McKennon Law Group, Author at McKennon Law Group

This is the 14th Year in a Row He Has Been Recognized

McKennon Law Group PC is proud to announce that its founding shareholder Robert J. McKennon has been recognized as one of Southern California’s “Super Lawyers” in insurance coverage for 2025, and appears in the 2025 edition of Southern California Super Lawyers magazine published today. Mr. McKennon has received this designation every year since 2011. Each year, Super Lawyers magazine, which is published in all 50 states and reaches more than 14 million readers, names attorneys in each state who attain a high degree of peer recognition and professional achievement. The Super Lawyer designation, the most prestigious award to be given to lawyers, is given to less than 5% of lawyers nationally after being nominated and voted on by their peers.

When filing a life insurance claim, many policyholders and beneficiaries are unaware of the complexities that community property laws can introduce. In California, community property laws can play a significant role in determining how life insurance benefits are distributed when the policy is purchased during a marriage and the married couple live in a community property state such as California. Understanding how these laws impact life insurance proceeds is crucial whether you are a policyholder, beneficiary, or dealing with a contested claim.

Four Facts About the Relationship Between Community Property and Life Insurance in California

Life insurance might seem like a simple concept. You purchase a policy and make all the required premium payments. If you or the insured party passes away, the named beneficiaries receive the contracted cash benefits.

However, life insurance is not always straightforward, and policies often come with many caveats and requirements. The same is true for accidental death and dismemberment claims and almost any other type of insurance policy. Understanding how the policy itself may impact the distribution of life insurance death benefits is critical, as is knowing when and how federal or state laws may impact your rights or benefits.

In California, one factor that can impact life insurance claims is community property laws. California is a community property state, meaning that assets acquired during a marriage are generally considered jointly owned by both spouses. This principle applies to life insurance policies purchased with marital funds. However, various factors, including divorce, separate property designations, and federal ERISA law, can complicate how life insurance benefits are ultimately distributed.

1. Life Insurance Acquired During a Marriage Is Community Property

Life insurance you purchase during a marriage is often considered community property in California. That is especially true if the life insurance premiums were paid for with marital assets. Thus, if a life insurance policy is purchased during a marriage and premiums on that policy are paid for using community funds, California law generally considers the life insurance policy to be community property. This means that both spouses have an equal ownership interest in the policy.

Issues can arise when the policyholder designates a beneficiary other than their spouse without obtaining the spouse’s consent. In such cases, a surviving spouse may be able to challenge the beneficiary designation and argue that he or she is entitled to their community property share of the proceeds. Courts will often examine the source of funds used to pay for the policy and whether the beneficiary designation violated community property laws.

This fact is most relevant in cases involving a term life policy or a life policy that accumulates cash value, such as a universal or whole life insurance policy. If such a policy is purchased during marriage and premiums are paid with community property funds, both spouses have a right to the policy’s cash value even if one spouse purchased the policy or only one person is named as a beneficiary. Moreover, concerning a term life policy that has a death benefit, a spouse who paid premiums with community property may have a claim of up to 50% of the death benefit even if he or she is not the named beneficiary.

2. Divorce Does Not Automatically Revoke Spousal Beneficiary Designations

Many family breadwinners purchase life insurance policies and name their spouses as the beneficiaries with the intent that the policies will help cover day-to-day expenses or pay off homes if the worst should happen. If a couple gets divorced, it might seem logical that the life insurance beneficiary would change. However, divorce does not automatically revoke an ex-spouse’s beneficiary designation in California.

If you get divorced and want to ensure that life insurance policy benefits go to someone other than your ex-spouse, you must change the beneficiary designation and have the ex-spouse disclaim the proceeds in a divorce settlement agreement. If this is not done, the life insurance policy will likely be deemed community property to the extent the premiums were paid with community property funds, even if the ex-spouse is not a beneficiary. Whether or not you change the beneficiary needs to be discussed as part of that process.

Consider a hypothetical example to understand how this type of situation can become complex. Imagine that Max and Eileen were married for 10 years. During their first year of marriage, they buy a whole life insurance policy on Max. By the time they get divorced, the policy’s cash value is $50,000. Max and Eileen may negotiate to divide the cash value equally through divorce. Or, they might decide that Max will continue to pay the premiums and Eileen will continue as the beneficiary as part of a spousal support agreement. Another option might be for Eileen to agree to give up any stake in the policy and for Max to change the beneficiary designation to someone else.

The outcomes can vary widely, but it is essential to understand that life insurance policies must be considered during divorce proceedings.

3. If Someone Outside of the Marriage Purchases a Policy, the Benefits Might Not Be Community Property

Not all life insurance policies are affected by community property laws. If spouses purchase a life insurance policy with marital funds but do not live in a community property state, the policy will not be considered community property. Or, if an individual purchases a life insurance policy before marriage and continues to pay the premiums with separate funds, the policy is generally considered separate property. Similarly, if a third party—such as a parent or business partner—purchases a policy on a married individual, the proceeds typically do not become subject to community property claims even if the married couple lives in a community property state.

However, disputes can still arise if premiums are paid using a mix of separate and community funds. In such cases, courts may use a tracing analysis to determine the proportion of the policy considered community property versus separate property.

But, if separate property proceeds are commingled with community property and those commingled funds are used to pay for a life insurance policy, the policy benefits can become community property.

4. ERISA Law Can Supersede Some California Laws About Beneficiaries and Community Property

One important caveat to California’s community property rules is the potential impact of the Employee Retirement Income Security Act of 1974 (ERISA). ERISA governs many employer-sponsored life insurance policies and can preempt and supersede state laws regarding beneficiary designations and community property interests. If you have an employer-sponsored life insurance policy or are the beneficiary of one, you should know that ERISA generally requires that the named beneficiary of the policy must be honored regardless of whether a policyholder is married and has named someone other than their spouse, unless there is what is known as a QDRO (Qualified Domestic Relations Order) that supersedes the beneficiary designation.

A QDRO is a court-ordered legal document created after a divorce that splits and changes ownership rights related to a retirement plan or insurance policy to give the divorced spouse their share of the policy or pension plan. A QDRO can be used to designate a specific individual as the beneficiary of life insurance benefits, even if a different beneficiary is named in the policy itself.
The need to consider the impact of ERISA is not unique to life insurance. In California, retirement benefits are often community property, but ERISA rules might also impact beneficiary considerations on these assets.

When You Might Want Legal Help With a Life Insurance Claim

Getting legal help to protect your rights and support your access to life insurance benefits can be a good idea. You should contact experienced life insurance lawyers if you believe an insurance company has wrongly denied a claim or delayed payment. You should also contact an experienced life insurance lawyer if multiple people claim a right to share in the policy benefits.

The team at McKennon Law Group PC is highly experienced in handling life insurance claims and we fight aggressively to assert your rights and protect your interests in disputes with insurance companies. Contact us at 949-504-5381 for help with your life insurance claim dispute.

The United States District Court for the Northern District of Indiana recently examined the issue of determining what constitutes the administrative record where an insurance company fails to meet regulatory deadlines under the Employee Retirement Income Security Act of 1974 (ERISA). Essentially, this meant that the Court had to decide whether Reliance Standard would be able to introduce evidence before the Court that was gathered after the expiration of the time period to make a decision on the long-term disability (LTD) claim at issue.

In King v. Reliance Standard Life Insurance Company, 2024 WL 5165572 (N.D. Ind. Dec. 19, 2024) the Court decided the issue of whether defendant Reliance Standard Life insurance Company (Reliance Standard) improperly denied plaintiff Megan King’s LTD claim. The case centered around Reliance Standard’s failure to render a decision on her claim within the 45-day requirement of the Department of Labor’s (DOL) ERISA claims regulations.

King became disabled in 2018 and Reliance Standard approved her LTD claim and paid her benefits for four years. In September 2022 Reliance Standard determined King was no longer disabled and notified her that her benefits would be discontinued. King appealed in July 2023. As of September 11, 2023 King had not received a decision from Reliance Standard, nor had Reliance Standard invoked a need for additional time to review her appeal. The DOL regulations require insurance companies to provide a response within 45 days and allow them to take an additional 30 days when they are unable to complete the review due to something outside their control, though they must notify the claimant of the need for this extra time before the 45-day period runs. When King did not receive either a decision or notice of a need for additional time within 45 days, she considered her administrative remedies exhausted and filed a federal lawsuit under ERISA. Reliance Standard denied King’s appeal four months later.

The issue before the court focused on whether evidence gathered by Reliance Standard after the exhaustion deadline could be included in the court’s review. King argued that the administrative record should close once the regulatory deadlines expired, emphasizing ERISA’s strict procedural safeguards. The court agreed, granting King’s motion to exclude post-exhaustion evidence from the record. The court held that once a claim is deemed exhausted, the plan administrator cannot introduce additional evidence to justify its denial.

The court cited Fessenden v. Reliance Standard Life Ins. Co., 927 F.3d 998 (7th Cir. 2019) and determined that because Reliance Standard violated its obligations mandated by the DOL regulations, its late decision is not entitled to the deference provided by the abuse of discretion standard of review. The court therefore determined that the standard of review was de novo. The court further cited Dorris v. Unum Life Ins. Co. of America, 949 F.3d 297 (7th Cir. 2020), noting that the court can limit itself to deciding the case on the administrative record but should also freely allow the parties to introduce relevant extra-record evidence and seek appropriate discovery. The court thus found that the scope of the record is within its discretion.

On this basis, the court found in King’s favor and against Reliance Standard, reasoning that affording Reliance Standard extra time to gather evidence would undercut the benefits of King having exhausted her administrative remedies. The court concluded that Reliance Standard relinquished its opportunity to establish its evidence in the administrative record and that to allow Reliance Standard to submit its evidence after already missing the deadline would circumvent the purpose of the DOL regulation.

The court focused on the evidence Reliance Standard wanted to include in the administrative record and held that if the court allowed the inclusion of post-exhaustion evidence that creates a party’s administrative record rather than supplements it, the court would be impermissibly extending the DOL deadlines.

The King decision demonstrates the importance of understanding ERISA’s complex regulations governing employee benefits such as disability claims and the importance of utilizing the regulations to maximize a successful outcome. McKennon Law Group PC has similarly used this specific ERISA regulation to achieve success in handling its clients disability claims. Having the right ERISA disability insurance lawyer can make the difference between success and failure.

The U.S. District Court for the Northern District of California recently clarified what a claimant must demonstrate to meet the standard of “disabled” under the Employment Retirement Income Security Act (ERISA). Specifically, the court found that a claimant is not required to demonstrate absolute incapacitation but must show an inability to perform the substantial duties of her occupation

In Linda Przybyla v. The Prudential Insurance Company of America, 2025 WL 28446 (N.D. Cal. Jan. 3, 2025), the court addressed a dispute involving the denial of long-term disability (LTD) benefits. The plaintiff, Linda Przybyla, filed suit under 29 U.S.C. section 1132(a)(1)(B) after Prudential denied her LTD claim. The court’s analysis focused on Prudential’s denial process, the sufficiency of medical evidence, and the proper interpretation of “disability” under the plan.

Przybyla was employed as an “Engineering Coordinator” and participated in a group LTD plan sponsored by her employer and insured by Prudential. Under the plan, disability benefits were available if a claimant could demonstrate an inability to perform the substantial and material acts of her occupation with reasonable continuity. The plan required proof of disability, including medical documentation, treatment records, and verification of functional limitations.

The plaintiff ceased working and submitted her LTD application in November 2022 due to significant health issues, including chronic pain, dizziness, and vestibular migraines. Her treating physician, Dr. Cameron Oba, diagnosed her with fibromyalgia, ataxia, and fatigue and supported her claim. Despite this, Prudential denied the claim, citing a lack of sufficient evidence demonstrating an inability to perform her occupational duties.

Prudential’s denial relied heavily on the opinions of its medical reviewers, including Dr. Amy Cao, Prudential’s VP and Medical Director. Dr. Cao concluded that while Przybyla had mild cervical stenosis and cervicogenic headaches, the findings did not explain her reported fatigue, dizziness, or gait instability. She also emphasized that the plaintiff showed improvement with physical therapy and medication. A vocational review by Steve Lambert similarly concluded that Przybyla’s occupation could be performed at a sedentary level consistent with Dr. Cao’s findings.

Przybyla appealed the denial and submitted additional medical opinions from multiple treating physicians, including Drs. Oba and Hovsepian, who detailed persistent functional limitations and ongoing symptoms. Dr. Oba emphasized that Przybyla’s “gait difficulties/ataxia requiring a cane for ambulation” and severe fatigue were supported by his direct clinical observations, not merely subjective complaints. Despite this supplemental evidence, Prudential upheld its denial following further review by external consultants, who asserted a lack of objective findings correlating with Przybyla’s reported limitations.

The court applied a de novo standard of review and evaluated the administrative record without deference to Prudential’s conclusions. The court found that Przybyla had met her burden of proving disability under the plan, emphasizing that her medical history, consistent treatment, and the extensive documentation provided by multiple treating physicians established a significant functional impairment. The court criticized Prudential’s reliance on “selective evidence” and failure to adequately consider the consistent clinical findings supporting Przybyla’s disability. The court noted that Plaintiff’s consistent reports of pain and her efforts to obtain pain relief via physical therapy and follow-up visits with her primary care physician, neurologist, rheumatologist, and ENT support the credibility of her complaints of disabling symptoms. The court cited Sangha v. Cigna Life Ins. Co. of New York, 314 F. Supp. 3d 1027, 1036 (N.D. Cal. 2018) (“[T]he consistency and severity of Plaintiff’s complaints and her pursuit of medical treatment over time support her claim of disability”). The court further noted that Przybyla’s treating physicians’ personal and emphatic corroboration of the severity of her symptoms is further support and that given the evidence, Przybyla easily met her burden.

The court cited Muniz v. Amec Construction Management, Inc., 623 F.3d 1290 (9th Cir. 2010) and reiterated that a claimant is not required to demonstrate absolute incapacitation but must show an inability to perform the substantial duties of her occupation. The court also noted, “where the opinions of treating physicians are consistent, well-documented, and supported by the claimant’s medical history, those opinions should not be discounted in favor of non-examining reviewers.”

The court also noted that Prudential’s physicians’ opinions did not persuade it otherwise because their opinions rely entirely on the purported absence from Plaintiff’s medical records of the objective findings they believed would support her reported symptoms. However, the Ninth Circuit has repeatedly stated that objective evidence for chronic pain conditions should not be required under a disability policy. The court cited Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 678 (9th Cir. 2011) for the statement that “Many medical conditions depend for their diagnosis on patient reports of pain or other symptoms, and some cannot be objectively established until autopsy. In neither case can a disability insurer condition coverage on proof by objective indicators such as blood tests where the condition is recognized yet no such proof is possible.” It also cited Cruz-Baca v. Edison Int’l Long Term Disability Plan, 708 F. App’x 313, 315 (9th Cir. 2017) (“Pain is an inherently subjective condition.”).

Ultimately, the court ruled in favor of Przybyla, granting her motion for summary judgment and ordering Prudential to pay LTD benefits. This case underscores the importance of comprehensive medical documentation and highlights the judicial scrutiny applied to insurer denials under ERISA, emphasizing the necessity for insurers to engage in a thorough and unbiased review of all evidence presented.

If you have made or are considering making an insurance claim pursuant to the Employee Retirement Income Security Act (ERISA) or a bad faith claim, choosing the right lawyer can make a significant difference in the outcome of your case. ERISA claims and insurance disputes are complex legal matters in which having the right legal representation can be the difference between success and failure for the claim. Here are key factors to consider when selecting a lawyer to handle your ERISA or insurance claim:

1. Experience with ERISA and Insurance Bad Faith Law

ERISA is a complex federal law and ERISA claims have unique procedural requirements, including strict deadlines, and limited evidence rules. For example, if your ERISA claim for disability benefits is denied, you will generally have 180 days to submit an appeal. If you miss the appeal deadline, then file a lawsuit against the insurance company for the benefits, the insurance company will almost certainly move to have the case dismissed for failure to exhaust administrative remedies, and you will likely lose your right to disability benefits. Choose a lawyer with specific experience handling ERISA disability claims, life insurance disputes, pension claims, health insurance claims, and accidental death and dismemberment (AD&D) cases. Verify that the attorney has a track record of successfully navigating ERISA’s administrative appeals process and litigation when necessary.

2. Knowledge of Insurance Company Tactics

Insurance companies often deny claims based on technicalities, policy exclusions, or insufficient evidence. A qualified ERISA and insurance bad faith attorney should be familiar with the strategies insurers use to deny claims and be prepared to counter them. You can gain a significant advantage in your case if your attorney understands how the insurance company and its counsel operate. For example, an attorney with experience defending claims for insurance companies who represents claimants will know how the insurance company will address any number of issues in a case. Such knowledge is a valuable asset. Robert McKennon, the managing attorney at McKennon Law Group PC, had 24 years of prior experience representing insurance companies prior to representing plaintiffs and ERISA plan participants and beneficiaries, and therefore has a deep understanding of how to deal with them.

3. Proven Success in Appeals and Litigation

ERISA requires claimants to exhaust all administrative remedies before pursuing a lawsuit; the appeals process is therefore critical. Look for an attorney who has successfully overturned claim denials at both the administrative and litigation stages. Check for settlements, verdicts, and client testimonials to assess their track record. Published court opinions, a firm’s success stories, and client reviews can provide insight into an attorney’s level of success, particularly with cases similar to yours.

4. Understanding of Medical Evidence and Expert Testimony

ERISA disability claims often hinge on the quality of medical evidence. The right lawyer should have experience working with medical experts, reviewing diagnostic reports, and presenting evidence that clearly demonstrates how the disability affects the claimant’s ability to work. For example, take an accidental death case handled by McKennon Law Group, PC. The claimant’s husband was an alcoholic who essentially needed alcohol to be able to function, so his blood alcohol level was elevated at virtually all times. In the middle of the night he got up to use the restroom then fell and hit his head. He went back to sleep. A few hours later he had a seizure. He never recovered and died in the hospital three days later. The insurance company took the position that his death was excluded from coverage based on a common exclusion found in such policies that says when a person has alcohol or another substance in his system, it is presumed that the alcohol or substance caused or contributed to the death. Because the knowledgeable lawyers at McKennon Law Group PC understood the medical evidence and the law and found a good expert to provide a report concluding that the death was not caused by the alcohol, the widow was successful in her case.

5. Clear Communication and Transparency

A good lawyer should be able to explain your legal options clearly, outline potential challenges, and keep you informed throughout the process. Look for transparency regarding fees, timelines, and case strategies during your initial consultation.

6. Familiarity with Federal Court Procedures

ERISA claims are governed by federal law and are litigated in federal court. Ensure the lawyer you choose is experienced with federal litigation and understands ERISA’s unique legal standards. If you hire a lawyer who is versed only in state law matters, you risk missing a deadline or failing to meet a requirement of the federal court and it could result in the dismissal of your case. Knowledgeable lawyers also know about the judges they appear in front of and this can be a significant help in understanding how a judge will rule.

7. Fee Structure and Costs

Understand how the attorney charges for their services. Many ERISA lawyers work on a contingency fee basis, meaning they only get paid if you win your case. Others may charge hourly or flat fees. Make sure you clarify fee agreements upfront. A prospective attorney should provide you with a draft agreement for you to review, will give you time to review it thoroughly, and will answer any questions you have about it until you have a full understanding of the terms included. Attorneys have many different types of fee agreements and some perform work on an hourly and contingency fee basis to best suit your needs.

8. Reputation and Client Testimonials

Research the attorney’s reputation within the legal community and among past clients. Look for client reviews, peer ratings, and professional recognitions that reflect the attorney’s competence and success in handling ERISA and insurance cases. On the McKennon Law Group PC website, you can find dozens of glowing review from previous clients and you will find a plethora of success stories that discuss the firm’s many successes. On this website, you will also find a biography of our attorneys and their recognitions. For example, look at the experience and professional recognitions for McKennon Law Group’s managing attorney, Robert McKennon. Compare that to any ERISA and employee benefits attorney in the country and you will find that he is at the top of the country’s legal profession.

9. Local Expertise with ERISA Claims

While ERISA is a federal law, some aspects of insurance claims can vary based on the jurisdiction, and even on the judge hearing the case. Choosing a lawyer familiar with your federal district court’s handling of ERISA cases can be advantageous. The lawyers at McKennon Law Group PC have extensive knowledge of the judges who handle ERISA matters around the United States, particularly on the West Coast.

Conclusion

Selecting the right lawyer for an ERISA or insurance bad faith claim requires careful consideration of experience, specialization, and a proven track record of success. By choosing a knowledgeable attorney who understands the intricacies of ERISA law and insurance bad faith disputes, you can ensure maximum success in your case. The lawyers at McKennon Law Group PC have all of the above and then some.

Reasons for Denials of ERISA Disability Claims

Many people make career decisions with employee benefits in mind. Being covered by employer-sponsored health, life, and disability insurance can provide peace of mind that you and your family have a safety net should the worst happen. This is especially the case with disability insurance. Disability insurance protects you if you cannot perform the important duties of your occupation because of an injury or sickness and thus cannot work at your job. What do you do if you cannot work due to medical conditions that prevent you from performing your job duties and your ERISA disability insurer denies your disability claim?

ERISA-related disability claims are often denied for numerous reasons. Here are some of the most important and common reasons for denial:

Insufficient Medical Evidence

Explanation: The claimant fails to provide adequate documentation or medical evidence to support the claim of a disabling condition.
Details:
- Lack of detailed physician reports or diagnostic test results.
- Gaps in medical treatment or inconsistent medical records.
- Opinions from medical professionals that do not align with the claimed disability.

2. Definition of Disability Not Met

Explanation: The claimant does not meet the policy’s definition of disability, which can vary between plans.
Details:
- Some plans distinguish between “own occupation” and “any occupation” definitions of disability.
- Claims are often denied if the insurer determines that the claimant can perform some form of work, even if it is not their previous occupation.

3. Pre-existing Conditions

Explanation: The disability is linked to a pre-existing condition that is excluded under the terms of the policy.
Details:
- Policies often exclude coverage for conditions that existed or were treated during a specified period before coverage began.

4. Failure to Follow Treatment Plans

Explanation: The claimant does not follow prescribed treatment plans or fails to attend required medical evaluations.
Details:
- Insurers may argue that treatment adherence could improve the condition and enable the claimant to work.

5. Lack of Objective Evidence

Explanation: Many policies require objective medical evidence (e.g., imaging or lab results) to substantiate the claim.
Details:
- Claims based solely on subjective symptoms like pain or fatigue may be denied if they lack corroborating objective evidence.

6. Administrative or Procedural Issues

Explanation: Errors or omissions during the claims process can lead to denial.
Details:
- Missing deadlines for filing claims or appeals.
- Failing to provide requested documents or forms.
- Incomplete or inconsistent application details.

7. Surveillance and Social Media Evidence

Explanation: Insurers use surveillance or social media activity to dispute the severity of the claimant’s disability.
Details:
- If the claimant is observed engaging in activities inconsistent with their claimed limitations, the insurer may deny the claim.

8. Independent Medical Evaluations (IMEs)

Explanation: Insurers often require claimants to undergo evaluations by their chosen physicians, who may dispute the claimant’s disability.
Details:
- IME reports that contradict the claimant’s physician’s findings can be used as grounds for denial.

9. Policy Exclusions and Limitations

Explanation: The disability falls under specific exclusions or limitations in the policy.
Details:
- Policies may limit coverage for mental health conditions, substance abuse, or conditions related to self-inflicted injuries are usually limited to 24 months.
- Some policies cap benefits for certain disabilities to a specific duration.

10. Claims of Improvement or Recovery

Explanation: The insurer argues that the claimant’s condition has improved sufficiently to allow a return to work.
Details:
- Often based on periodic reviews of medical records or IMEs.
- The insurer may use minimal improvement to justify denial or termination of benefits.

11. Vocational Assessments

Explanation: Insurers may argue that claimants are capable of alternative work based on vocational assessments.
Details:
- Denial may occur if the insurer identifies jobs the claimant is allegedly qualified for and capable of performing.

12. ERISA-Specific Procedural Safeguards

Explanation: ERISA governs procedural requirements for claims and appeals.
Details:
- Denials may result from claimants not adhering to the administrative processes outlined in ERISA, such as failing to appeal within specified timeframes.

Determine Why Your Claim Was Denied

You must start by understanding why your claim was denied. When waiting for insurance payments to help cover expenses, a denial letter can make you angry, sad, and stressed. Take your time and read the disability denial letter carefully and consider why your disability claim was denied.

If the denial letter does not include a reason or you do not fully understand the reason, consider calling or writing to your disability insurer representative listed in the denial letter. In a professional, straightforward manner, ask for more details about the denial. Do not agree to or sign anything, but document any additional information you learn.

Review Your Rights and Benefits

Once you have detailed information about the insurance company’s reasons for denying your claim, turn to your benefits documents. Start by reviewing your disability insurance policy/plan. Understanding your policy can help you support a better chance at a satisfactory appeals outcome. Pay attention to your rights under your plan, such as how long you have to file an appeal and what resources are available if your claim is denied.

Meet With an Experienced ERISA Disability Attorney

Once you have basic information about your case, consider contacting an experienced ERISA disability attorney. A lawyer with insurance claims and appeals knowledge can provide critical information and guidance through the process. That starts with understanding the regulations that govern ERISA disability insurance claims and making informed decisions about your claim and appeal.

Even if you are unsure as to what you should do or how to handle your next steps, highly experienced attorneys such as McKennon Law Group PC who regularly handle ERISA disability claims can be extremely helpful. They can review your case and tell you whether an appeal is possible and probable. They can also show you how to achieve the best chances for a positive outcome. Understanding the reasons for denial is crucial for claimants, as it allows them to proactively address potential issues and strengthen their claims or appeals under ERISA-governed disability policies. Here are several reasons to contact experienced ERISA disability attorneys (like McKennon Law Group PC) when your disability claim is denied:

1. Expertise in ERISA Regulations

Reason: ERISA is a highly technical federal law with strict rules and procedures. Understanding its requirements can be challenging for non-experts.
Benefit: An experienced attorney knows how ERISA governs disability claims, appeals, and litigation. They can guide you through the process to ensure compliance and avoid procedural missteps.

2. Assistance with Administrative Exhaustion

Reason: Under ERISA, you must exhaust all administrative remedies (appeals within the insurer) before filing a lawsuit.
Benefit: An attorney can help you build a strong administrative appeal, including gathering the necessary evidence and addressing the insurer’s reasons for denial.

3. Navigating Strict Deadlines

Reason: ERISA has rigid timelines for filing claims, appeals, and lawsuits. Missing a deadline can forfeit your right to benefits.
Benefit: An attorney ensures that all documents and appeals are submitted on time, preserving your legal rights.

4. Building a Comprehensive and Winning Appeal of a Denied Disability Claim

Reason: Insurers often deny claims due to insufficient evidence or technical deficiencies in the application.
Benefit: An attorney can help you gather and present the medical, vocational, and other supporting evidence needed to substantiate your disability claim.

5. Challenging Denials Effectively

Reason: Insurers use various strategies to deny claims, such as disputing medical evidence or relying on biased IMEs.
Benefit: An experienced attorney can identify flaws in the insurer’s reasoning, challenge biased IMEs, and present counterarguments that strengthen your case.

6. Addressing ERISA’s Procedural Barriers

Reason: ERISA limits the scope of evidence and judicial review in disability cases, favoring insurers.
Benefit: An attorney understands how to navigate these procedural barriers, ensuring your case is presented in the strongest possible way.

7. Managing Insurance Company Tactics

Reason: Insurers may use surveillance, vocational assessments, or legal technicalities to undermine your claim.
Benefit: An attorney knows how to counter these tactics, ensuring that your rights are protected and your case is not unfairly dismissed.

8. Maximizing Success in the Appeal Process

Reason: The appeal process under ERISA is often your best chance to secure benefits without going to court.
Benefit: An attorney can help craft a compelling appeal that addresses the insurer’s reasons for denial, includes additional evidence, and maximizes your chances of success.

9. Preparing for Litigation

Reason: If the administrative appeal fails, ERISA allows claimants to file a lawsuit in federal court. However, only the evidence presented in the appeal is typically allowed before the judge who will decide your case.
Benefit: An attorney experienced in ERISA litigation can effectively represent you in court, leveraging knowledge of case law and legal strategy to challenge the denial, while making sure that all relevant evidence is presented in the appeal process.

10. Minimizing Stress

Reason: Handling a disability claim or appeal can be overwhelming, especially while dealing with a disabling condition.
Benefit: An attorney manages the legal and administrative aspects of your claim, allowing you to focus on your health and well-being.

Gather Evidence About Your Case

Whether you work with an attorney on your case or decide to proceed with the appeals process on your own, the next step is likely gathering evidence. Relevant evidence includes medical records, letters from medical providers, images and videos, and written statements from family, friends, co-workers or employers, certification letters from medical professionals, etc.

The more evidence you can gather to support your claim, the better. You may not need to include everything you gather in your appeal, and a lawyer can help you understand how to create a compelling narrative with supporting evidence for your case.

File an Appeal On Time

It is essential to file any appeal within the timelines set out by your plan and by ERISA’s claims regulations, which are normally set forth in the denial letter from your insurance company. For example, your denial letter may state that you have up to 180 days from the date you receive the letter to file an appeal. An appeal filed after that date may not be effective, as missing the deadline can result in automatic forfeiture of your appeal rights and also your ability to file a lawsuit.

Avoid rushing through the appeals process, which can lead to errors and missing information. However, it may be a good idea to try to file your appeal a few weeks or at least several days before the deadline at the latest. This gives you some breathing room and helps ensure your appeal arrives promptly.

Address the Reason for Denial

In your appeal, make sure you specifically address the reason(s) the insurance company listed for denying your claim. For example, if your insurance company denied the claim because there is insufficient medical evidence to support your claimed restrictions and limitations, then you must focus your evidence and arguments on this rationale for denial.

Consider Including Personal Statements

One thing to consider including in an appeal is personal statements from persons who have knowledge of important facts concerning your claim. For example, suppose you are appealing a disability claim denial. In that case, you should include statements from persons who know your medical conditions and who know why you cannot perform your job duties. Letters from your doctors providing an expert opinion on your disability or statements from family, co-workers or friends about your disability status are often important to include in your appeal.

Prepare to Take the Matter Further if Necessary

Remember that your appeal may only be one step in the overall process of getting your claim paid. Depending on your case, you may be able to seek remedies beyond the appeals process. An experienced ERISA lawyer can help you understand your options.

If you are struggling with an ERISA-related claim denial and need help with your appeal, we can help. Reach out to the McKennon Law Group PC by calling 949-504-5381.