California Long-Term Disability Lawyers

Fighting for Disability Policyholder’s Rights

Insurance companies are notorious for their shady claim denial practices. The problem is that policyholders pay them premiums, hoping they will do the right thing when they become disabled Unfortunately, the insurance company is motivated to protect their shareholders, not the policyholders who pay for benefits. That means they have an incentive to deny your claim instead of doing the right thing and helping you during your time of need. Now that your claim has been denied, you wonder what to do to take care of your family.

McKennon Law Group PC has a track record of fighting to protect policyholders for their rightfully earned disability benefits. Our law firm is here to help you through the process of applying for long-term disability insurance, the appeal process and/or the litigation process to ensure you can successfully obtain your well-deserved disability benefits.

We are going to help you understand the process of getting your benefits and the appeals process, as well as some things to look out for. If you need immediate help, please call 949-504-5381 to schedule a consultation. Your initial consultation is free and is a great first step toward discovering and protecting your rights.

What is Long-Term Disability Insurance?

Long-term disability insurance, often shortened to LTD, is a form of income replacement. It is designed to provide monthly benefits to individuals who are unable to work for a short or an extended period of time due to an illness or injury. These policies usually only cover a portion of the policyholder’s income, typically from 50% to 70% of their income, depending on the policy. Benefits can last for a few months, years or until retirement age. LTD insurance can be purchased privately but is most often offered as group insurance through an employer.

Most plans offered through an employer are governed by the Employee Retirement Income Security Act of 1974 (ERISA). ERISA claims are handled differently from individual claims and are usually litigated in federal court when disability benefits are not received through the administrative claims process. That means you will need an attorney who not only understands long-term disability insurance claims but you will also need one who understands how to litigate them.

How Does ERISA Impact Long-Term Disability Claims?

ERISA is a federal law that sets the minimum standards for most voluntarily established retirement and employee benefit plans in the private sector, including LTD insurance.

You may be wondering, “How does that affect me?”

It may affect you a lot more than you would think. If your LTD insurance was purchased through your employer or sponsored by your employer, your LTD insurance claim or appeal would almost assuredly be made according to ERISA’s law and regulations. ERISA laws and claims regulations are primarily focused on benefits offered through employers. That means if you purchased your LTD insurance policy independently, you will likely not have to worry about ERISA.

ERISA severely limits the options you have. Here are things to be aware of when dealing with an LTD insurance claim that is governed by ERISA laws:

Before you can sue, you must exhaust your insurance company’s internal appeals process. This means you must submit your appeal to the insurance company within 180 days of your receipt of a claim denial. If you miss that deadline, your claim will likely be finished and you cannot bring a lawsuit.
ERISA severely limits your legal remedies. In a claims dispute covered by ERISA, you can only recover the benefits you were denied, your legal fees, and sometimes, accrued interest on past-due benefits payments. You cannot sue for punitive damages nor can you sue for emotional distress or economic damages caused by the claim denial. This gives insurance companies an unfair advantage because they can deny LTD claims in bad faith, knowing that if they lose a court battle over the claim, all they will have to do is pay the original claim amount in addition to interest and legal fees. They count on their policyholders giving up or improperly navigating the ERISA process so they can profit from the claim denials.
Once the appeal process is closed, you generally cannot introduce new, post-appeal evidence in court. That means that you and your attorney must build the entirety of your case during the appeal phase. If this is not done properly, you will not likely have the chance to introduce compelling evidence, not even during litigation.
ERISA heavily favors insurers because of something called “discretionary authority.” That’s a complicated way of saying that your insurance company has the right to use its judgment to determine whether or not it will pay your claim, and the court will only overturn the denial if the insurance company abused its discretion. Most insurance policies include this discretionary authority clause in the fine print. However, certain jurisdictions prohibit these types of clauses.
For claims covered by ERISA, you do not have the right to a jury trial, and your dispute will be handled in federal court, not in a California state court. California has established strong laws to protect policyholders’ rights but these laws mostly do not apply in an ERISA case.

ERISA strips away many of the rights that California normally offers insurance policyholders. That means you will need an experienced long-term disability lawyer who knows how to handle litigation in federal court. McKennon Law Group PC has a legal team that is ready to fight for the LTD insurance benefits you have paid for and rightfully deserve.

What are Common Reasons LTD Insurance Claims Are Denied?

When you purchased and paid for your long-term insurance policy, you did so with the assumption that if you were ever injured or fell ill and needed it, it would be there. Now that you need it, the insurance company is going to do everything in its power to deny your claim.

Some common reasons your insurance company may use to deny your claim may include the following.

Lack of objective medical evidence: Not all illnesses or pain are visible and insurers know this. They often require extensive lab tests, like MRIs and X-rays, or clinical findings to support your claim. That means that if your affliction is something that does not show up on a test, your claim will probably be denied.
Your claim does not meet the insurance company’s definition of a disability: Your policy likely has a strict definition of a disability. Many policies require you to be unable to perform your occupation, but later, they include any occupation based on your education, training and experience.
Missed deadlines and imperfect paperwork: Insurance companies hide behind bureaucratic red tape. They count on you missing deadlines or turning in incomplete or imperfect paperwork. They will use any missing documentation or mistakes to deny your claim.
Medical nonsense: You should follow your doctor’s treatment plan because if you do not, the insurance company may use it as a reason to deny your claim. They will use gaps in your medical record to argue that you are not disabled.
Policy Exclusions: Most disability policies have numerous exclusions in them. Insurers will liberally construe them in their favor and use them to deny claims. For example, if you receive treatment for an illness or injury that causes your disability prior to the date that coverage begins, they may claim you have a preexisting condition that is excluded under the policy.

If your denial letter lists any of the above or some other reason that does not sit right with you, you should speak with a long-term disability attorney who can help you understand your legal options and what your next steps should be.

What Rights Do You Have After a Denial?

In California, your rights after a denial are heavily reliant on how your policy was purchased, either privately or through your employer.

If You Privately Purchased Your LTD Insurance Policy

California and many states have very strong consumer and insurance protections in place. If you purchased your policy directly from an insurance company without the assistance of an employer, you have the following rights:

Right to sue immediately: You do not have to work through the insurance company’s internal appeals process. You can avoid this step and sue your insurer.
Right to sue in state court: You can sue in state court and have available to you the more favorable laws protecting policyholders like you.
Right to a jury trial: You have the right to present your case and trial to a jury when it is heard in California state court.
Right to sue for bad faith: This is the one insurance companies are most afraid of. If your insurer denied your claim unreasonably, you can sue for insurance bad faith. This gives you the ability to sue for more than just insurance benefits, interest and legal fees.
Right to full damages: When you privately purchase your policy, you have the right to sue for:
- The benefits you are owed plus interest
- Emotional distress
- Economic damages
- Punitive damages
- Attorney’s fees

Employer-Sponsored LTD Policy (ERISA)

If your coverage was offered through your employer, you will have to follow ERISA law and guidelines, which we described above. You still have these rights:

Right to a full and fair review: You have 180 days to file an administrative appeal. During this time period, you can submit new medical records, expert opinions, personal statements, medical provider certifications, and legal arguments. ERISA law and regulations require that your insurance company give your claim a full and fair review.
Right to expedited case and trial: When suing under ERISA, the litigation process is much more streamlined because discovery is strongly discouraged and trials are typically scheduled more quickly than in state court jury trial cases.
Right to receive your insurance claim file: You may request and review your full claim file (known in ERISA as the Administrative Record), which includes internal notes, reports, and communications used to justify the denial of your claim.
Right to sue in federal court: ERISA cases are handled in federal court, not state court. You only have the option of having your case heard by a judge. There is not an option to have it heard by a jury.
Right to sue for your denied benefits: You have the right to ask the court to award you the LTD benefits you deserve that were wrongfully denied. You may also ask for interest on past-due benefits owed and attorney’s fees and costs.

As you can see, if you privately purchased your disability policy, you have more options you can use to hold your insurer accountable. Regardless of how you obtained your policy, our long-term disability attorneys will be ready to protect your rights.

How Does a Long-Term Disability Attorney Help During the Claims Process?

You may think that filing for long-term disability benefits should be pretty straightforward. You have always paid your bills on time, you never missed an insurance payment, and you take good care of yourself; why would the insurance company not deliver on its obligations?

The process is rarely straightforward, and it is never easy. Every policy is different, and insurers use loopholes, bureaucracy, and narrow interpretations to deny claims. Our team can help you through the entire process. Some things we do to help include

Evaluate Your Eligibility

Our team will review your policy before you file your claim or when we handle your appeal. We will help determine whether you qualify for benefits according to your policy’s terms and provisions. We can translate the legal jargon into a language you can understand.

Handle Insurer Correspondence

One of the biggest benefits a long-term disability insurance attorney offers is taking over all communication with the insurance company. We will direct their letters and phone calls to our office. That means there are fewer chances for miscommunication, and a clear legal record will exist. While we represent you and handle all communication with the insurer, you can relax and focus on getting better. Insurers are much less likely to take advantage of you when we are handling your claim.

Gather Medical Evidence

We will ensure you have the medical evidence you need when you file your claim or your appeal, making it more likely that we remove the insurance company’s ability to deny your claim based on “a lack of medical evidence.”

Build Your Case With Specialized Evaluations

We will understand how to prove that you are unable to perform your or any job by hiring a specialist who can evaluate your restrictions and limitations or who can evaluate the important vocational issues that need to be addressed.

Prepare You

Insurers often send questionnaires or request interviews, hoping you will slip up. Our team can help you answer questions in a way that is honest but legally strategic. We will make sure to avoid inconsistencies that can be used against you.

Bureaucratic Approach

We will ensure that bureaucratic red tape does not trip you up and give your insurer a reason to deny your claim. We will ensure that every form is properly completed and every document is filed on time, so your insurer will not be able to count on you missing a deadline.

Be Ready to Appeal

Your case will be approached as though it will need to be appealed and litigated. If your claim is denied, it becomes a part of the administrative record. That means that during ERISA cases, you will have a well-prepared claim with a well-prepared claim file that sets the stage for a much stronger appeal or lawsuit.

When Should You Call an LTD Lawyer?

You should speak with an attorney as soon as you know you will need to file a long-term disability claim. As you can see, building a strong case from the start is vital to insurance claims, even before they are denied. When you work with an experienced attorney, you have someone who can study your policy, answer your questions, and stop your insurance company from mistreating you.

McKennon Law Group PC has a history of championing policyholders’ rights. We are not afraid to take on insurance companies, and if litigation in federal court is necessary, we will be ready to handle it.

Call 949-504-5381 to schedule a free consultation. Your initial consultation will answer your questions and help you determine whether our firm is a good fit for your case. Take the first step in getting what you worked hard for.