Whether your injuries are visible or not, a condition that keeps you from going out, working, or doing what you love to do can be catastrophic. Having the right team of disability insurance lawyers in Los Angeles can make all the difference.
Our Los Angeles disability insurance lawyers at Haffner Law know how to get just payment for disability claims, prevent terminations, and bring the case to court. Through our experience, we have developed a strategy to win, and we vigorously pursue clients’ benefits from the outset of the case.
So, do not be afraid to ask for our legal help, or risk losing your appeal on a technicality. Let us help.
Disability Insurance and the Laws Related to It
Disability insurance protects you by supplementing or replacing your income if something happens to your health and well-being and you become disabled and can no longer work.
There are two types of disability policies which have very different avenues for redress against the disability insurers if a dispute arises. Disability policies issued through your employer are covered by the Employee Retirement Income Security Act (ERISA), and can only be brought in federal court, and have more limited remedies available to the insured. Disability policies purchased in the open market, however, are subject to normal California insurance bad faith rules. Suit can be brought against those insurers with the full panoply of damages you could claim in any other insurance bad faith case (contract benefits, general damages, punitive damages, etc.). It is important to understand what kind of policy you have because it effects your legal options.
Like with any other insurance policy, when seeking disability benefits, the claims process starts by making an insurance claim. Sometimes the insurance company will accept the claim, but often they will not. Under ERISA, if there is a denial, an insured is required to exhaust administrative remedies before they can proceed in court. It can be important for claimants to retain an attorney who understands this process, as ERISA administrative appeals can be legally tricky and have a detrimental effect on your claim if not handled appropriately. If you have private disability insurance, on the other hand, you can bring your bad faith action immediately after the denial of your claim. However, for any legal action, it is important to have an experienced insurance attorney on your side.
When presenting your disability claim, it is extremely important to provide all records that document your claim and disability, particularly medical records. Often it is best just to sign a medical authorization giving your insurer complete access to your medical history. An insurance company must have access to medical records related to the disability in order to evaluate the claim.
You also want to have a copy of your disability policy or plan so you know what coverage you have, and its terms, limitations, and exceptions. Coverage differs when the disability policy provides coverage for “own occupation” versus “any occupation.” Disability policies also usually have provisions, and different coverages for “total” and “partial” disabilities, and short-term and long-term disabilities. Many disability policies have an elimination period (during which no benefits are paid during the first months of a disability) and termination dates, where disability payments end. There are usually special definitions for “permanent” disability, and often can be differences in coverage defending on whether the disability was caused by a sickness or an accident. Many disability policies also have exclusions or limitations for mental disabilities. All of these coverage issues can be very technical, and the assistance of good legal representation can make all the difference in getting your claim paid.
There are special rules in California regarding providing notice of exclusions or limitations in disability policies prior to onset of the disability. Thus, if you have not been provided a copy of your disability policy, which can happen with some frequency in group policies, there may be avenues to challenge exclusions or limitations that deny of limit your coverage.
If you are having difficulty getting your disability claim paid, we encourage you call or contact Haffner Law PC for a free consultation with one of our disability insurance attorneys in Los Angeles.