North Carolina Disability Insurance Claims

We are a healthcare/professional disability insurance law firm with a national reputation for obtaining successful results for our clients. Our firm has represented physicians, dentists, lawyers, executives and other professionals throughout the country, with the goal of securing and protecting their entitlement to benefits on own-occupation disability insurance policies.

We consult with physicians, dentists, attorneys and business executives filing disability claims throughout North Carolina, including the Charlotte, Raleigh, and Greensboro areas. If you’d like to discuss your particular claim with our attorneys, we are happy to set up a free consultation.

Below are some resources for policyholders filing disability insurance claims in North Carolina. If you would like to learn more about the disability claim process or insurance bad faith in other states, please visit our homepage.

Does North Carolina Recognize Insurance Bad Faith?

The Supreme Court of North Carolina has not provided much recent guidance in the area of first-party disability insurance bad faith, but in the past has shown a tendency to recognize restraint in this area.

For example, in Newton v. Standard Fire Ins. Co, the Supreme Court of North Carolina stated “[w]e are slow to impose upon an insurer liabilities beyond those called for in the insurance contract” and concluded that “[t]o create exposure to such risks except for the most extreme circumstances would . . . be detrimental to the consuming public whose insurance premiums would surely be increased to cover them.” Newton v. Standard Fire Ins. Co., 291 N.C. 105, 115-16, 229 S.E.2d 297, 303-04 (1976) (internal citations omitted).

However, at the same time, the Supreme Court of North Carolina did note that “because of the great disparity of financial resources which generally exists between insurer and insured . . . we recognize the wisdom of a rule which would deter refusals on the part of insurers to pay valid claims when the refusals are both unjustified and in bad faith.” Id. The Court then suggested that punitive damages might be appropriate in some circumstances, but determined that question was not before them in this case. Id.

More recently, when looking at insurance claims more broadly, the Supreme Court of North Carolina has evaluated insurer conduct in the context of North Carolina’s Unfair Claim Settlement Practices Act and has instructed that “where a party engages in conduct manifesting an inequitable assertion of power or position, such conduct constitutes an unfair act or practice.” Gray v. N. Carolina Ins. Underwriting Ass’n, 352 N.C. 61, 68, 529 S.E.2d 676, 681 (2000) (internal citations omitted).

In the same opinion, the Supreme Court of North Carolina also cited with approval a federal district court that concluded that “[f]ailing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies” and “[n]ot attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear” are practices that “could support a finding of unfair or deceptive acts or practices under Chapter 75.” Id.

Interestingly, the Supreme Court of North Carolina then went on to hold that “[a] n insurance company that engages in the act or practice of ‘[n]ot attempting in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear,’ also engages in conduct that embodies the broader standards of N.C.G.S. § 75-1.1 because such conduct is inherently unfair, unscrupulous, immoral, and injurious to consumers.” Id.

The case excerpts above are not meant to be a comprehensive discussion of each state’s first-party bad faith or disability insurance law. They are merely meant to act as a resource/starting point for those interested in learning more about how insurance bad faith works in their state.

You should always speak with an attorney before making any legal arguments relating to your disability claim.

Notable North Carolina Disability Insurance Cases

Duke v. Mut. Life Ins. Co. of New York, 286 N.C. 244, 210 S.E.2d 187 (1974) (North Carolina railroader filed for disability after an injury to his left knee culminating in the removal of his kneecap; the disability company initially made payments but then terminated the policyholder’s disability benefits after a gap in treatment appointments with his doctor; the court determined that “when need for care and attendance ceased, the coverage ceased, according to the plain language of the policy” and upheld the dismissal of his lawsuit).

Walsh v. United Ins. Co. of Am., 265 N.C. 634, 144 S.E.2d 817 (1965) (North Carolina farmer filed for disability benefits due to osteoarthritis, hypertensive cardiovascular disease, anxiety and depression; the disability policy had a “continuous confinement” disability provision that required “continuous confinement within doors and regular and personal attendance by a licensed physician, surgeon, osteopath or chiropractor”; the disability insurance company learned that he had made trips to Virginia Beach and Myrtle Beach; even though this was encouraged by the treating doctor to help with the depression and arthritis, the insurance company strictly interpreted the “within doors” requirement and terminated benefits; the court determined that the provision allowed for trips to the doctor “for treatment which cannot be administered in the house of the insured” but that the trips to the beach disqualified him from benefits under the policy).

Common Disability Claim Questions

What should I expect when filing a disability claim?

What issues am I most likely to face handling my disability insurance claim alone?

Why are disability insurance claims made by physicians, dentists and other professionals especially targeted for denial or termination?

My disability claim was just denied. What should I do now?

What can my insurance company do when it is investigating my claim?

Do insurance companies conduct surveillance and, if so, when are they watching?

Why does my insurer want to conduct a field interview?

How can I tell if I have a true own-occupation policy?

What are the different types of disability policies?

North Carolina Federal District Court Locations

Professional disability claims are often filed in, or removed to, Federal Court given the amounts in controversy. When we work with local counsel to be admitted pro hac vice, we identify the courthouse that is closest to you. Below is a list of the primary Federal Courthouses in North Carolina, but there may be satellite courthouses that are closer to where you live.

Raleigh. 310 New Bern Avenue, Raleigh, NC 27601.

Fayetteville. 301 Green Street, 3rd Floor, Fayetteville, NC 28302.

Greensboro. L. Richardson Preyer Courthouse, 324 W. Market Street, Greensboro, NC 27401.

Charlotte. Charles R. Jones Federal Building, 401 W. Trade Street, Room 1200, Charlotte, NC 28202.

Who Do Your Disability Insurance Attorneys Represent?

The lists below provide a representative overview of the types of professionals we represent, the disability companies we file claims with and litigate against, and a non-exhaustive list of some of the disabling conditions our prior clients have had.

Professionals

Physician Claims & Resources | Dentist Claims & Resources

Disability Insurance Companies

Disabling Conditions

The information provided above is offered purely for informational purposes. It is not intended to create or promote an attorney-client relationship, and does not constitute and should not be relied upon as legal advice.

Every claim is unique and the discussion above is only a limited summary of information that may be relevant to your claim. An experienced disability insurance attorney can help you assess your particular disability claim, or potential disability claim, and determine what options are available to you.

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