Doe v. Provident Life & Accident (U.S. District Court for the Northern District of Georgia, Long Term Disability)
We represented a 55 year old, long-time insurance salesman and financial planner. In the early 1980′s he purchased two disability policies from Provident. In 1990, he suffered a bout of major depression necessitating in-patient hospitalization. He returned to work full time, full duties, but at reduced effectiveness due to a continuing diagnosis of depression vs. dysthymia (a minor, chronic form of depression resulting in impaired concentration, impulsivity, a lack of motivation, etc). As a result of his diminished capacity, our client’s income never approached his pre-disability levels. Provident initially accepted the claim, paying residual disability benefits of $4,500.00 per month, but also subjected our client to multiple medical examinations over the years, many of which questioned the diagnosis and/or extent of his disability.
Eventually Provident unilaterally terminated benefits based upon four adverse medical opinions. We filed suit on behalf of our client alleging breach of contract and bad faith denial of insurance benefits under O.C.G.A. § 33-4-6. Our investigation of the matter in litigation revealed that the Provident’s medical examiners’ analysis was flawed and unreliable, and that the Provident had not disclosed policy improvements issued to all policyholders which substantially liberalized the definition of residual disability. The claim involved net present value exposure for future benefits of approximately $850,000.00. After the above information was disclosed in a settlement conference, the case settled for a confidential sum. Benefits had also been suspended under a third disability policy taken out by Plaintiff with another insurer not a party to the lawsuit. Much to the client’s delight, we were able to get benefits reinstated on this policy merely by advising the insurer of the outcome of the earlier litigation.