Arizona Claims & Resources
Comitz | Stanley’s founding partner, Ed Comitz, was born and raised in Tucson, Arizona.
After graduating at the top of his class in law school and serving as associate editor of the law review, Ed was privileged to be offered a position with DeConcini McDonald Yetwin & Lacy, P.C., a large Tucson firm deeply rooted in Arizona history. The firm was founded by Evo DeConcini, a former Arizona Supreme Court Justice and former Arizona Attorney General, and his son, Dennis DeConcini, a U.S. Senator representing Arizona from 1977 until his retirement in 1995.
While practicing in Tucson, Ed built his healthcare and disability insurance practice from the ground-up. In 2000, Ed moved to Phoenix, practiced briefly with the international law firm Squire Patton Boggs, but soon settled back in to what he has most enjoyed, helping Arizona dentists, physicians, attorneys, executives, and other professionals collect on their private, own-occupation disability policies.
Ed has successfully filed, litigated and resolved countless disability insurance cases in Arizona and the U.S. District Courts of Arizona, which typically have jurisdiction over disputes involving own-occupation disability insurance policies.
Below, we have answered the most common questions we are asked by professionals filing disability insurance claims in Arizona. In doing so, we discuss several key components of Arizona insurance law, and explain why it is important to have a disability attorney involved in your claim from the start.
We have also included some answers to common questions about our disability insurance law firm, links to our Arizona disability insurance blog post series, and other helpful links for professionals filing disability claims in our state.
Arizona Disability Claims FAQs
Is Arizona Disability Insurance Law More Favorable than the Disability Laws in Other States?
Generally speaking, yes. Arizona law potentially allows certain benefits that other states may not permit, including:
- Construing ambiguous terms in your disability insurance policy against the insurer;
- Bad-faith damages, including damages for emotional distress;
- Punitive damages; and
- Accelerating benefits by awarding your future disability insurance benefits as a lump sum under special circumstances.
Over the last few years, the District Court of Arizona has also shown some willingness to adopt favorable rules from other jurisdictions, such as the “usual or customary” requirement that originally was adopted in California. This rule provides that, if you have an “own occupation” policy, the relevant question under a disability policy in Arizona is whether you can perform the substantial and material duties of your occupation in the “usual or customary way,” even if your policy does not expressly contain that more favorable phrase.
If My Disability Claim is Denied, Can I Sue My Disability Insurance Company for Bad Faith and Punitive Damages in Arizona?
Yes, unlike many other jurisdictions, Arizona does allow disabled policyholders to sue for what is termed “insurance bad-faith,” which allows the policyholder to obtain enhanced damages for insurance company misconduct.
For example, a disabled policyholder suing for bad-faith may obtain emotional distress damages, if his/her disability insurance company has acted unreasonably in the administration or handling of the claim and either (1) knew that its conduct was unreasonable, or (2) acted so recklessly that “knowledge” of its mishandling of the claim is implied.
In rare cases, punitive damages may also be allowed to punish outrageous misconduct and deter other disability insurance companies from engaging in similar misconduct in the future.
The standard of proof for punitive damages is very high—“clear and convincing evidence” that your disability insurance company acted with an “evil mind.” In making a determination of whether punitive damages are appropriate, courts consider various factors, including: (1) the severity of the misconduct, (2) the duration of the misconduct, (3) whether the insurer attempted to conceal its misconduct, and (4) the insurance company’s net worth.
Are There Any Rules My Disability Insurance Company is Required to Follow When Reviewing My Claim Under Arizona Law?
Arizona courts have routinely held that disability insurance companies must act within certain parameters when administering claims, most of which should be self-evident. For example, disability insurance companies must:
- act reasonably when handling disability insurance claims and paying benefits;
- reasonably interpret the provisions of disability insurance policies;
- properly and evenhandedly investigate disability claims;
- treat policyholders filing disability claims fairly and honestly at all times;
- make claims decisions without regard to the disability insurance company’s own profitability;
- communicate with policyholders regarding the basis for disability claim denials; and
- act promptly in paying legitimate disability insurance claims.
Similarly, in Arizona, disability insurers must not knowingly:
- misrepresent facts or policy provisions to avoid paying disability insurance benefits;
- take unreasonable legal positions;
- impose requirements on the policyholder that are not contained in their disability insurance policy;
- try to gain an unfair advantage over the policyholder seeking to collect disability insurance benefits;
- attempt to influence the opinions of medical examiners, in an effort to secure a disability claim denial;
- destroy or alter documents to conceal evidence of disability claim mishandling;
- lie about actions taken on a disability insurance claim; or
- force policyholders to go through needless adversarial hoops to secure their rightful disability insurance benefits.
If your insurer knowingly breaks these rules, they can be liable for insurance bad faith under Arizona law.
What Defenses Do Arizona Courts Allow Disability Insurance Companies to Assert in Defense of a Bad Faith Claim Denial?
Arizona courts allows disability insurers to invoke certain defenses, such as the “fairly debatable” defense to avoid bad faith liability. This defense allows insurers to potentially avoid bad faith damages if they can establish that they had a legitimate basis to believe that your disability insurance claim should be denied at the time, even if the weight of all the evidence shows that their claim decision was in fact incorrect.
What Have You Seen Disability Insurance Companies Do to Support a “Fairly Debatable” Defense in Arizona?
If you don’t handle your claim correctly from the start, you can end up with a one-sided claim file that omits important information and gives your insurer cover to avoid bad faith liability. This is called “artful neglect”—i.e., your disability insurance company purposefully avoids asking you for information that would support your claim, and only focuses on information that might help them deny the claim. Then when you sue them for bad faith, they assert that, based on what was in their file, they had a reasonable basis to deny your claim.
Are There Other Legal Hurdles I Could Face if I File a Lawsuit Against My Disability Insurance Company?
While Arizona law provides certain tools to a disabled policyholder seeking benefits, there are also specific legal requirements that the insured must satisfy first.
For example, in order for a policy provision to be construed against the insurer, you must first establish it is legally “ambiguous”—i.e. that the provision is reasonably susceptible to more than one interpretation. You must also assess whether there is any relevant parole evidence (i.e. evidence extrinsic to the contract) and be prepared to argue about the scope of what can be considered and what the intent of the parties was at the time of contracting.
Similarly, if you seek bad faith damages, you must overcome the “fairly debatable” hurdle noted above.
If you seek emotional distress damages, you must satisfy certain legal burdens of proof, such as establishing you were in a vulnerable state and your insurer was the proximate cause of the distress.
To secure acceleration of future benefits, you must, among other things, establish that your disability is “permanent” and will last for the lifetime of the policy.
And if you seek punitive damages, you must meet strict legal requirements, such as proving that your disability insurance company had an “evil mind” and consciously intended to injure you, by clear and convincing evidence—a very high legal standard of proof.
Seeking to satisfy the legal requirements for establishing bad faith and punitive damages also requires securing evidence revealing your insurer’s employees’ internal conduct. This is not something that insurers hand over freely, and it can require long, drawn out discovery disputes and carefully crafted depositions of key witnesses before you have the evidence you need to claim those damages.
Additionally, Arizona, like other states, has complex legal rules (based on ratios and multipliers, the nature of the underlying damages, and prior damage awards in other cases) that insurers invoke to appeal and challenge punitive damage awards by juries. On appeal, Arizona courts regularly reduce jury awards that are deemed to be excessive under these rules.
Consequently, you cannot just throw the words “bad faith” and “punitive damages” around with your insurer and expect them to be intimidated—you have to back them up with substance, and if you do not, your threats to sue will ring hollow and be ignored.
The upshot is that, while Arizona disability insurance law is generally policyholder-friendly, this is not an arena you want to enter unless you fully understand the terms of your policy and the underlying law.
What Is the Disability Claim Process Like if I File a Disability Claim in Arizona?
While there are Arizona rules and regulations that govern what insurers can and cannot do when investigating claims (discussed above), insurers do not always take these rules as seriously as they should when they are investigating claims.
As noted above, much of the disability claims process takes place behind the scenes. Disability insurers collect broad authorizations at the outset of each claim and use these authorizations to gather as much information as they can about you. While, in some instances, they may ask you for information in your possession, you should also expect that they will contact others in your orbit who might have relevant information related to your disability claim.
It is not uncommon for disability insurance companies to contact your doctors, co-workers, employers, or professional licensing boards without letting you know. Insurers also regularly conduct surveillance—both online and in-person—and obviously do not give you a heads up before they do this.
Do I Need to Hire a Disability Insurance Attorney to File a Disability Claim for Benefits in Arizona?
Disability insurance law is a discrete area of law, that requires knowledge of both the law and how each disability insurer operates.
We often speak with professionals who filed their claims on their own, without counsel, who waited several months without a claim decision and then were blindsided by claim denials. If you lack experience in this area, filing a claim often turns into doing your best to submit information that is requested by the insurer, then waiting in silence for weeks and weeks, wondering: what is taking so long?
The problem with this approach is that it lets the insurance company dictate how your claim file is documented, which often results in a one-sided narrative. For instance, some insurers hire doctors to go through your medical records and cherry-pick statements out of context, and then rely on those doctor’s opinions as the basis for denying your claim.
As another example, insurers know that you expect them to tell you when they want more information. So, another common tactic is leaving you alone for a time, in the hopes that you stop seeing your doctor regularly. Then, their in-house doctors identify the period of time where there are no medical records, claim that they cannot verify the ongoing nature of your disability, and use this as an excuse to justify forcing you to attend an in-person medical exam by a doctor of their choosing.
While these tactics are improper, and there are ways of eventually holding insurers accountable, if you wait to contact an attorney until your claim is denied, it may be too late.
With disability claims, establishing certain dates and timelines can be crucial to securing benefits under your policy. If you fail to appropriately document your file at a critical point, it can become very difficult to reverse claim denials. For example, if you allowed a gap in your treatment history, or do not receive a diagnosis until after an important date, or did not see the proper specialist for your disabling medical condition, you can’t go back in time to fix that.
An experienced disability attorney can explain what to expect, identify the type of claim you should file under your policy (e.g. total or partial/residual disability), and help you gather what information is important to prove up your particular disability.
If you own your practice, a disability attorney can help you make a transition plan that fits with the requirements of your policy. And once your claim is filed, a disability attorney can act as an intermediary between you and the company, monitor interviews and requests for information to ensure they are proper, ensure that you are protected from surveillance that is overly-intrusive, and make sure that you don’t miss any important claim deadlines or opportunities to provide important information.
If My Disability Claim is Denied, How Long Does It Take to Win a Lawsuit Against a Disability Insurance Company?
Each case is different, and there are many factors that go into how long it takes to resolve disputes with insurers. Complex cases obviously can take much longer than cases involving one or two discrete issues; however, generally speaking, even a relatively straightforward lawsuit can take years to resolve, if the parties do not settle and the case goes to trial. And even if a case goes to trial, disability insurers have the money and resources to appeal unfavorable decisions, and drag out the appeals process for several more years.
Below are a few examples of actual Arizona disputes between professionals and their disability insurers, including how long it took each case to resolve.
- Invasive cardiologist practicing in Scottsdale, Arizona filing a claim under her specialty- specific policy was denied due to a dispute over how her “occupation” should be defined. When her insurers (General American and Paul Revere/Provident) failed to timely pay her disability benefits, she had to go back to work as a general cardiologist to meet her expenses. Her insurer tried to use this against her, but she ultimately won in court and was able to prove that her specialty (invasive cardiology) was different than her new job (general cardiology), and therefore she was disabled under her specialty-specific policy. Her disability claim was filed in 1995 but the jury verdict was not entered against her insurer in the U.S. District Court for the District of Arizona until 2003—nearly a decade later.
- Orthopedic Surgeon practicing in Arizona became disabled due to depression. In April 2001, his insurers (General American, Paul Revere/Provident/Unum) terminated his claim and refused to pay further benefits. His insurers wanted him to go back to work as an assistant surgeon; however, the Arizona Board of Medical Examiners had previously prohibited the surgeon from working on patients and refused to remove those restrictions. His insurers also ignored the fact that he had recently had surgery on his cervical spine due to radicular symptoms and numbness in his hand. Ultimately, the surgeon had to sue his insurers and, in September 2005, the U.S. District Court for the District of Arizona determined that his breach of contract claims, bad faith claims and punitive damages claims could proceed to trial. Following this ruling, the insurance companies settled in November 2005—over four years after benefits were terminated.
- Anesthesiologist practicing in Page, Arizona continued to practice in spite of a diagnosis of degenerative disc disease in his lumbar and cervical spine. In 2015, he acutely injured his back when attempting to lift a patient from the operating table to the hospital bed. The anesthesiologist filed a claim seeking lifetime benefits under the injury provision of his policy. His insurer, Provident, argued that the disability was due to a sickness (the degenerative disc disease), not an injury, and told him he was only entitled to 48 months of benefits. He sued his insurance company and three years later, in 2018, the U.S. District Court for the District of Arizona ruled in his favor, granting him summary judgment on the lifetime benefit component of his claim. The remainder of his dispute with his insurer continued to be litigated and was not settled until 2021—nearly six years after the injury.
- General Dentist practicing in Arizona injured his back in January 2013 when he fell backwards out of his truck and landed on his back on his cement driveway. He returned to his dental practice four days later, but had ongoing problems from the injury and ultimately filed a disability claim. His insurers (Paul Revere/Provident/Unum) denied the claim, going so far as to dispute whether the fall/injury even happened. The dentist sued his insurers in September 2014 and, in February 2017—nearly three years later—the U.S. District Court for the District of Arizona permitted the dentist’s bad faith and punitive damages claims to proceed to trial. The parties ultimately settled in April 2017, and the case was dismissed nearly four years after the initial injury.
- Anesthesiologist practicing in Arizona filed a disability claim in July 2015 due to problems with his back, legs, and hips. His insurers (Paul Revere/Unum) conducted surveillance in October 2015. In denying the claim, his insurers claimed that video of the anesthesiologist walking without a cane, carrying a box, moving a garbage can, and driving a vehicle proved the doctor was not disabled, and had their in-house doctors sign-off on this assessment. The anesthesiologist sued and, in May 2020, the case had reached summary judgment. The U.S. District Court for the District of Arizona ruled in favor of the insurer and did not allow certain “aiding and abetting” claims against the company’s in-house doctors to proceed to trial; however, the Court permitted the bad faith and punitive claims to proceed to trial. Ultimately, this case was settled in June 2021—nearly six years after the date of disability.
As you can see, once a disability insurance claim is denied, it enters the lawsuit phase, which can take years to resolve (particularly if the case goes all the way to trial).
The cases above were not appealed, as most of them settled; however, if they were appealed, this could tack on several more years and it is not uncommon for cases that are appealed to take eight years or longer to resolve.
In some cases, certain aspects of a claim can be won at summary judgment; however, disability insurance lawsuits often involve issues of fact that must be tried in front of a jury. And, while surviving summary judgment can prompt an insurer to settle, once they have denied a claim, insurers typically have little incentive to settle before the eve of trial.
Consequently, if your goal is to secure your benefits as quickly as possible, it is much better to file your claim the right way from the outset. If you fail to properly present your claim, and it is denied, it can be difficult to reverse the denial and, even if you win, it can take a long time.
Other Arizona Disability Claims FAQs
Can I Sue My Disability Insurance Company for Violating Arizona’s Insurance Regulations?
Arizona does have statutes that list several unfair claim settlement practices Arizona disability insurers are prohibited from engaging in. However, these statutes also state that they do not provide a private cause of action.
In other words, you cannot use them to support a count or claim damages in a private lawsuit between you and your insurer. However, you can file compliant with the Arizona Department of Insurance if you feel your insurer is violating Arizona’s insurance regulations.
Notably, many of these regulations prohibit insurers from engaging in these acts so frequently that it indicates they are a “general business practice” of the insurer. Consequently, insurers are unlikely to be hit with high sanctions unless the Arizona Department of Insurance receives enough complaints about the same insurer to justify a thorough investigation of the disability insurance company, and that investigation reveals widespread misconduct.
My Disability Insurance Company Is Not Responding to My Calls/E-Mails/Letters? Do I Have a Remedy Under Arizona Law?
Arizona disability insurers have a statutory obligation to act reasonably and promptly if they receive claim communications that reasonably suggest a response is suggested. Arizona’s administrative code further provides that disability insurers must make an appropriate reply within 10 working days.
However, as noted above, Arizona’s insurance regulations do not give rise to a private cause of action, so you cannot base a lawsuit solely on a failure to respond. However, if the insurer is acting unreasonably and repeatedly ignoring you, in some instances that may rise to the level of bad faith.
In other instances, the insurer may have a legitimate reason for delaying a claim decision. For example, they may still be evaluating information that you sent in or they gathered from other sources, without your knowledge.
If you feel like your claim is being unreasonably delayed, an experienced disability attorney can help you assess the situation and determine whether the delay is improper.
Can a Disability Insurance Company Put Me Under Surveillance in Arizona?
As noted above, disability insurers do conduct surveillance—particularly on long-term disability claims involving high-paying policies.
Common surveillance tactics can include physical surveillance (i.e. having a private investigator follow you), internet/social media tracking, and field visits/interviews. These methods seem invasive; however, they are allowable in Arizona in certain circumstances.
While surveillance is allowed, an investigator is not allowed to trespass on your property or to intimidate, harass, or stalk you. Additionally, in Arizona, the duty of good faith is a non-delegable duty. Consequently, both the insurer and private investigator may be held liable for any misconduct by an investigator that harms a claimant.
If you feel that your disability insurer has crossed this line, an experienced disability attorney can help you determine your legal remedies under Arizona law.
FAQs About Our Disability Insurance Law Firm
What Type of Disability Claims Do You Handle?
Our law firm is different from other disability insurance law firms.
We do not handle Social Security disability claims, and focus exclusively on “own occupation” claims filed by professionals. We do not have a volume practice, or a “win-some, lose-some” mentality. Our firm is selective in the matters that we take, and we only take on claims we believe in.
The majority of our Arizona clients are dentists and physicians, but we also represent lawyers, business executives and other professionals with private disability insurance policies.
We focus on long-term disabilities, and typically do not handle short-term disability claims (unless there is a chance that the claim could develop into a more long-term, permanent disability).
Do You Provide Free Consultations?
Yes. We vet each disability claim before accepting representation, and we do not charge for this process.
Do You Charge a Contingency or Hourly Fee?
If we decide to take a matter on, we typically charge a contingency fee that varies depending on the nature of the claim, the stage in the claim process, the particular difficulties involved, the amount involved, and the risk we assume. We determine the fee after we have finished our initial review/vetting of the potential claim or case.
We do represent clients on an hourly basis in certain limited circumstances, in situations involving discrete issues; however, our typical fee is a contingency fee.
Where Are You Located in Arizona?
Our firm’s main office is located in Phoenix/Scottsdale, Arizona. Our law firm also has a satellite office in Tucson, Arizona.
Are Your Attorneys Admitted to Practice in Federal Court?
All of our Arizona disability attorneys are admitted to practice in Arizona state courts, the Arizona Supreme Court and the U.S. District Court for the District of Arizona.
Do You Represent Clients Outside of Phoenix?
Yes. Our disability attorneys work with clients in Phoenix and the surrounding metropolitan areas, including Ahwatukee, Anthem, Chandler, Cave Creek, Fountain Hills, Gilbert, Goodyear, Litchfield Park, Mesa, Paradise Valley, Peoria, Scottsdale, Surprise, and Queen Creek.
Our attorneys also represent clients throughout the state of Arizona, including Tucson, Flagstaff, Sedona and Yuma.
Submit A Question
Our firm believes that attorney access is important. We welcome you to contact us directly, and if we are unavailable, we will be sure to respond to your call or e-mail promptly.
If you have a specific question for us, please fill out the form below.
Arizona Disability Blog Series
- What Can I Do If My Insurer Misrepresents My Policy? Do I Have a Remedy Under Arizona Law?
- Why Was My Claim Denied? Can I Sue for Bad Faith in Arizona?
- Can You Collect On Your Specialty Specific Policy? An Arizona Case Study
- Sickness or Injury? Does it Matter Under Arizona Law?
- What is an Incontestability Clause? An Arizona Case Study
- Disability Insurance Bad Faith: Different States – Part 1 (Arizona)
- Does Arizona Require My Disability Insurer to Respond to My Letters?
- Disability Claim Investigation: What Can My Insurer Do in Arizona?
- Are Disability Insurance Benefits Marital Property in Arizona?
- Has My Disability Insurer Acted in Bad Faith Under Arizona Law?
More Arizona Disability Claim Resources and Links
Medical Resources and Information
- Mayo Clinic (Phoenix) – Disease and Conditions Glossary
- Mayo Clinic (Phoenix) – Medical Departments and Centers
- Barrow Neurological Institute (Phoenix) – Centers and Programs
- Joseph’s Hospital (Phoenix) – Conditions Treated and Services
- Chandler Regional Medical Center – Conditions Treated and Services
- Banner Health – Conditions Treated and Services
- TMC Healthcare (Tucson) – Medical Specialties and Services
Government and Association Websites
- State of Arizona Website
- Arizona Department of Insurance – Homepage
- Arizona Department of Insurance – File a Complaint Against an Insurance Company
- Arizona Department of Insurance – Life and Disability Guaranty Fund FAQs
- National Association of Insurance Commissioners – Homepage
- National Association of Insurance Commissioners – Resource Center
- Arizona Judicial Branch Website
- Arizona Court Locator
- Arizona Court of Appeals
- Arizona Supreme Court
- United State District Court for the District of Arizona
- Ninth Circuit Court of Appeals