California Denied Disability Insurance Law

People who have health insurance and become disabled sometimes have a California denied disability insurance claim for illegitimate reasons. In such instances—whether the denied claim is due to bad faith insurance or an ERISA violation—victims of unethical health and disability insurance denials can file an appeal or a California denied disability lawsuit, depending on their situation, against their insurance company. A California disability insurance attorney can help file a denied ERISA disability lawsuit or a denied long-term disability lawsuit.

If you have purchased insurance on your own through an insurance broker (i.e., not an employee benefit health plan through your employer), you have "first party insurance". In cases where you have a dispute with your insurance company over a denied disability claim, you are eligible to file a California bad faith insurance lawsuit against your insurance company, to attempt to force them to cover your medical expenses. You may also be able to claim punitive damages and pain and suffering, if the insurance company's conduct has been outrageous.

Tactics insurance companies use to deny or unreasonably delay claims include requesting information be sent multiple times, canceling an insurance policy claiming the patient lied on the insurance application—even if the question that was answered wrongly had nothing to do with the current claim—having employees dispute or argue against a medical diagnosis, and claiming a person is not disabled, despite evidence from a doctor that the person is disabled.

California state law governs all insurance policy agreements for California residents who have "first-party insurance" (as opposed to an employer-sponsored insurance plan, which falls under the Employee Retirement Income Security Act (ERISA), see below) . As such, insurance companies are required to assess insurance claims with "good faith and fair dealing". When an insurance company denies disability claims due to the above disability insurance denial tactics, they have acted in bad faith, and may be subject to a California denied disability lawsuit.

If your insurance was provided by your employer, your insurance claim is covered under the Employee Retirement Income Security Act (ERISA). In this case, you must first file an appeal of your insurance denial within 180 days. If your appeal is denied, you may then file a lawsuit. In this situation, it can be a good idea to have a California disability insurance lawyer help with the appeal process as the process must be correctly adhered to, and all paperwork and supporting documents correctly filled out and included.

Because victims of a denied ERISA disability claim do not have the opportunity to testify at an ERISA claim appeal, a California denied disability attorney can be of help in navigating the appeals process. Not all California insurance lawyers will take on ERISA denied disability claims because they are typically litigated in Federal Court, and not all attorneys have the experience or comfort level with arguing a case there; attorneys who specialize in California ERISA denied disability cases have that experience and are more apt to take such cases.

The judge deciding a California denied ERISA disability case looks only at the paperwork and the patient's file, so having the paperwork in order helps a lot with the appeal. A California insurance attorney can help ensure you have the proper reports and can make a statement on your behalf at the hearing. Once a denied ERISA appeal is closed, however, the attorney cannot help with that part of the process.

With ERISA-covered insurance, patients are only eligible to recover attorney's fees and medical coverage. There is no allowance for punitive damages or pain and suffering.

Regardless of whether you have first-party or group insurance through your employer, once you receive a denial of your claim, you can contact a California denied disability attorney to help you through the claims process. Depending on what type of insurance you have, you will either file a denied disability lawsuit to recover costs or file an appeal of your California ERISA denial.

California Denied Disability Insurance Legal Help

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Last updated on Nov-6-13