Provident Life and Accident Insurance Company paid our client, Ronnie H., his long term disability benefits from October 2001 until February 2004. Then, as of March 1, 2004, Provident terminated Ronnie’s LTD benefits, claiming he was no longer disabled. Provident terminated Ronnie’s benefits even though the medical records showed that Ronnie’s condition had not improved during this time; quite to the contrary, his physical condition had declined since 2001.
I filed suit against Provident for breach of contract for wrongfully terminating Ronnie’s LTD benefits, and simultaneously filed a Civil Remedy Notice of Insurer Violation (CRN) pursuant to Florida Statute Section 624.155.
Prior to trial, Provident agreed to reinstate Ronnie’s LTD benefits, pay all past due benefits, and pay my attorneys fees and costs. By that time, the CRN had expired, exposing Provident to liability for extracontractual bad faith damages.
As a result of Provident’s conduct in this case, and others, I recently filed a Bad Faith lawsuit against Provident in the United States District Court, for the Middle District of Florida.
This is not the first time Provident’s LTD claims handling procedures have been questioned. We will present evidence in this case showing that in November 2004, Provident entered into a Multi-State Plan of Corrective Action/Regulatory Settlement Agreement with 49 jurisdictions including the State of Florida, as a result of Provident’s improper claims handling procedures for LTD claims. The Multi-State Agreement was the culmination of a lengthy and exhaustive investigation into Provident and its affiliates, Unum Life Insurance Company of America, and The Paul Revere Life Insurance Company’s LTD claims handling procedures. Among other things, the investigation revealed specific areas of concern that Provident:
• improperly relied upon in-house medical professionals;
• unfairly construed attending physician and IME physician reports;
• failed to evaluate the totality of the claimant’s medical conditions;
• placed an inappropriate burden on claimants to justify eligibility for benefits.
All of these were a calculated and systemic business practice by Provident and its affiliates. As a result of the multi-state investigation, in November 2004, Provident, Unum and Paul Revere agreed to reassess claims; modify claims handling and benefit determination practices, establish a specific claim reassessment process, and pay a $15,000,000.00 fine.
In Ronnie’s case, the initial Rule 26 meeting recently took place, and the parties are now providing their initial voluntary disclosures.
One of our experts in the case is a former insider from Provident and its affiliates who will be able to expose Provident’s bad faith claims handling experience.