Now that the UnitedHealthcare guy is in custody and the bizarre celebration of murder has died down, I’d like to talk about ERISA (long-term disability benefits) denials and the horrifying lengths insurance providers will go to deny people lifesaving care, while raking in billions in profit each year.

Over the past two years, while writing legal content for FindLaw, one of my monthly tasks was to find some of the most egregious court cases involving providers spending vast sums of money to avoid paying benefits to seriously sick and injured people.

In short, I’ve seen some shit, man. Here’s just a sampling:

Empathy does not compute

Some insurance providers, like Prudential and Cigna, are using AI to bulk-reject claim applications at a rate of five per second. A human eye never sees these. Any claim touched by AI should be regarded with maximum suspicion.

Claims are commonly denied for no discernible reason

Denying benefits for no reason is a common strategy in insurance provider playbooks. A KFF Health News study revealed only one person submits an appeal for every 500 claims rejected by ACA plan providers. (I went through this exact nightmare myself. I appealed, twice, and was still unsuccessful.) Since so few people bother to challenge benefits denials, arbitrary denials have proven to be a financially shrewd tactic.

UnitedHealthcare really does suck

This story is too long to quickly summarize here, but it’s worth a read just to get a sense of how coordinated insurance companies are, up to the highest levels, when it comes to denying their paying customers life-saving care.

You may be under surveillance

Insurance companies routinely investigate customers who have submitted claims to see if they do anything that might suggest they’re not disabled after all. This includes following and taking videos of people in public places and scouring their social feeds. They’ll follow people into restaurants, parties and even church. They are only prohibited from surveiling people in their homes and at work.

A denial addressed to a newborn baby

Speaking of KFF Health News, much like my monthly assignment to find the worst claim denial court cases, KFF and NPR collaborate on a “Bill of the Month” feature, which rehashes the most ridiculous insurance claim denials.

In one segment, a provider’s denial letter, addressed directly to a newborn baby, explained that they would not pay for the baby’s fourth day in the neonatal ICU because it was breathing on its own and drinking milk from a bottle. The implication was that the baby didn’t read its policy closely enough.

Insurance staff doctors are… not good

Insurance provider staff doctors, the ones in charge of approving or denying claims, are often hair-raisingly unqualified. I’ve seen cases with reviewing doctors who hadn’t treated an actual patient in more than a decade, doctors that the courts previously found to be not credible, and doctors making diagnoses in fields of medicine they had never studied or practiced.

These same doctors also routinely override the notes and recommendations of doctors that, you know, actually treated the patient. These fan fiction diagnoses do not play well in court. Again, ALWAYS APPEAL.

Nor are their lawyers

Insurance provider lawyers are sometimes hilariously incompetent. To be fair, they are often in the position of defending the indefensible, which would make anyone look like a galloping ding dong in court. In any case, it’s highly unlikely that a team of the best lawyers that money can buy will be grilling you on the stand.

If it quacks like a duck…

If a benefits denial seems absurd, then it’s probably absurd and it should be challenged. Don’t let providers gaslight you into thinking you’re simply not smart enough to understand the legalese in the policy. Appeal any and all denials. See above.

There’s (usually) no need to rush an appeal

Yes, having your only financial lifeline cut off is panic attack material. But a rushed appeal will mostly likely not help your situation. Typically, people have 180 days to submit an appeal, unless they give you a shorter deadline. You only get one appeal before it turns into a court drama, so use that time wisely.

You want to carefully, comprehensively review your claim and denial. Insufficient or incomplete paperwork is one of the most common reasons for benefit denials, and you cannot introduce evidence in court that wasn’t already in the appeal, so thoroughness will be key.

Make sure you have a firm understanding of why you were denied and then collect every scrap of paper and piece of supporting evidence you can find. There’s no such thing as too much evidence (probably). You want to thoroughly rebut every point in the denial letter. Your doctor can help with this.

If you don’t have it already, request a copy of your full claim file. The insurance company must provide this by law.

Finally, it’s going to be the worst beach read of your life, but reread your entire policy. Read it twice for good measure and use a highlighter liberally to flag the important parts. These things are intentionally written to be as confusing and impenetrable as possible, so you’ll need to focus up.

It’s not required, but enlisting an ERISA attorney is strongly recommended. They can do all of this faster and more thoroughly than you can, especially if your disability has a cognitive component.

Et tu Social Security?

Due to new quotas, Social Security disability claim rejection rates are at an all-time high. Courts are finding fault in six out of every 10 denials. The rejection quotas are an over-correction that resulted from a 2012 case when a Kentucky lawyer ran a disability scheme that defrauded taxpayers for almost $600 million. (Why is it always a rich, white guy ruining things for the rest of us?)

This renewed oversight got worse during the first Trump presidency, when tight-fisted political appointees started firing judges with a record of high claim approvals. The other judges quickly fell in line.

The reason I mention this is because already having an approved Social Security Disability claim can force an insurance provider’s hand into approving your claim without a courtroom showdown. If the insurance provider is bold enough or dumb enough to deny a claim with SSDI backing, they aren’t going to last five minutes in even the most conservative court.

Lawyers are the unlikely heroes in these cases

Talk to a lawyer. Many of them don’t charge a fee unless you win your appeal. Sure, they get some of your payout, but that’s better than no payout at all. And boy do they LOVE beating insurance companies.

Be careful what you sign during an ongoing appeal

We absentmindedly sign user agreements and such almost every day. Do not do this during a long-term disability case. I wrote about one situation when a plaintiff signed an employment separation agreement, including compensation, without carefully reviewing its contents. Her employer assured her that the agreement wouldn’t affect her long-term disability appeal. They straight up lied – and she lost her appeal, worth $1.2 million.

Avoid Medicare Advantage at all costs

If you hear about any of your older relatives thinking about enrolling in “Medicare Advantage,” tackle them to the ground. It’s a scam that actually un-enrolls them from Medicare and hands them off to private insurers with only a fraction of Medicare’s coverage and a squillion restrictions. Even worse, once someone leaves Medicare for a private insurer, they may never be able to go back.

I’ve spent a lot of time visiting a family member in the hospital this past month, so I’ve seen numerous Medicare Advantage commercials on CNN. Disingenuous talking points, meant to conceal the true nature of these privatized programs, include terms like “consumer choice,” “competitive prices,” “empowering shoppers,” and “encouraging innovation.” Sometimes these commercials are several minutes long. I have no idea how this is legal. The whole Medicare Advantage concept appears to be the brainchild of the hated Heritage Foundation.

The so-called Department of Government Efficiency (DOGE), proposed by Elon Musk and Vivek Ramaswamy, will almost definitely encourage Medicare Advantage to cut spending and possibly even eliminate actual Medicare.

Sick and injured former NFL players are being aggressively screwed

The Bert Bell/Pete Rozelle NFL Player Retirement Plan spends most of its time plotting ways to deny benefits to former players with traumatic brain injuries and other debilitating conditions. Google “Michael Cloud v. NFL Player Retirement Plan” or read my posts on the subject here, here and here.

On a related note, the Fifth Circuit Court has devolved into a GOP tool.

Don’t quit your job due to a disability right away

No matter how disabled and incapacitated you are, do not quit your job until AFTER you apply for long-term disability benefits.

Quitting before you apply will make your benefits case far more difficult. But also, don’t be a hero and keep working through the pain while you apply for benefits, because the insurance company will argue that if you’re still working, you must be fine.

“Denial nurse” is a job title now

Insurers have become so brazen with their snap claim rejections, that a former Medicaid worker in California, tasked with upholding preliminary rejections from thousands of claims, was given the job title “denial nurse.”

Again, this is just a sampling from my two-year effort to track down the worst of the worst long-term disability insurance denials. Not all claims are a nightmare, but a substantial portion are, and untold millions of claims never got to the nightmare stage because the customer didn’t appeal. It’s best to go into these situations with the mindset that your insurance provider is deliberately, enthusiastically trying to deny your rightful disability claim, so you’re mentally prepared for an appeal and possibly a court battle.