| Claimant | Rebecca Miller |
| Insurer | New York Life |
| Condition | Chronic Lyme Disease (PTLDS) |
| Employer | Taylor Morrison |
| Jurisdiction | Georgia |
| Benefit Type | Long-Term Disability (LTD) |
| Nominal Benefits | $108,000 |
| Discount Rate | 4.25% (blended) |
| Present Value | $105,138 |
| Offer vs. PV | +$2,862 (2.7% above PV) |
The insurer's offer barely exceeds present value, meaning there is virtually zero premium for risk transfer, medical uncertainty, or litigation avoidance.
| Factor | Low | High |
|---|---|---|
| Medical Uncertainty | +10% | +15% |
| Termination Risk | -10% | -5% |
| Loss of Structure | +5% | +5% |
| Admin Relief | -5% | -3% |
| Inflation Exposure | +3% | +5% |
| Litigation Avoidance | +8% | +15% |
| Bad Faith Exposure | +5% | +10% |
| Net Premium | +16% | +42% |
| Component | Range |
|---|---|
| Remaining Benefits | $108,000 |
| Attorney Fees (§ 33-4-6) | $25K–$50K |
| Bad Faith Penalty (50%) | $0–$54K |
| Defense Costs | $30K–$80K |
| Total Exposure | $163K–$392K |
Expected litigation cost to insurer: $136,700 (probability-weighted). Our demand of $145K represents savings for the insurer.
| Metric | Value |
|---|---|
| Industry LTD Buyouts | 60%–150% of nominal |
| Chronic Condition Buyouts | 110%–140% |
| GA Disability Settlements | 105%–135% |
| Our Position | 134% (within range) |
| Statute | Application |
|---|---|
| O.C.G.A. § 33-4-6 | Bad faith penalty — up to 50% of claim + attorney fees |
| O.C.G.A. § 33-24-2 | Policy ambiguities construed against insurer |
| O.C.G.A. § 33-6-5 | Unfair claims settlement practices prohibition |
If the policy was employer-sponsored through Taylor Morrison, ERISA may preempt Georgia state law claims:
Action Item: Confirm whether this is ERISA-governed or individual policy.