Winchester, Va. — Until a few years ago, Debra Potter fabricated abiding that her ancestors could cruise the Caribbean, watch the NFL on big-screen TV and accumulate her aged mother and ancestors at home in comfort.
She did so by earning $250,000 a year affairs added allowance than about anybody abroad in the accompaniment of Virginia, around all of it affliction and bloom behavior that she anticipation put a assurance net beneath common and flush families such as her own.
Potter so believed in the aegis she was accouterment that she fabricated abiding she was covered beneath a action her employer, Southeastern banking casework behemothic BB&T, had with UnumProvident Corp., the nation’s better affliction insurer.
But back Potter began falling bottomward in 2002 and was after diagnosed with assorted sclerosis, she apparent that the aegis didn’t assignment annihilation like she’d expected.
UnumProvident, whose behavior the 50-year-old allowance abettor had been selling, questioned whether Potter absolutely was disabled and banned to pay her. Although the firm, based in Chattanooga, Tenn., relented a few weeks ago, the changeabout took three years and did not appear afore the Potters had run through best of their savings, yanked one of their bristles accouchement from academy for abridgement of charge and assassin a lawyer.
The $10.5-billion-a-year insurer denies corruption Potter’s case, adage alone that “new information” acquired it to change its position and alpha paying.
“People charge assurance nets, and that’s what I anticipation I was affairs them,” Potter said. “But actuality I am with all my adeptness of allowance and I couldn’t accomplish it assignment for me.”
When common Americans allocution about assurance nets, they usually beggarly such things as aliment stamps or apartment subsidies — accessible abetment on which about alone the poor depend. In fact, alive bodies up and bottomward the assets spectrum angular heavily on a continued account of protections such as healthcare coverage, unemployment advantage and pensions or 401(k)s.
But an assay of Potter’s experience, UnumProvident’s acknowledged and authoritative almanac and the practices of several added insurers suggests that a key basic of alive Americans’ careful absorber fails with alarming regularity.
Disability allowance — now agitated by added than 50 actor Americans — about promises to alter at atomic bisected of a person’s accomplishment in case of affliction or injury. However, in a abundant cardinal of cases, abnormally those involving workers with abiding or abiding disabilities, it doesn’t deliver.
The arch acumen — and one that affects not alone affliction but the accomplished cosmos of employer-provided allowances — is a alternation of cloister decisions ambidextrous with the federal allowances law accepted as ERISA. The decisions accept prevented states from extending about any anatomy of customer aegis to these benefits, and accept acutely bound individuals’ adeptness to auspiciously sue their insurers.
“People who book affliction claims today are worse off than they were two or three decades ago,” said Judge William M. Acker Jr., who was appointed to the U.S. District Cloister in Alabama by President Reagan. “The law that was declared to assure them has been angry on its head; the arch beneficiaries are now the allowance companies,” said Acker, who has presided over a array of affliction allowance cases and has accounting abundantly on the subject.
That such a across-the-board change could action and that it could alter addition as flush as Debra Potter illustrates how abutting best Americans are to the bread-and-butter edge, area a few setbacks at assignment or in bloom can accelerate a actuality tumbling.
“The assurance nets advised to assure bodies from actuality run over by bread-and-butter armament above their ascendancy accept been shredded,” said California Allowance Commissioner John Garamendi, a Democrat whose administration is investigating UnumProvident.
For years, affliction was a sideline, generally befuddled in by allowance agents as an allurement to buy activity insurance. But starting in the 1960s, the ambit and accent of the affliction assurance net added dramatically.
Types of behavior broadcast to accommodate both alone and employer-provided coverage. Benefit-payment periods were continued to aftermost to age 65 or later. Eligibility rules were alone to accommodate not alone bodies who could do no assignment at all but those clumsy to do aloof their “own occupation.” An archetype of the difference: An airline pilot whose apparition had attenuated so abundant that he couldn’t fly but could still do a board job would not accept been covered beneath the old system, but would be covered beneath the new one.
Washington advised in by extending Social Security to awning the best disabled, aged or not, and by advocacy allowances several times.
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