The long-term disability coverage that your employer has been providing may not be there when you need it. That is why, even before you file your disability claim, you should seek the advice of a California ERISA disability claims attorney.

The Employee Retirement Income Security Act – also known as ERISA – was enacted by Congress in 1974 to make sure that the insurance benefits provided by private employers will be there when employees need those benefits.

ERISA sets minimum legal requirements for the group insurance plans provided through many employers in the private sector. However, long-term disability claims under ERISA are routinely denied by insurance companies. If you need disability benefits that have been denied, you may also need seek the services of a top-rated legal expert for disability insurance cases in San Diego.

What Does a Long-Term Disability Policy Cover?

Long-term disability insurance typically provide benefits if you are unable to perform the important duties of your own occupation due to an injury or sickness. Most disability policies cover a variety of serious illnesses and medical conditions, whether they are classified as physical medical conditions or mental-nervous conditions. On-the-job injuries may be covered, but about 95 percent of the long-term disability claims filed under ERISA are not work-related.

Cancer, mental illness such as depression or anxiety conditions, chronic illnesses, neurological disorders, and certain degenerative diseases may also be covered by your ERISA disability policy.

What Does ERISA Require?

ERISA does not require private employers to provide employee benefit plans. The federal law simply establishes minimum standards for insurance plans that employers choose voluntarily to offer.

When an insurance company or an employer takes advantage of ERISA to reject a disability claim and unfairly deny disability benefits, a California ERISA claims lawyer may be able to appeal the denial of that claim and recover the benefits, or if that appeal is denied, file a lawsuit in federal court to recover these denied disability insurance benefits.

Why are disability claims under ERISA so frequently denied? Are there ways to avoid the most common reasons for denials? How can a denial be appealed, what are your rights if your claim is denied, and what steps will you have to take? These questions will be answered below.

Avoid These Mistakes If You File an ERISA Disability Benefits Claim

If you consult an ERISA claims attorney before you file your ERISA disability benefits claim, your attorney can assist you to avoid these common mistakes, and it is even possible that your claim may be approved:

When a doctor determines that you are disabled, do not assume that you will qualify for disability benefits. Insurers frequently deny disability claims even those that are supported by one or more of the insured’s doctors. Have your doctors write up a comprehensive evaluation of your condition and your disability that discusses your medical conditions and how these conditions affect your ability to conduct everyday activities and your job duties.
Provide a comprehensive statement from you and others that discuss in detail why you are disabled. The statement must include the following information: 1) a detailed description of the duties of your occupation as you performed them; 2) a detailed discussion of the history of your condition; 3) a detailed discussion of your symptoms; 4) an explanation for how those symptoms negatively impact your ability to return to work such that you cannot work; 5) how your disability also impacts your overall quality of life; and 6) a discussion of the things you could previously do but can no longer do.
Adhere to your doctor’s recommendations and do not participate in any physical activities against those recommendations. Do not post anything about your claim online or give the insurer anything that could be used to justify the denial of your disability claim.
The easiest mistake to avoid when you make a claim for ERISA benefits is not working with an ERISA claims lawyer from the start. You must have sound advice because ERISA is a complicated law with many exemptions, terms, conditions, and deadlines.

Will Your ERISA Disability Claim Be Denied?

An ERISA disability claim could be denied for almost any reason – if you make a mistake in the paperwork, for example, or if you miss something in your policy’s fine print. Here are the most common reasons offered by disability insurance providers for denying ERISA disability claims:

inadequate medical documentation of a disability
a pre-existing condition
missing details, paperwork mistakes, and overlooked deadlines
policy exclusions
self-reported, undocumented symptoms or unauthorized or inappropriate treatment
evidence compiled through social media or private investigation contradicting your claim

When you’ve paid an insurance company premiums for years, and when a doctor has determined that you are disabled, receiving a letter from your insurance company that denies your disability claim can be devastating.

Too often, legitimate disability claims are denied because some insurance companies look for every possible technicality that will allow them to reject a claim. However, an experienced ERISA disability claims attorney may be able to help you if your claim is rejected.

What Are the Rules for ERISA Disability Claims?

Before 2018, you could sue an ERISA insurance provider for the denial of disability benefits only if you and your lawyer could prove the denial was “arbitrary and capricious.” But since 2018, ERISA insurers must provide a “reasoned explanation” when a disability claim is denied.

An insurance company must clearly explain why it disagrees when one or more doctors have concluded that you’re disabled. The company must also identify which of its procedures and policies authorize and support its denial of your claim.

One rule governing disability claims was not changed in 2018. You may not sue an ERISA disability insurance provider until one or more “administrative” appeals of the denial have been filed and considered by that insurance provider.

When Should You Speak to an ERISA Attorney?

When you file a long-term disability claim under ERISA, your best option is having the guidance and advice of a California ERISA claims attorney from the start – even before you begin to fill out the insurance company’s paperwork.

But if your disability claim under ERISA is denied, and if you are not already working with a lawyer, speak with a claims lawyer at once about filing an appeal. A claims lawyer can handle your appeal and ensure that you’ve complied with ERISA’s numerous guidelines.

Because ERISA is a federal law, U.S. District Courts hear ERISA-related lawsuits. If the insurance company rejects your administrative appeal, your attorney may recommend bringing a lawsuit in a U.S. District Court, where a District Judge will decide the case.

What Else Will You Need to Know?

You will need personalized guidance and advice if you apply for disability benefits under ERISA or if your claim is rejected. Your lawyer should have considerable experience representing disabled clients and appealing the denial of their ERISA disability claims.

ERISA does not apply to public-sector employees or to the employees of religious organizations. It also does not cover privately-purchased, individual insurance policies or any benefit or program that is not provided by a private-sector employer.

Most California attorneys who handle ERISA claims provide an initial legal consultation to prospective clients without any obligation or cost. That consultation is your chance to obtain personalized legal advice and to find out more about your rights and legal options.

If you’re disabled, and if you intend to claim disability benefits under ERISA, or if your claim has already been denied, there’s no reason to wait. Do what it takes to obtain the disability benefits you have paid for and need, and contact a California ERISA claims lawyer at once.

In this several-part blog series titled The Basics of an ERISA Life, Health and Disability Insurance Claim, we discuss the basics of an ERISA life, health, accidental death & dismemberment and disability claim, from navigating a claim to handling a claim denial, through the subsequent appeal and litigation. In Part Seventeen of this series, we discuss when ERISA applies. ERISA governs a wide variety of employee benefits. It is safe to say that most employee benefits are controlled by ERISA. As such, if the employee benefit plan is provided through a private employer, it is likely, but not necessarily certainly, governed by ERISA. However, at times, instead of ERISA, state law or a governmental organization’s own unique laws and procedures apply. If a claimant wins their case, ERISA provides for an award of the denied benefits, attorneys’ fees, interest and costs. State law varies from state to state but may provide for the award of the denied benefits, consequential damages, punitive damages, attorneys’ fees, litigation costs and interest, among other potential remedies. In other words, if state law applies to an employee benefit claim, greater remedies are available to the claimant. The trial procedures for these two types of claims are very different. ERISA claims are decided by a judge, typically based on the administrative record consisting mainly of documents submitted to the claims administrator during the administrative appeals process. Discovery is much more limited. However, for state law claims, the usual litigation procedures are available. These include a full panoply of discovery, use of experts and a jury trial. The procedures for disputing claims for benefits from different governmental agencies vary greatly with each organization often being quite different. Some claims benefit from being governed by ERISA. Other claims benefit from being governed by state law. Given these drastic differences, it is critical to determine which body of law and procedures apply to a claim.

The first broad exception to ERISA’s applicability is that it does not apply to benefits provided by government employers. See 29 U.S.C. § 1003(b)(1). This exception applies to benefits provided by municipal, state and federal governments and thus affects the benefits earned by a wide variety of people. People who work for these different governmental entities may have very different benefits and rights thereto if a claim for benefits is denied. If a claim is denied, some governmental entities may have a simple appeal process resembling ERISA. Others may provide for an entire trial and discovery process. However, this exception may not apply to all government employees. It depends on how one obtains the benefits. For example, if the benefits in question were actually obtained through a union, ERISA may control because the benefits were not provided by the government entity, but rather, they were provided by an employee organization: the union. One has to look at the plan documents and who provides the benefits to determine which area of law applies.

A second major exception to ERISA’s applicability is that it does not govern church plans unless the religious entity specifically elects to be governed by ERISA. See 29 U.S.C. § 1003(b)(2). Religious organizations have the right to either be governed by state law or opt into being governed by ERISA. Religious organizations, such as churches and their affiliated hospitals or schools, provide a wide variety of benefits to their employees. Given that religious organizations have the right to opt into ERISA, it is often difficult to determine whether ERISA applies. Once again, checking the relevant plan documents is often the only way to be certain.

A third common exception to ERISA is for plans that are “maintained solely for the purpose of complying with applicable workmen’s compensation laws or unemployment compensation or disability insurance laws[.]” 29 U.S.C. § (b)(3). This exception is relatively simple. If the plan merely exists to comply with a state’s worker’s compensation laws, then ERISA does not apply.

There are other exceptions to ERISA, but these are the most common ones. In light of the differences between ERISA and state law, many people mistakenly assume that one is better than the other. Even many attorneys make this mistake. Most attorneys make this error because they are more comfortable with one form of litigation than the other. Assuming that one form of litigation is superior is simply incorrect. It depends on the specific details of the claim. For example, for relatively small claims, ERISA is often much more favorable to the claimant. Under ERISA, if a claimant establishes that they are entitled to the benefits in question, it is fairly easy to win an award of reasonable attorneys’ fees. However, under the law of most states, whereas attorneys’ fees and a variety of other damages are available upon successfully establishing bad faith, establishing bad faith may be difficult. Furthermore, it is often difficult to obtain large amounts of damages beyond the contract benefits if the initial amount in dispute is small. As a general rule, a claimant seeking a smaller benefit will fare better if their claim is governed by ERISA, with its limited discovery and simplified procedures.

If, however, there is a significant amount of money in dispute, having the matter be governed by state law may be useful. This is especially true if the party denying the claim behaved in a particularly egregious manner, which may allow an insured to collect punitive damages. This makes the matter prime for a very large award if the case is won at trial. These factors will also influence any settlement negotiations and result in a potentially larger settlement.

Given the differences between the various forms of litigation related to employee benefits, it is important to confer with an expert in this area of the law. Consulting with knowledgeable attorneys, such as those at the McKennon Law Group PC, is critical if you want to receive all of the benefits that you are entitled to under the applicable law.

Life insurance exists to help those who’ve lost a loved one. Family members of the deceased are protected by their life insurance plans after they pass away, as they provide financial relief and compensation when the surviving loved ones need it most. But even life insurance policies that are thoroughly drafted, with contracts signed, can take awhile to pay out.

Insurance companies seem to always find a way to delay paying out claims, or deny claims altogether. The reasons below are some of the most commonly occurring reasons we see at McKennon Law Group. If you or a loved one are being denied a life insurance policy claim, or your claim is being delayed, contact our attorneys for a free case evaluation.

Reason 1: Drugs or alcohol were involved in the death

Unfortunately, many life insurance companies will disqualify deaths that occurred under certain circumstances. Death due to drug or alcohol abuse are often included as some of these circumstances. This manner of death is referred to as “self-inflicted,” and typically refers to any death that occurs when the deceased happened to be under the influence of these substances– even if their cause of death wasn’t directly due to the consumption.

If your life insurance policy claim is being delayed or denied due to a drug- or alcohol-related death, contact McKennon Law Group for help.

Reason 2: The deceased died via homicide

There are some exceptions, but many life insurance policies don’t cover homicide. These cases are especially complex. If a beneficiary is suspected of homicide, and it’s believed that they intentionally killed the deceased, they won’t have a chance at receiving the benefits until the investigation ends. Similarly, if a beneficiary engaged in any other criminal or unlawful activity, especially one that’s believed to have contributed to the death of the deceased, the claim will be held up until the investigation is resolved or the beneficiary is no longer under investigation.

Reason 3: Death by suicide

Life insurers have the right to delay or deny a claim if the death occurred by suicide. There are clauses in most insurance policy contracts that aim to discourage those contemplating death from buying a life insurance policy. Sometimes, insurance companies will flag this as a type of life insurance policy fraud. It’s important to note, however, that not all life insurance policies exclude suicide as a rule, so be sure to check the fine details.

In situations like these, it’s wise to seek the help of an attorney who can contact the deceased’s insurance company, find out valuable and detailed information from the contact, and fight for your right to life insurance policy money.

Reason 4: The deceased passed away during the contestability period

If an individual passes away within the first two years of their insurance policy being active, the insurer can contest the policy if they so choose. When someone applies for life insurance, the application will require certain information. This information might include their income, health, criminal history, age, body mass index, and more. Insurer’s have the right to contest the applicant’s information in order to make sure it’s accurate.

During this window, which is referred to as “the contestability period,” the insurance company may discover that the information was not entirely accurate, or there might be important information that was excluded from the original life insurance policy application. The insurer has the right to deny coverage if this occurs. For example, if an individual fails to disclose that they’ve been arrested before, or doesn’t disclose that they smoke cigarettes, the insurer can back out of coverage.

Similarly, an insurance company can deny paying out a life insurance claim if it’s been discovered that information in the application or life insurance policy was inaccurate, misrepresented or untruthful. Even if the death in question did not occur as a direct result of the misrepresentation, for example, if someone failed to say they smoke cigarettes, but died due to a car accident.

Reason 5: The insured failed to pay their insurance policy premium

This is one of the most commonly occurring reasons that an insurance company might delay in giving a claim or deny it altogether. Life insurance policies are only active for as long as the insured completes payments on time. When the insured fails to pay their premium, the insurance can lapse or be canceled altogether.

This type of denial and delay are quite common. If you or a loved one has an insurance policy, always be certain that payments are being made on time and the full amount of the premium requested is paid by any associated deadline. It’s important to note as well that beneficiaries have the right to know whether or not insurance companies sent late payment notices to the policyholder, and whether or not the situation was rectified.

When it comes time to receive life insurance benefits, beneficiaries, who are often friends and family members, sometimes create disputes, as each person has conflicting ideas of how much money they should receive from the policy. Percentages of money owed are listed out in the policy for each beneficiary, but when life changes occur, relationships change and it can be difficult to know where life insurance policy money rightfully belongs. Due to the personal, familial nature of these issues, life insurance policy disputes can be sensitive, and run the risk of straining relationships between close loved ones.

If you or a loved one are tangled in a life insurance policy dispute, contact McKennon Law Group to schedule a free consultation with one of our skilled dispute attorneys. By teaming up with an experienced, hard working attorney, you mitigate the risk of missing out on money that’s rightfully owed to you, as well as gain a trusted partner to guide you through this tough challenge with your loved ones.

What Are Common Reasons For Life Insurance Beneficiary Disputes?

It’s never easy to deal with beneficiary disputes, especially when they occur due to a major life change. These major events, such as divorce, death, marriage, childbirth, or even adoption can make disputes arise between life insurance policy beneficiaries. For example, someone may have a child and forget to reflect this change in the policy, which would in turn make that child miss out on money that some feel they should receive.

Sometimes, a policyholder who is sick will make last-minute changes at the end of their life. In other cases, family members or loved ones simply feel left out, and will want to claim some of the insurance policy money as well.

Those who feel they deserve money from the policy have the option to file a competing claim, stating that the life insurance policy holder was influenced by others, was not of sound mind, or maybe was even coerced to choose certain beneficiaries when they were making their designation plans.

What Happens During A Life Insurance Policy Dispute?

Once an insurer receives the dispute, they may file what’s referred to as an “interpleader action,” where the life insurance money is placed into escrow and only re-released once the dispute has been settled. Beneficiaries involved in the dispute might require mediation or arbitration to be resolved, or may need to bring their case before a jury.

Whether you are seeking life insurance money as a beneficiary, or could potentially lose out on your cut of the policy money, teaming up with a lawyer is a wise decision, as they will help you share your side of the story and defend you before others.

Do I Need A Lawyer For A Beneficiary Dispute?

It is always wise to defend yourself with the help of a lawyer. With the help of a qualified life insurance dispute attorney, you can fight for the money you rightfully deserve and protect yourself from others with malintent.

WIthout the help of a lawyer, it can be difficult to state your claim before a judge, jury, mediator and of course, other beneficiaries. With the help of a lawyer, it’s easier to gain access to important documentation, evidence, and other resources that prove you are a worthy beneficiary and are entitled to money.

Our attorneys at McKennon Law Group use their vast network of legal resources to create a strong case for your defense, and have decades of skill and expertise to help you win your case. Without a life insurance dispute attorney, it can be harder to create a strong case.

How Does A Lawyer Help Me Win My Life Insurance Dispute?

Our attorneys can help you navigate tough situations, such as when beneficiaries are improperly changed, or changed at the last-minute, as well. Even if no beneficiaries are listed on a life insurance policy, or attorneys can step in and help make sense of this confusing situation, eating your stance and your side is sufficiently communicated before a judge.

Other disputes our team can handle include:

Denied claims (due to fraudulent beneficiary designation, or otherwise).
Disputes between children as beneficiaries.
Disputes between current spouse and former spouse.
Disagreements on percentages of payout to each beneficiary.

We’re aware that life insurance policy beneficiary disputes can be especially challenging, as they often involve close family members, loved ones and even friends. Our attorneys are compassionate to this information, and pledge to make every step of the proceedings as effortless and stress-free as possible on your behalf, so your situation can be resolved as efficiently as possible.

Call McKennon Law Group PC today to schedule a free phone evaluation regarding your life insurance policy dispute. Together, we can help win your dispute and claim the money that’s rightfully owed to you.

What Is Life Insurance?

If people in your life rely on you financially, they could quickly be put into financial distress if you were to die unexpectedly. Life insurance is a contract between the insurance company and an insured in which the company promises that at the death of the insured, the company will pay a certain amount of money to a person the insured designates in the contract if that person survives the insured. In return for the promise to pay, the insured will pay the life insurance company a premium.

Many people are unsure whether or not they need life insurance, let alone if they need a lawyer to help them get a policy or get a claim from their policy. If you have any questions about the information below, contact McKennon Law Group to speak to a qualified insurance attorney about your options.

How Do I Know If I Need Life Insurance?

Not everyone needs life insurance. Parents don’t typically take out life insurance policies on their children, as parents are responsible for their children’s financial wellbeing. Rather, parents would take out a life insurance policy on themselves to mitigate the risk of bringing financial hardship upon their children.

If your death would financially impact the other people in your life, it’s wise to get life insurance. If you have a life insurance policy and pass away, the people who receive your death benefit – your spouse, children, or other family members – are permitted to use that money to cover their financial needs, such as paying a mortgage or car payment.

If you die unexpectedly and you feel that your sudden death would put your loved ones in a bad financial position, getting life insurance would be wise. Having life insurance takes care of any debt you hold during your lifetime after you pass away, meaning it won’t become a burden to your loved ones. Your spouse or children may inherit certain debts after you pass away, making it a wise decision to get insurance to avoid this. Many people also get life insurance if they believe their funeral costs would be a financial burden on their loved ones.

How Should I Choose A Life Insurance Lawyer?

As with any time you need the help of a lawyer, you should make your choice based upon their record of success, any awards they’ve won, referrals they’ve gotten, and so forth. You want to work with a law firm that can prove their success and has repeatedly demonstrated their care and concern for their clients.

With over 70 years of experience, the McKennon Law Group has specialized in long-term disability and short-term disability insurance, life insurance, health insurance, accidental death insurance, and long-term care claims, as well as all types of ERISA litigation claims involving employee benefits, including group insurance claims, pension claims and severance claims.

Our law firm provides aggressive advocacy to those who need it most. We’ve recovered millions of dollars for our clients, and are proud to receive superb testimonials from our many thankful clients. Our attorneys have received many recognitions and awards as top insurance and ERISA attorneys, including Super Lawyers, The American Lawyer, Martindale-Hubbell, AVVO, Forbes, and the Los Angeles Times, among others. See our Awards & Recognitions. These awards and accolades are testament to our commitment to our clients, and proof that we will stop at nothing to ensure our clients receive the best possible outcome for every case, every time.

How Much Does It Cost To Speak With A Life Insurance Lawyer?

At McKennon Law Group, most of our cases are taken on a contingency fee basis. A contingency fee basis means that you pay nothing at all unless we win your case by way of judgment, reinstatement of benefits or settlement. If we don’t win your case, you pay nothing.

Not all California insurance lawyers offer a free consultation either, but our law firm does. We offer a free, no-risk case evaluation to anyone with issues regarding life insurance – or any other insurance policy they hold. We understand that when insurance companies fail to properly pay out claims, or delay in paying out claims, it can put you in a tight financial spot. That’s why our initial phone consultation is offered free of charge to any California resident in need.

Schedule A Case Evaluation With A Life Insurance Lawyer Today

If your life insurance company has acted in bad faith, or you have questions regarding the legal terms and conditions laid out in your life insurance policy, schedule a free case evaluation with the California insurance attorneys at McKennon Law Group today.

What Is Bad Faith?

Under Federal law, all people owe a basic duty of care to others. This duty of care extends to businesses and business owners as well. Insurance companies are not exempt from this basic duty of care. Insurance companies are required by law to operate in good faith with every policyholder. This means, a policyholder should not have to worry that their insurance company is taking advantage of them when they’re not looking. This is considered bad faith.

“Bad faith” is a term that generally describes dishonest dealing in any capacity. Depending on the exact setting, bad faith may mean a dishonest belief or purpose, untrustworthy performance of duties, neglect of fair dealing standards, or a fraudulent intent. All insurance contracts and documents should imply a duty of good faith and fair dealing between both the insurance company and the policyholder. When this is breached, policyholders have the right to take action.

What Are Examples Of Bad Faith Insurance Dealing?

Insurance companies have a bad reputation for being focused solely on their profits, and not giving policyholders the money they deserve when they need it most. Because insurance companies must meet their bottom line, bad faith claims are somewhat common. Many insurance companies will deny a claim immediately, in hopes that a policyholder will give up and accept defeat. In other cases, an insurance company will treat a policyholder unfairly, take far too long paying out a claim, or worse – wrongfully deny a claim altogether.

Consult with an attorney if your insurer:

Improperly investigated an insurance claim
Made a lowball offer
Was dishonest or fraudulent
Changed your policy without telling you
Denied your claim without any explanation
Ignored your attempts to communicate
Refused to accept you supporting documentation
Charged an unfairly high premium
Wrongfully cancelled your policy
DIdn’t advise you of a lapse in your coverage

Is A Denied Claim Always Bad Faith?

When an insurance company denies a claim, this doesn’t always constitute bad faith. There are a handful of reasons why an insurance claim could be rightfully denied. However, if your claim has been denied and you feel that it should have been accepted instead, you have every right to contact a bad faith insurance lawyer with any questions you may have.

Insurance claims can be denied for legitimate reasons, such as when a policyholder seeks compensation for damages that are not included under their policy. Insurance claims can also be denied if the claim does not contain sufficient information to back up the claim, proving why the policyholder requires compensation. This situation can be fixed with the help of a lawyer.

Sometimes, insurance companies do make mistakes. Sometimes insurance adjusters calculate a different amount of damages than the policyholder calculates, leading to a discrepancy. This is not necessarily bad faith, but doesn constitute a mistake that needs to be addressed. If you are unsure if your denied claim is bad faith or not, speak to a lawyer as soon as you possibly can.

How Can I Fight A Bad Faith Insurer?

Sadly, it’s not rare for an insurance company to act in bad faith- but fighting back is possible. If you have any inclination that your insurance company has been acting in bad faith, contact the McKennon Law Group as possible.

If applicable to your situation, our lawyers will help you hold the insurance company accountable by filing a lawsuit against them for acting in bad faith. Before filing a lawsuit, your lawyer will likely advise you to work with your insurance company as best as you can. One of the best ways to fight back against a bad faith insurer is to keep all documents, records and emails that demonstrate evidence of your loss. If you can provide this to the insurance company, they are required to adjust their actions accordingly. If they refuse, contact a lawyer.

Schedule A Free Consultation With McKennon Law Group Today

Your initial consultation with our law firm is free of charge. Additionally, most of our cases are taken on a contingency fee basis, which means that you pay nothing unless we successfully resolve your case by way of judgment, reinstatement of benefits or settlement.

If you need to fight back against a bad faith insurance company, schedule your free consultation with McKennon Law Group as soon as possible.

For What Reasons May ERISA Disability Claims Be Denied?