Disability Claim Denials and Terminations
Disability insurance claim denials and terminations can be extremely difficult to reverse, since insurance companies expertly document their reasons for denying or rescinding benefits. We provide prompt legal advice and counseling on what to do when an insurance carrier has denied a disability claim or attempted to stop paying benefits. Our attorneys uncover the reasons for the insurer’s decision and take immediate action to address and reverse the denial or termination.
Some disability insurers target “high end” policies—such as those issued on doctors, dentists and other professionals—for denial or termination and may use extreme efforts with the hope that the Employee Retirement Income Security Act of 1974 (ERISA) will limit their exposure for bad faith and punitive damages. ERISA deprives insureds of significant rights to which they would normally be entitled under many state’s laws, such as the right to trial by jury and the possibility of punitive damages where the carrier has acted unreasonably or maliciously. ERISA governs employer-sponsored policies, not individual policies. However, there are some situations where individual disability insurance policies can be converted to employer-sponsored policies without the policyholder’s knowledge. We research our clients’ policies to determine whether they are currently governed by ERISA, then counsel our clients on how to ensure that their policies do not become governed by this far-reaching law.
We also assist clients in cases where disability benefits have been denied based on the insurance carrier’s insistence that the insured’s subjective claims, such as back and neck pain, rheumatoid arthritis or depression do not provide objective evidence of disability. Our attorneys evaluate the limitations of the client’s insurance policy and work to ensure that disability benefits are not denied simply because medical science has not progressed to the point of creating objective testing for certain conditions. We consider the totality of our client’s occupation and make the insurance company understand how the frequency, severity and duration of our client’s symptoms affect every aspect of his or her work. In addition, we analyze how the pain, medication, or associated depression of both objective and subjective conditions may have caused cognitive decline that interferes with our client’s ability to work.