Monthly Earnings’ includes her ‘compensation from the partnership.’”  The courts’ unpublished decision stated that Reliance “undermined the intent of the policy as a whole,” and that the denial was arbitrary and capricious.

If courtrooms allowed confetti, this is when it would be thrown.

Don’t fall prey to insurance gaslighting

Insurance providers are not all-knowing, all-powerful Goliaths. And applicants aren’t Davids. If a benefits denial seems absurd, then it’s probably absurd and it should be challenged.

Despite the remote possibility of an epic and exhausting court battle, applicants should keep in mind that the first step toward appealing a denial is the easiest: call a lawyer. No sane lawyer will take on a doomed appeal. Worst case scenario, the lawyer agrees that the case is a longshot, in which case all you’ve lost is the time it took to make that phone call. Best case scenario, they find the flawed logic used to justify the denial and now you have a ringer in your corner that knows how to beat the opponent.