Disability Insurance Archives - Page 5 of 41

If you or someone you love needs to file a disability insurance claim due to a mental health condition that makes it impossible to perform your occupational duties, you are going to need the advice, insights and services of a California disability insurance claims attorney.

How can you prove to an insurance company that you are suffering from a disabling mental health condition, a condition that cannot be observed or measured? What steps can you take if an insurance company denies your mental health disability insurance claim?

Keep reading this article concerning disability insurance mental health claims and you will learn why you may need the advice and services of a California disability claims lawyer in order to prevail with your disability insurance claim.

What Should You Know About Filing a Disability Insurance Claim?

People who struggle with certain mental health conditions may be eligible for benefits through employer-sponsored short-term disability insurance (STD) or long-term disability insurance (LTD). There are also STD and LTD policies purchased directly from an insurance company, typically through a life and disability insurance agent or broker.

Qualifying mental health conditions may include anxiety, depression, eating disorders, obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder (PTSD). These conditions are often as debilitating as any physical illness or injury.

Most STD and LTD policies require you to be covered by the policy for a certain period of time – called an “elimination” or “qualifying” period – before you may file a claim for benefits. That time period may vary, but most policies establish a two-year qualifying period.

In addition, most employer-sponsored STD and LTD policies have a limitation on the time period for which you can receive disability benefits. This period is typically 24-36 months. Most individual disability income policies have no time limitations for receiving disability benefits based on a mental health condition.

How Can You Prove a Mental Health Disability?

To prove your mental health disability claim to your disability insurer, you will need to submit a disability insurance claim form along with an attending physician statement signed by your treating physician or other medical provider who provides a statement of your mental health conditions and how and why you have restrictions and limitations as a result. You will also be required to provide your disability insurer with your medical records, test results and any other pertinent medical evidence which indicates that you are unable to perform your work or maintain full-time employment.

A comprehensive professional letter that discusses your condition should include a clinical diagnosis for the condition (i.e., depression, bipolar disorder or schizophrenia) and indicate that you cannot perform work or maintain employment because of that condition. The statement should also address how your mental health condition affects your activities of daily living. A statement of the restrictions and limitations you have should be clearly stated and your medical health professional should state why your medical condition renders you unable to perform your occupational duties.

Provide the insurance company with as much medical evidence as you can in order to strengthen your claim. Include statements from those who are closest to you (e.g., friends, co-workers and family members) because they are the ones who see how your mental health affects your ability to perform work, maintain employment and your activities of daily living.

If Your Claim is Denied, Can You File an Appeal?

In most situations, you will be able to appeal the denial of a disability insurance claim. Whether you are required to do so depends on whether your claim is covered by a federal law called the Employer Retirement Income Security Act of 1974 (ERISA). Often, an appeal will be necessary since insurers or their hired medical consultants will work hard to uncover any evidence to deny your claim for disability insurance benefits. For example, we often see insurers hire medical consultants who misrepresent that they attempted to contact our clients’ medical health professionals but were unable to do so. The insurer will then use this information to deny the claim, asserting that our clients’ doctors did not cooperate with claim investigation and infer that the clients’ doctors were afraid to have contact because they did not truly have support for the mental health disability claim. These medical consultants who are beholden to the insurers that pay them will ignore medical evidence or misconstrue it to justify a conclusion that you are not disabled.

If your disability claim is denied, you typically have the right to appeal the disability denial decision within a limited time period. To begin the process of filing an appeal, you should contact an experienced disability insurance claims attorney for help. You can appeal a denial of your claim for mental health disability insurance benefits, but the appeals process is usually more complicated if your insurance is employer-provided than if you purchased the policy privately.

Private sector, employer-provided disability policies are governed by ERISA, the federal law which sets legal requirements for group insurance, retirement and pension plans provided by private employers. As discussed in more detail below, if your disability insurance claim is governed by ERISA, you will be required to file an appeal of your denied disability insurance claim.

What Does ERISA Require?

ERISA requires you to pursue at least one “administrative” appeal through your insurance company before you may take the company to court. In most cases, you will have 180 days from the date you receive a claim denial letter to file an administrative appeal with the company.

If you fail to follow the insurance company’s administrative appeal process, you could waive your right to continue to pursue your disability claim. If you do not present adequate evidence of your disability claim to the insurer on appeal, you will likely have waived the ability to provide any further evidence in your subsequent court case against the insurer. Therefore, you can ensure that no mistakes are made by asking an experienced disability insurance claims attorney to handle your administrative appeal on your behalf.

Federal courts have jurisdiction in ERISA-related legal matters, but if you purchased disability insurance privately in California, and if you believe that your claim has been wrongly denied, a California disability insurance claims attorney can negotiate with the company on your behalf, or if necessary, take your case to the California or other state courts. Many attorneys handle disability claims nationwide, including the McKennon Law Group PC.

What is Bad Faith?

In California as in most states, if your disability claim for your mental health condition is denied by your insurance company, you may be able to bring a bad faith lawsuit against the insurer for your unpaid disability benefits as well as for:

emotional distress and other damages caused by the company’s bad faith
interest on past-due benefits
your attorney’s fees
possible punitive damages

Bad faith is the legal term for what happens when an insurance company handles a claim unfairly or, more precisely, unreasonably. An insurance company’s bad faith practices may include but are not limited to:

persistently trying to settle your claim for less than it is actually worth
unreasonable delays
rejecting your claim for disingenuous or false reasons
threatening to cancel your coverage unless you accept a “lowball” settlement amount
continually demanding more information as a delaying tactic
inadequate investigation of the disability insurance claim

How Will a Disability Insurance Claims Attorney Help You?

If you are struggling with either the claims process or the appeals process, contact a California disability claims lawyer at once for the legal assistance you need. In fact, the smart move is to consult an attorney even before you submit your initial mental health disability insurance claim.

Your disability claims attorney will ensure that all of your paperwork is accurate, complete, and on time, and your attorney will additionally ensure that there are no misunderstandings or mistakes on your part that could delay or derail the claims or appeals process.

If you let an experienced California insurance claims lawyer guide you through the claims or appeals process, you will be much more likely to prevail. In order to prevail, you should work from the beginning of the process with an attorney who has thorough knowledge of ERISA, disability insurance claims, your rights, and the law.

If you need to file a mental health disability insurance claim, or if you have already filed a claim that has been denied, arrange a legal consultation – at no cost and with no obligation – to discuss your case with an experienced and capable disability insurance claims lawyer as soon as possible. We believe McKennon Law Group PC should be that law firm.

State and federal laws obligate disability and life insurance companies to treat every policyholder fairly and to act in good faith. If your insurance company is not treating you fairly, or if it is acting unreasonably and in bad faith, you will need the advice and services of a California insurance claims attorney. You may need to take legal action against an insurer and it will be critical that you consult with the best and most experienced life and disability insurance attorneys you can find.

How is insurance bad faith defined? If an insurance company does not meet its legal obligations to you, what are your rights? What steps can you take? If you will keep reading this article discussion of insurance bad faith and your rights, you may find some of the answers you need.

What do we know about Bad Faith?

Your insurance policy is a contract and a pledge that it will pay your covered claim expeditiously and fairly. It is your insurance company’s commitment to provide coverage when you require it. If you are paying for a life, accidental death or disability insurance policy, the insurance company may have the legal duty to provide coverage and to negotiate in good faith any claim you submit.

When your insurance company violates what is known as the implied covenant of good faith and fair dealing implied in all life and disability insurance policies, by for example unreasonably denying your life or disability insurance claim, you have the right to file a lawsuit to recover what the company owes you. This may include not only contract damages, but also extracontractual damages, such as emotional distress, consequential damages and punitive damages. Insurance bad faith includes but is not limited to an insurance company’s failure to:

pay a claim in a reasonable amount of time
offer a settlement figure that represents the claim’s actual value
pay or negotiate a claim, or clarify the reason for rejecting it
reasonably investigate a claim
use a non-biased expert who evaluates the claim
follow reasonable claim standards

When Should You Contact a Life or Disability Insurance Claims Attorney?

By itself, a reasonable disagreement about the value of your life or disability insurance claim is not bad faith, but if the insurance company has not treated you fairly, has not negotiated with you in good faith, or fails to pay a claim within a reasonable amount of time, then you should take the case to a life, disability or accidental death insurance claims lawyer.

A fight with an insurance company is the last thing that a seriously ill person or a disabled person needs. If your claim has been denied – or ignored – and you believe that an insurer has acted in bad faith, you may have to take legal action to recover your damages caused by the insurer denying or ignoring your life, accidental death or disability claim. .

How can you know if your insurer has acted in bad faith? Schedule a consultation with a California life or disability insurance claims attorney. That attorney will review your situation and help you determine if filing a lawsuit is the best way for you to proceed.

How Will Your Life or Disability Insurance Lawyer Fight on Your Behalf?

A California life and disability insurance claims lawyer will investigate your claim of bad faith and your insurance company’s practices, policies and procedures. That attorney will file a lawsuit against the insurance company and then conduct discovery, such as taking depositions of the disability or life insurance claims representative or other representatives of the company or may subpoena one of those parties to testify in court.

Your attorney may also hire appropriate experts, such an experienced life or disability insurance claims expert that will provide a report about the insurer’s bad faith and/or to testify about the insurance industry’s procedures, standards, and practices.

How Do You Prevail With an Insurance Bad Faith Claim?

Lawsuits that assert bad faith on the part of an insurance company must include specific facts that are evidence of that bad faith. Your life or disability insurance claims lawyer must show that rejecting or mishandling your claim was not simply a mistake but was instead either intentional bad faith or neglect amounting to unreasonable behavior.

You can help your own case by making and storing copies of the documents related to your case: medical bills, policies, and correspondence, for example. Take notes when you have discussions with the company representatives; include the date, time, and the name of the party you spoke with.

Insurance bad faith cases are about betrayal. Particularly after paying your insurance premiums, the product and services that you have paid for should be provided.

What Else Should You Know About Insurance Bad Faith?

If you are convinced that your insurance company is negotiating or acting in bad faith, sometimes merely sending a letter to the company – or asking your attorney to send a letter on your behalf – may prompt the company to take the action you need.

In fact, merely retaining an experienced and aggressive life or disability insurance claims lawyer will often persuade an insurance company to treat you properly. If the company knows you may take legal action, and that it could be ordered to pay additional damages along with your contract damages, it may be willing to deal properly with your claim.

The prospect of paying additional damages is one reason insurance companies try to avoid going to court, but a top California life or disability insurance attorney will use every appropriate legal tool to hold your insurance company accountable and recover your payout.

Can You Receive Punitive Damages?

If you prevail in court with your insurance bad faith claim, you will be entitled to damages. Along with the payout on your contract claim, you may also receive punitive damages, which are intended to penalize and deter insurance bad faith. When are punitive damages awarded?

If your lawsuit prevails, you may receive compensatory damages: the payout of your original claim along with your attorney’s fee and other quantifiable financial damages (such as lost income) that were the result of a bad faith delay of your payout or denial of your claim.

California also allows a court or jury to order the payment of punitive damages when a company’s bad faith amounted to intentional fraud, oppression or malice. However, punitive damage awards are rare in California. Your attorney will explain whether or not your own case may qualify for punitive damages.

What Will It Cost You to Seek Your Damages?

Only by retaining a California insurance attorney who routinely handles life, disability or accidental death bad faith insurance cases will you be able to recover your damages from your insurance company based on its bad faith behavior.

Your first consultation with a California insurance attorney is provided with no cost or obligation, and it typically costs you nothing to begin the legal process. Life and disability insurance attorneys in California work on a contingent fee basis, so if for any reason your claim does not prevail and you do not receive a recovery, you will owe your attorney nothing.

If you believe that your insurance company is not treating you properly, take advantage of your first free legal consultation to learn more about your rights as a policyholder and to learn how the law applies to your own bad faith case. McKennon Law Group PC has over 75 years of collective insurance bad faith experience handling life insurance, disability and accidental death insurance claims.

Carpal Tunnel Syndrome may impair your ability to lift, carry, and grip objects. If Carpal Tunnel Syndrome is keeping you from work, you may qualify to obtain long-term disability insurance benefits, but you may need help from a California disability insurance attorney.

Applying for disability insurance benefits for Carpal Tunnel Syndrome is often a challenge because insurance companies often deny Carpal Tunnel Syndrome claims, but a California disability insurance lawyer will fight for your right to your disability insurance benefits.

You need to know what steps to take if you dispute a decision made by your disability insurance company. If you keep reading, you will learn what steps to take, and you will also learn more about your rights as a disability insurance policyholder who is disabled from Carpal Tunnel Syndrome.

What is the Definition of Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a physical condition that causes weakness, tingling, and numbness in the arm and in the hand. The cause of Carpal Tunnel Syndrome is pressure on the median nerve, the nerve running through the carpal tunnel on the palm side of the wrist.

Pressure on the median nerve may be caused by repetitive hand or thumb motions, an injury to the hand, or a number of different illnesses. The median nerve sends signals to the muscles at the bottom of your thumb.

If the median nerve is irritated or compressed, you may have Carpal Tunnel Syndrome. Carpal Tunnel Syndrome symptoms begin gradually, with a slight numbness and tingling in the hands or fingers. That numbness and tingling slowly increases and may move through your arm.

Proper treatment usually relieves the tingling and numbness and restores hand and wrist functions. Without treatment, permanent muscle and nerve damage may occur.

Does Carpal Tunnel Syndrome Strike Particular Groups?

A variety of factors make some people more likely than others to suffer from Carpal Tunnel Syndrome:

Conditions like arthritis and diabetes may have an effect on the median nerve.
A wrist fracture or dislocation can place pressure on the median nerve.
Fluid retention and obesity may also increase carpal tunnel pressure.
Kidney failure and thyroid disorders increase the chances of Carpal Tunnel Syndrome.
Prolonged, repetitive wrist flexing or twisting may create median nerve pressure.
Carpal Tunnel Syndrome is more common in women than men.

In many cases, there is no single cause of Carpal Tunnel Syndrome. A combination of risk factors may contribute to the development of the condition.

Are Computers at Fault for Carpal Tunnel Syndrome?

If you routinely use a keyboard, a mouse, or a vibrating tool, it can exacerbate Carpal Tunnel Syndrome and make it difficult to ease the inflammation of the median nerve. Pain and the inability to use your arm or hand fully can make it hard or even impossible to perform your job.

Researchers have looked for a link between computers and Carpal Tunnel Syndrome. Several studies suggest that using a mouse or excessive typing may trigger Carpal Tunnel Syndrome in some patients.

Carpal Tunnel Syndrome Diagnosis and Treatment

Diagnosing Carpal Tunnel Syndrome requires a physical exam and an electromyography test or a nerve conduction study. Several Carpal Tunnel Syndrome treatments are available including corticosteroid injections and non-steroidal anti-inflammatory drugs.

If your Carpal Tunnel Syndrome is caused by a condition like arthritis, treating the arthritis may also help you reduce your Carpal Tunnel Syndrome symptoms. If those symptoms do not respond to any treatments, a Carpal Tunnel Syndrome sufferer may have to undergo surgery.

Are You Eligible for Disability Insurance Benefits?

If you are partially or totally disabled by Carpal Tunnel Syndrome, and if you apply for long-term disability insurance benefits, an insurance company typically will look for evidence suggesting that you are not disabled and will deny your claim for disability insurance benefits.

The insurance company may also conduct interviews with your doctor and your employer to evaluate the validity of your disability claim.

If you have applied for long-term disability insurance benefits and have not heard back from your insurance company for six or eight weeks, you may need to contact the company for a decision. Under ERISA and most state laws, there are strict time limits for making decisions on disability insurance benefit claims.

Intentionally delaying a claim decision is one way that some insurers operate in bad faith. In most situations, until you receive a denial letter, you cannot take any action or file an appeal.

When Should You Contact a Disability Insurance Attorney?

If your insurance company denies your long-term disability insurance claim, your next best move is to contact the best and most experienced California disability insurance attorney who can help you appeal that denial or file a lawsuit. If there has been a substantial delay in deciding your disability insurance claim, you should not wait until your claim is denied in order to seek the advice of a California disability insurance lawyer.

If you have not yet filed a claim for long-term disability insurance benefits, a disability insurance lawyer can help you with the paperwork to ensure that it is complete, accurate, on time, and that there are no misunderstandings or mistakes on your part that could trigger a delay or denial of your benefits. Most disability insurance lawyers do not handle claims prior to an insurer’s denial of a claim so make sure you do your research to find qualified disability insurance attorneys who handle disability insurance claims from their inception.

If Your Claim for Disability Insurance Benefits is Denied, Take These Steps

To dispute a denial of your disability insurance benefits, your first and best move is to contact a disability insurance claims attorney who can assist you with your next move. An experienced disability insurance claims attorney can give you advice regarding whether your claims was improperly denied, whether you should file an appeal or file a lawsuit against your disability insurance attorney.

There are many important decisions that you must make and a California claims insurance attorney can give you the advice you need to take the next steps to protect yourself and your family.

Your Lawyer Can Appeal a Denial of Benefits

If you need to appeal the denial of a disability insurance claim, an appeal begins by reaching out to a disability insurance attorney. Depending on whether ERISA applies to your denied disability claim, you may have only a brief amount of time to appeal a denial of long-term disability insurance benefits, so the sooner you contact a disability insurance lawyer, the better.

It is important to prepare a strong appeal that can withstand the scrutiny of your insurance company. You can file an appeal without a lawyer’s help, but if you make mistakes and your appeal is denied, your remaining options may be significantly limited.

Instead, work with a lawyer who will fight aggressively and effectively on your behalf. If your appeal fails, your lawyer can then file a lawsuit against your insurance company to maximize your chances of receiving your disability insurance benefits.

McKennon Law Group PC has extensive experience handling all types of disability insurance claims, including claims based on Carpal Tunnel Syndrome.

We all pay a substantial amount for insurance. If you become disabled, or if a loved one dies accidentally or otherwise, you expect your insurance company to approve your disability claim or accidental death/life insurance claim quickly.

The policy you hold is a promise from your insurer to be there with the coverage its policy promises when coverage is needed. When you pay for a policy, the company is legally obligated to provide the coverage as it is stated in the policy terms. It is also obligated to handle your claim in a reasonable manner and resolve in good faith any claim you make.

If your insurer does not act in good faith, do not allow it to take advantage of you or to continue to act in bad faith when it handles your claim. By law, insurers cannot avoid their obligation to make a payout on a covered claim or to offer a reasonable and legitimate reason for denying the claim.

How Is Bad Faith Defined?

If your insurance company does not take its legal obligations to you seriously by not handling your claim in a reasonable manner, you may have sufficient grounds for a lawsuit alleging insurance bad faith. A simple denial of your claim is not enough. A bad faith lawsuit must be based on an insurance company’s specific acts or failures.

In California, as in most states, insurers have an obligation to handle all claims reasonably and to pay all legitimate claims. But in practical terms, what does this mean? Below are listed some – but not all – of the reasons why an insurance company may be targeted with a lawsuit that claims bad faith:

Failure to investigate or negotiate your claim in good faith;
Failure to share with you important information;
Failure to provide an explanation for a claim’s denial;
Failure to offer a reasonable settlement in a case where the liability is reasonably clear;
Failure to act on a claim within a reasonable time-frame;
Offering a settlement amount that is less than the value of your claim;
Hiring biased experts to review claims;
Failure to conduct an adequate investigation before denying a claim.

Bad faith insurance practices include prolonging a claim investigation needlessly, coercing or intimidating you into taking an insufficient payout amount, or rejecting your claim for a fabricated or disingenuous reason.

Will a Letter to the Insurance Company Help?

Sending the insurance company a letter – or asking your attorney to send a letter – might be enough to generate some action from the company. When an insurance company knows that you have taken the matter to an attorney, the company is much more likely to begin treating you right.

The potential for legal action may compel an insurance company to make a settlement offer that is reasonable, because if you prevail in court with a bad faith claim, the company may have to pay your attorney’s fees and additional damages over and above the original claim amount. In other words, you will have some leverage with an experienced disability, life or accidental death insurance bad faith attorney involved. As can be seen by our success stories, we have had many successes in taking on insurance companies after we have been hired.

How Can You Help Your Bad Faith Case?

If your case goes to court, you and your insurance attorney will have to offer specific instances of an insurance company’s bad faith. You can help your case by making copies of the pertinent insurance documents and copies of any letters or emails to or from the insurance company.

Also, be sure to maintain a record of any conversations with the company. Take notes that include the time, date, and the name and job title of the individual who spoke with you.

If your case goes to court, you and your insurance attorney will have to prove that by denying your claim, the insurance company was not merely making an honest mistake but was acting unreasonably in making its decision. If you can show that the insurer acted with fraud, oppression or malice, punitive damages may be available.

How Will Your Attorney Prove Your Bad Faith Claim?

A California bad faith insurance attorney will ask your insurance company for the documents and records related to your claim and for other documents detailing the company’s procedures and policies.

The insurance adjuster or another representative of the company may be subpoenaed for a deposition or to testify in a court hearing. In certain cases, an insurance claims attorney may ask an insurance expert to make a statement or testify about insurance industry practices and that expert may be able to comment on whether in his or her opinion, the insurer’s actions were unreasonable and/or violated appropriate industry standards. Case law and State insurance statutes and regulations, such as California’s Fair Claims Regulations, will often provide the appropriate reasonable standards that insurers are required to follow.

If the company did not comply with these standards or even its own practices, procedures, and guidelines, a qualified and experienced bad faith insurance claims lawyer will be able to prove these bad faith claims practices, likely leading to success in your bad faith insurance lawsuit.

When Should You Speak to an Insurance Claims Attorney?

How can you find out if you are dealing with bad faith insurance practices? You could send a complaint to the California Department of Insurance, but we found that our clients who have done so have received no real help.

Realistically, you must consult a California bad faith disability, life, and accidental death insurance lawyer to know if you have sufficient grounds for a bad faith lawsuit and to know if the denial of your claim can be overturned. Schedule a consultation as soon as you suspect that you are dealing with insurance bad faith.

As mentioned above, in the State of California, a plaintiff who succeeds with a bad faith lawsuit may recover attorney fees and compensatory damages (including emotional distress damages), in addition to payment of the original claim. Your first consultation with an attorney is free and entails no obligation.

Do Not Be a Victim Twice

If you have made a claim on an insurance policy, you may be at a difficult point in your life. You may have lost a loved one accidentally, or you may have sustained a severe personal injury that disabled you or you may have become sick and needed medical attention for which you expect to be covered. You should not have to be victimized a second time by an insurance company’s bad faith.

As a policyholder, you have the right to be dealt with in good faith by your insurance company.
If you believe you are the victim of an insurer’s bad faith practices, contact McKennon Law Group PC for a free consultation.

What if you file an insurance claim, and instead of simply denying your claim, your insurance company informs you that your policy has been rescinded? The company may be operating in bad faith. You should arrange to discuss the matter at once with a California insurance claims attorney.

In what circumstances may an insurance company legally rescind your insurance policy? If you believe that your insurance claim was legitimate, do you have any legal recourse against the insurance company? Is there still any way for you to receive the payout the company owes you?

If you continue reading this brief discussion of rescinded insurance policies and bad faith insurance practices, these questions will be answered, and you will learn more about your legal rights as an insurance policyholder in California.

What Is “Rescinding” an Insurance Policy?

When an insurance company “rescinds” a policy, it treats the policy as if it never existed. In practical terms, it means the company is no longer obligated to pay claims for health insurance, life insurance, accidental death insurance, long-term disability insurance, or long-term care insurance.

Insurance companies may rescind an insurance policy in order to deny an insurance claim, but rescinding a policy is different from simply denying a claim. Determining that a policy, in effect, never existed compels the insurance company to refund any premiums that you have already paid.

Why Are Insurance Policies Rescinded?

Rescinding a policy can boost an insurance company’s profits. Rescinding policies eliminates policyholders who seek payouts while the company accepts payments from policyholders who are not seeking payouts. This could leave you with no coverage at precisely the time you need it.

By rescinding a policy, the company is claiming that the policy was invalid from the beginning. California insurance companies may rescind a policy if a policyholder made a false statement on the initial policy application, meaning that the policy was based on a “material falsehood.”

The company may claim, for example, that you denied being a smoker or that you failed to list DUI convictions when you completed the application. When a policy is rescinded, the company must send the policyholder a rescission notice and return the premiums or offer to do so.

When You Purchase a Policy, Take All the Time You Need

If you have purchased a life, accidental death, or disability insurance policy, you know how much paperwork is involved, including policy applications, supplemental applications, personal history questionnaires, policy notices, and medical documents.

You will answer dozens of questions when you purchase a policy. Take all the time you need to consider the questions thoughtfully, and get the answers right. Presume that anything you tell an insurance company could be used against you to deny a claim.

California insurance law requires all questions on disability, life or accidental death insurance applications to be clear, specific, and understandable. You can indicate if you are unsure of or cannot remember the answer to a particular health history or other question.

What Are Your Rights If Your Life, Accidental Death, or Disability Policy Is Rescinded?

Your insurance policy cannot be rescinded if the purportedly false statement made on the application was trivial or irrelevant, or if you did not know that you suffered from a latent medical condition, or if you did not understand the significance of your response at the time.

A policy is rarely rescinded unless you have made a claim. If an insurance company unlawfully rescinds your policy to avoid making a payout that the company owes you, that insurance company is operating in bad faith, and you should consult a lawyer about taking legal action.

Typically, a California insurance claims lawyer will write a letter on your behalf to the insurance company and demand a detailed explanation for the rescission of your policy. Simply by having a lawyer on the case, you will compel some insurance companies to reverse course.

How Will an Life, Accidental Death, or Disability Insurance Claims Attorney Handle Your Case?

If a letter from an insurance claims attorney does not change the insurer’s position, you may be able to take legal action against the insurance company for breach of contract and breach of the implied covenant of good faith for attempting to rescind your insurance policy.

When you turn to your insurer for a payout that you need – and you have faithfully paid the premiums – a denial of coverage that uses rescinding the policy as an excuse can be catastrophic, particularly if you have lost a loved one, if you are in poor health, or if you need long-term disability coverage.

Insurance bad faith laws provide that an insurance company cannot rescind a policy merely to get out of its legal obligation to pay a legitimate insurance claim. When an insurance company does not take its obligation to you seriously, you may have sufficient grounds for legal action.

How Can You Know If You Are an Insurance Bad Faith Victim?

You may submit a complaint about your policy’s rescission to the California Department of Insurance, but only a California insurance claims attorney will be able to tell you if the insurance company was operating in bad faith and whether you have grounds for taking legal action.

A California insurance claims lawyer will provide you with a free, no-obligation initial case evaluation. You will be able to receive the detailed, personalized legal advice that you’ll need, and you’ll be able to make a more informed decision about moving forward with a legal action.

Most insurance claims attorneys in California work on a contingency fee basis, which means that you pay no attorney’s fees until and unless the matter is resolved in your favor. In many bad faith cases, the insurance company will also be ordered by the court to pay your attorney’s fees.

When Should You Contact an Insurance Claims Lawyer?

Particularly if you have lost a loved one or if you are recovering from accidental injuries or from a serious illness, the last thing you need is your insurance company dealing with you in bad faith, complicating your life, and making your days even more difficult.

Some insurance companies in California are operated professionally and provide the services they are supposed to provide, but there are still many insurance companies that place profits above the legitimate claims of their policyholders.

If your insurance policy has been wrongfully rescinded, or if your life, accident, or disability insurance claim has been unreasonably denied, you should fight for the coverage you are owed. Contact an insurance claims lawyer at once to review your options or to begin the legal process.
If you believe you are the victim of an insurer’s bad faith practices, contact McKennon Law Group PC for a free consultation.

Private sector, employer-sponsored insurance plans are regulated by the Employee Retirement Income Security Act of 1974 – ERISA. ERISA is the federal law that establishes the minimum standards for group insurance plans that are offered through private-sector employers. Should your claim for ERISA disability benefits be denied, you will need to have a California ERISA claims attorney challenge that denial on your behalf.

However, under ERISA, before you may bring a lawsuit against an insurance company for denying your claim, you are required to pursue one or more “administrative” appeals through the company. If the appeals fail, only then may you bring a lawsuit challenging the claim denial.

If your own ERISA life, health or disability insurance claim has been denied, and if your administrative appeal does not succeed, what happens when you file a lawsuit to overturn the denial and to obtain your disability insurance benefits?

As we discuss below, there are different review standards used by the courts in these cases, and you will also learn where to turn for the legal help you may need if your own ERISA life, health or disability claim is rejected.

What Is a Standard of Review?

When a lawsuit against an employer or insurance company for denying an ERISA life, health or disability claim gets to court, there is no jury, and even if you can convince the judge that the insurance company was wrong, in some states, your lawsuit still may not prevail – because of the “standard of review.”

Two standards of review may be used by a court in these cases: the “de novo” standard and the “abuse-of-discretion” standard. A court will use one of these review standards when it hears your lawsuit:

To succeed with a lawsuit in a court that uses the abuse-of-discretion review standard, a judge must determine that the insurer was wrong to deny your claim, and the judge also must determine that the company abused its discretion by denying your claim.
To succeed with a lawsuit in a court that uses the de novo standard, the judge, reviewing the administrative record with “fresh eyes,” essentially determines if the insurance company was right or wrong to deny the claim for disability insurance benefits.

In other words, to win under the abuse-of-discretion standard of review, the judge must find that the insurance company’s denial of your life, health or disability claim was so unreasonable that it constituted an abuse of the company’s discretion. This standard of review gives a decided advantage to employers or insurers who deny life, health or disability claims.

But under the de novo review standard, a judge simply decides if the company was right or wrong to deny your claim. This standard of review gives neither party any advantage going into the courtroom. But, a life, health or disability claimant always has the burden of proof.

Why Do Insurance Companies Prefer the Abuse-of-Discretion Standard?

Under the abuse-of-discretion review standard, a court must agree with the employer’s or the insurance company’s denial of your disability claim and its denial of your administrative appeal – unless the company actually “abused” its discretion when it rejected your claim or your appeal.

In recent years, fewer states are allowing insurance companies to hide behind the abuse-of-discretion standard. California and other states now have laws that require courts to use only the de novo standard of review.

If you are seeking ERISA disability or life insurance benefits in California, and if your claim was denied and your appeal also failed, you will in most instances receive a de novo review of your claim if you and your attorney file a lawsuit against your employer or insurance company.

What Does the De Novo Standard Mean?

Even under a de novo review standard, if you have a California life, health or disability ERISA claim, you and your California ERISA claims lawyer still must prove that you are entitled to the ERISA life, health or disability insurance benefits you were denied. The de novo standard, however, lets the court make its determination more fairly and independently than if the abuse-of-discretion review standard applied.

In other words, under a de novo review, the court may consider both the legal and the factual issues about your entitlement to life, health or disability insurance benefits, and the court is not required to give any deference to the plan administrator’s or insurance company’s decision to deny benefits.

This all means that states that have required a de novo review through legislation, such as California, allow courts to make their own decisions in these cases, thus allowing the courts to substitute their own discretion rather than giving deference to the decision of an insurance company or plan administrator who have obvious biases toward denying life, health or disability insurance claims that negatively affect their financial interest.

What is the “Default” Standard of Review and What Standard is Now Used in Most Courts?

The de novo standard of review is the “default” national standard, and it has been since 1989, when the United States Supreme Court held (in Firestone Tire & Rubber Co. v. Bruch) that, by default, claimants are entitled to de novo reviews of ERISA life, health or disability insurance benefit denials.

However, the court also held that the abuse-of-discretion standard may apply if the language of the ERISA-governed plan unambiguously grants the plan administrator or insurance company full “discretionary authority” to determine benefits or to fully interpret the plan’s terms and conditions.

How Does the De Novo Standard Benefit California Consumers?

As explained above, California law prohibits the inclusion of discretionary authority clauses in life, health, and disability plans. The effect of that prohibition is to require California courts to use only the de novo standard of review in all cases that involve fully-insured plans.

Thus, in the words of the Ninth Circuit Court of Appeals (in Abatie v. Alta Health Life Insurance, 2006), the court “must conduct an independent, thorough analysis of the entire administrative record” and “evaluate the persuasiveness of conflicting testimony.”

In fact, to conduct an adequate de novo review, the court may take additional evidence into account by allowing the parties to augment the administrative record to evaluate the credibility of medical opinions or to hear claims that the medical reports in the case are inaccurate. For example, if a disability claimant received a favorable disability opinion from Social Security Administration, courts will typically allow disability claimants to augment the record to include them.

When Do You Need an ERISA Attorney’s Advice and Services?

Would you go to a knee surgeon if you had cancer? Of course not. You need to consult with an experienced ERISA attorney who knows ERISA life, health or disability insurance inside and out. A workers’ comp or personal injury attorney will almost certainly not be familiar with ERISA. You must be represented by a California ERISA life, health or disability insurance claims attorney who has considerable experience advocating for clients who are seeking ERISA insurance benefits.

If you are applying for ERISA life, health or disability insurance benefits – or if your claim has been rejected – you should have the specific and personalized advice that only a lawyer who is familiar with ERISA can provide.

ERISA lawyers usually provide your initial legal consultation at no cost and with no obligation. Your first consultation is your opportunity to obtain the personalized advice you need and to learn how the law applies to your own case and circumstances.

If you are disabled and you are applying for ERISA life, health or disability insurance benefits, or if your claim has been denied, act now. To initiate legal action – or if you need to learn more – contact California ERISA claims lawyers McKennon Law Group PC as quickly as possible.

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