Scott Paulson experienced an on-the-job injury that rendered him disabled. He claimed long-term disability with his employer-sponsored plan with Principal Life Insurance. While Scott was attempting to build a new career as a real estate agent, Principal Life Insurance miscategorized his job as a real estate broker, resulting in his denial. Scott hired the experts and long-term disability attorneys at Roy Law Group, settling his case to give him the benefits he rightfully deserved.

From long-haul truck driver to disabled

Scott experienced a permanent back injury as a result of his work as a long-haul truck driver in the Seattle – Tacoma, Washington area. He made a disability claim under his employer-sponsored long-term disability plan, which was honored by Principal Life Insurance in 2010. After the first two years of Scott’s policy, Principal Life Insurance continued to pay him benefits under his disability plan.

Scott had switched professions and started building his career as a real estate agent. His disability insurance policy required Principal Life Insurance to continue to pay benefits until Scott could reasonably be expected to earn at least sixty-five percent of his pre-disability income. Considering Scott was just beginning his career as a real estate agent, his income was nowhere near the requirement. They paid Scott full benefits until April of 2015.

Like most insurance companies, the Principal Life Insurance team was looking for ways to discontinue Scott’s claim, and they finally thought they had found a way. They alleged that through their investigation, they had found evidence that Scott could finally meet the sixty-five percent income requirement. As Roy Law Group ended up proving, under Washington State law this was not accurate, nor the case.

When the going gets tough, insurance companies get tougher

Principal Life Insurance has an army of attorneys and doctors who are paid to provide the means to deny disability claims. Moreover, disability insurance providers like this bank on the fact that the majority of individuals who are denied are going to make mistakes. Even when the simplest of errors happen, it can mean the end of benefits and without the ability to appeal.

With the majority of disability denials, there are subtleties built into the fine print of your plan that are not clear to anyone but a disability attorney and the insurance company.

With the majority of disability denials, there are subtleties built into the fine print of your plan that are not clear to anyone but a disability attorney and the insurance company.

When Scott’s disability insurance claim was denied, he hired Roy Law Group to take on his multi-state and formidable case.

When it came down to it, Scott’s disability appeal was fought from every possible angle. Principal Life Insurance was pulling out all the stops in what would end up being a three-year battle of multiple hearings, appeals, and court hearings.

Luckily, Scott had his team at Roy Law Group who are well versed in disability and ERISA law.

Semantics in law is everything

Scott was an up-and-coming real estate agent. The data was clear that he could not reasonably be expected to earn enough money at that stage in his profession. Principal Life Insurance tried to get around that fact by intentionally playing word games, alleging that Scott was not a real estate agent, but in fact a full-fledged real estate broker.

It does not seem like this would be a dealbreakerHowever, that one word – broker versus agent – made all the difference. The average income for an agent in Washington was much lower than for a broker, who typically owns their own business. If Principal could get away with calling Scott a broker, that one word would disqualify him from any further disability benefits.

This argument was absurd, but also very complicated – and while a foreign language to most, this is the language that Roy Law Group is fluent in.

State vs. state law

Scott’s case was being dealt with in the Western District of Washington State, where he resided, yet the disability insurance plan was issued and delivered in Texas, where the company he worked for was headquartered. This is where things got even more complicated.

Principal Life Insurance had a clause that stated they had the sole authority to determine the validity of his disability claim. In Texas, this clause was allowed. In Washington State, however, there was a ban on this specific clause. For a multitude of legal reasons, the validity of this clause had a significant impact on his case.

If an insurance company has sole authority to determine the validity of a claim, how is that fair? Also, how can an individual fight a denial? The answer is, it’s complicated.

If an insurance company has sole authority to determine the validity of a claim, how is that fair? Also, how can an individual fight a denial? The answer is, it’s complicated.

In a prior similar case, Roy Law Group was able to set the legal precedence to overturn this clause with Principal Life Insurance and prove that even though the insurance was issued in another state, it was invalid and unenforceable in Washington.

In this case, we did it again. Roy Law Group beat Principal Life Insurance from every angle of attack, settling Scott’s dispute with what he rightfully deserved.

Don’t let insurance companies like Principal Life Insurance win

If you have been denied on your long-term disability claim, do not go at this alone. You are not an attorney, and they have hundreds ready to take you on.

Roy Law Group has a compassionate team of experts who do disability law and nothing else.

Contact Roy Law Group right away to set up your consultation.