AN INSURER’S MERE MENTION OF EVIDENCE CONTRARY TO ITS DENIAL DOES NOT MEAN IT CONSIDERED IT
June 26, 2017
When an insurance company denies a claim, it will often summarize in its denial letter the evidence cited by the insured in support of the claim. The insurance company will do so in order to attempt to create an appearance that it actually reviewed and considered in good faith the evidence contrary to its decision. The insurance company, however, will almost never articulate a reason why the particular evidence cited by the insured is not true or not worthy of belief.
In Montour v. Hartford Life & Accident Ins. Co., 588 F.3d 623, 635 (9th Cir. 2009), in denying the insured’s claim, the disability insurance company, Hartford, mentioned that the Social Security administration had found that the insured was disabled but failed to explain why such a finding was incorrect. In stating that Hartford’s mere mention of a contrary conclusion is not the same as actually considering it, the 9th Circuit stated:
“In its decision denying Montour’s appeal, Hartford acknowledged the SSA’s decision but did not articulate why the SSA might have reached a different conclusion. See MetLife I, 461 F.3d at 671 n.3 (noting that there is a distinction between mentioning a contrary determination and discussing it). Montour v. Hartford Life & Accident Ins. Co., supra at 635.”
The insurance company mere repetition of the formulaic or conclusory opinion of its “go to” medical consultant to support its denial is not the same as explaining why the insured’s evidence is not persuasive. If you received a denial letter from your insurance company, it is important to review it carefully to see whether the insurance company ever articulated a specific and credible reason why your evidence should not be believed. As the 9th Circuit has made clear, the insurance company’s failure to state specific and credible reasons to reject your evidence may be an important ground for overturning the denial.
-Posted June 26, 2017, by Bennett M. Cohen