California Disability Insurance Lawyers

Fighting Against Wrongful Disability Insurance Claim Denials

Short-term disability (“STD”) and long-term disability (“LTD”) insurance benefits offer income replacement because of an accident or sickness, or if a person is disabled and unable to work. However, insurance companies often deny disability insurance claims and impose a burden on claimants to provide additional evidence of their disability. The entire claims process, especially the appeals process, is riddled with deadlines and loopholes, and a mistake could end a claim immediately.

There are several types of disability insurance policies governed by different laws. STD and LTD insurance policies are typically purchased individually or are issued as group policies through employers. Individual policies purchased directly from an insurance company are typically governed by state laws, such as the California Insurance Code and California contract law. Most of the policies issued through employers as group insurance are governed by the Employee Retirement Income Security Act of 1974 (ERISA). If an insurer or employer improperly denies a disability claim under ERISA, it is necessary to act quickly to preserve one’s rights. At this stage, it is always a good idea to consult an experienced long-term disability lawyer who can help clients through the process.

If an insurer improperly denies a disability claim under California law or the law in most states, a policyholder can bring an insurance bad faith claim and a breach of contract claim for policy benefits, “consequential damages” (damages that are caused by a company’s bad faith conduct), emotional distress damages, punitive damages, attorneys’ fees and interest on past-due disability insurance benefits (typically at the legal rate of 10%).

If an insurance company denies a disability claim, a person has legal options available to fight it. What may seem like a proper denial could actually be improper under the law. An attorney experienced in disability insurance and ERISA law can help a person dispute the denial and secure much-needed benefits. The attorneys at McKennon Law Group PC in California are nationally recognized experts in resolving disputes involving disability benefits and have over 70 years of experience in helping clients gain the benefits that they deserve. Do you need immediate help with your disability insurance claim? Call 949-504-5381 to schedule your no-obligation consultation.

Has Your Disability Insurance Claim Been Denied?

It can be incredibly frustrating when a disability claim is denied, especially if the insurance company uses reasoning that a claimant disagrees with to deny it. If the disability insurance is a group policy provided by an employer, the claimant will have to know and utilize the ERISA process for their claim and appeal.

ERISA favors employers and the insurance companies that issue disability policies and limits how a person can legally proceed with a claim, as well as what they can sue for. The frustrating part is that insurance companies rely on this to deny claims in bad faith with minimal risk. They are counting on policyholders not to sue them for their denials. And, because you cannot sue for punitive or consequential damages, the only risk your insurance company faces is having to pay the original benefits claim plus interest and your attorneys’ fees.

Insurance companies count on plan participants and their policyholders not understanding the ERISA process and thus missing deadlines, jeopardizing their chances of successfully receiving their benefits. It is wise not to take any risky chances in representing oneself. Call McKennon Law Group PC to find out your legal options.

Common Tactics Insurance Companies Use to Deny Disability Claims

Many disabled individuals in California find themselves shocked when their disability benefits are suddenly denied, even after faithfully paying premiums for years. Unfortunately, insurance companies often use calculated tactics to delay, underpay, or deny valid disability claims, forcing policyholders to fight for the insurance benefits they are legally entitled to. At McKennon Law Group PC, our California disability insurance lawyers understand these unfair practices and are dedicated to protecting our clients’ rights.

One of the most common tactics involves claiming there is “insufficient medical evidence.” Insurers may demand excessive documentation, disregard the opinions of treating physicians, or require an independent medical examination designed to minimize your medical conditions. Others use surveillance, misinterpret medical reports, or assert that your serious illness or injury does not meet the policy’s definition of “disabled.” Some insurers even exploit the complexity of short-term disability benefits and long-term disability, hoping claimants will not know the difference in coverage or deadlines for an appeal.

These wrongful denials leave many disabled claimants without income to meet basic needs or support their families. Our disability attorneys and legal team provide personal attention to each client, ensuring every piece of evidence, medical record, and insurance policy term is reviewed to strengthen the claim. If your benefits have been wrongfully denied by an insurer or employer, our California disability lawyers will fight for you in court to recover the compensation you deserve.

How Does ERISA Differ From State Law Insurance Claims Disputes?

Most insurance claims disputes are settled in one of two ways:

Through the application of state law in state courts
Through the application of federal law in federal courts under ERISA

When you independently purchase your insurance policy directly from the insurer, disputes are handled at the state level under state law. California has strong laws that protect policyholders, which means insurance companies do not have the legal advantage. For insurance claims disputes that are handled at the state level, you have these rights:

The right to sue immediately.
The right to a jury trial.
The right to sue for bad faith denials.
The right to sue for consequential, extracontractual damages.
The right to sue for punitive damages.
The right to sue for your attorney’s fees.
The right to sue for accrued interest for past-due denied benefits.

These rights make it harder for insurance companies to flagrantly deny claims in bad faith because they could face serious consequences if they do so. When your insurance claim is procured through a group policy provided to you by your employer, you must follow ERISA guidelines. ERISA severely limits what a policyholder can and cannot legally pursue, and filing a late claim or missing an appeal deadline is enough to lose your chance to sue your insurance company. When your claim is governed by ERISA guidelines, you have these rights:

ERISA lawsuits are handled by the federal court. You cannot request a jury trial or a state trial.
You are unable to sue for anything other than the benefits you are owed by the policy, interest on past-due benefits, and attorneys’ fees and costs. You cannot seek consequential damages or punitive damages.
All evidence to support your claim must be provided during the appeal process. Once the appeals process is completed, you or your attorney will generally not be able to introduce new evidence when you sue your insurance company or your employer. That means any new evidence gained after the appeals process will not be considered by the court.
Many insurance policies have discretionary clauses, which means the insurance company has the discretion to interpret policy language and whether or not a claimant meets the policy’s definition of “disabled.” In those cases, a federal court reviews the insurance company’s denial for an abuse of discretion, which is a standard that is highly favorable to the insurance company. However, discretionary clauses are prohibited in some jurisdictions, such as California.
If you are unsure of how your claim will be handled, either on the state level or via ERISA, we can evaluate your case and inform you of your options. While California law is more friendly to policyholders, the McKennon Law Group PC is ready to guide you through the federal or state process, and we will be prepared to handle any litigation.

If you are unsure of how your claim will be handled, either on the state level or via ERISA, we can evaluate your case and inform you of your options. While California law is more friendly to policyholders, the McKennon Law Group PC is ready to guide you through the federal or state process, and we will be prepared to handle any litigation.

You have fewer rights under ERISA, as is evident when you see what rights you specifically do not have. Under ERISA, you must completely exhaust the insurer’s internal appeals process before filing a lawsuit, which includes submitting an appeal to the insurance company within 180 days after the date you receive notice that your benefits were denied. Under ERISA, you should be aware of the following:

How Can Our Skilled Litigators Help You Recover Your Disability Insurance Benefits?

Our attorneys have handled thousands of disability insurance claims, and thus, we have a comprehensive understanding of how to resolve STD and LTD claim disputes involving individual and group policies. We have represented clients with insurance claims involving, among others:

We can help you through the appeals process, litigation, and negotiation. We can take over communication with the insurance company so you can get your life back and avoid accidentally saying the wrong thing. If you have not filed your claim yet, we will build the best case for being approved for benefits not only to win but also in preparation for the appeals and litigation process, which can be incredibly difficult to navigate. Our attorneys are some of the most experienced in California and nationwide, and we are prepared to aggressively fight for you.

Do You Need a California Disability Insurance Attorney to Advocate For You?

If you are unsure of when you should speak to an attorney or if you even need one, remember that this decision could be one of the most important in your life. These are benefits you have dutifully paid for with the expectation that those benefits will be available to you when you need them the most. That means you have rightfully earned them! The best time to speak with an attorney is the moment you know you are going to file a claim. This allows you to build a strong case from the start.

If you have already filed your claim and your claim has been denied, we can still help! We will work tirelessly to build a strong case that shows your benefits were wrongfully denied and that you deserve to receive the benefits you have worked so hard for.

At McKennon Law Group PC, our lawyers routinely represent clients concerning their STD and/or LTD claims. We have over six decades of experience handling these types of disability insurance claims. If you are an employee covered under a group disability policy, or if you purchased your own individual disability policy directly from a disability insurance company and your claim was denied, do not give up. We can help. For a free initial consultation, call 949-504-5381.