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By DL Law Group 15 Jan, 2022
ERISA stands for the Employee Retirement Income Security Act of 1974. It is a piece of federal legislation that governs employer-provided benefit plans. It sets up minimum standards that employers must adhere to when they offer their employees benefits. These standards include: Informing employees of their benefits packages Requiring that insurance providers and administrators follow strict policies for managing employee benefits Employees may receive legal recourse through federal court
By DL Law Group 06 Dec, 2021
Discovery is tedious, monotonous, boring, repetitive, time consuming and unexciting. Nevertheless, most victories at trial or good settlements depend on the quality of the discovery that takes place before. Plaintiffs’ firms are usually much smaller and have fewer resources than defense firms. Therefore, from a plaintiff’s perspective, much discovery is defensive-fending off the massive discovery requests. Plaintiff’s, however, are increasingly using discovery in a cost-effective and offensive manner.  For example, let’s say you file multiple claims in different cases or jurisdictions against the same corporate defendant. These often involve essentially the same or similar allegations. Thus, it makes little sense to depose the same witnesses over and over again. Likewise, where internal company documents are an important part of the litigation, it makes no sense to have to separately depose the custodian of records repeatedly in order to establish authenticity. In addition, many businesses face mergers and acquisitions. Unfortunately, this means litigants increasingly find that the company they thought they were suing has been acquired, merged with or sold to another entity. Often key officers and managers that were part of company number one, continue in their role with companies two or three. Attorneys may try to hide the ball on this issue. This is especially true if they are aware that a predecessor corporation or individual managing agents may have previously made damaging admissions.
By DL Law Group 26 Oct, 2021
Insurance benefits operate as a contract between the policyholder and the insurance company. The policyholder pays premiums over time in exchange for coverage later if needed. This contractual understanding leaves many individuals shocked when their claims later get denied . Insurance companies must weed out invalid claims to protect the insurance pool. However, they may also engage in bad faith tactics to intentionally deny valid claims. In this situation, the policyholder may file a bad faith lawsuit for damages . This option is only available to people with certain types of policies. Below, our insurance lawyers in San Francisco explain bad faith claims under ERISA. Individual Insurance Policies vs. Group Plans The type of insurance plan you have directly affects your options for disputing a bad faith denial. You should determine whether your plan is an individual policy or a group plan. An individual insurance plan is not purchased through a group or employer. Typically, individuals purchase individual policies if they are contract workers, self-employed or desire supplemental benefits. Individual insurance plans are subject to state laws, including laws about bad faith practices. Plans purchased through a group or employer , however, are subject to a federal law called ERISA. Within this law is a provision about preemption. Essentially, ERISA pre-empts, or trumps, any state laws about the benefit plan. This means that plans subject to ERISA do not play by the same rules as individual plans when it comes to bad faith claims. Can I File a Bad Faith Claim Under ERISA? While ERISA was initially designed to protect certain workers’ benefits, the law does not protect policyholders against bad faith. In other words, you cannot file a bad faith claim under ERISA. If ERISA governs your policy, then your options for overturning a denied claim differ in significant ways. Further, recoverable damages are significantly limited. ERISA damages only include the amount owed under the insurance contract, and sometimes attorney’s fees. An insurance company is not punished for getting caught denying a group policy claim in bad faith. They must pay out what they should have paid out originally. Can I File a Bad Faith Claim Under an Individual Policy? State laws cover individual policy claims for a breach in contract. This means states can hold insurance companies accountable for engaging in bad faith practices in regard to a contract. Damages awarded in these cases may include: Punitive damages Attorney’s fees Awards for other costs Prejudgment interest Secure Your Insurance Benefits With Help From a San Francisco ERISA Attorney While pursuing a bad faith claim under ERISA is not possible, you still have options . Your best bet for overturning a denied claim is to work closely with an experienced ERISA attorney. After a denied claim, your next step is to appeal the decision, but the appeals process is also subject to ERISA. The appeals process is your very last chance to submit new evidence for your claim. If your appeal fails, then you can sue the insurance company, but your suit cannot introduce new evidence. For this reason, you will want an experienced San Francisco ERISA attorney on your side. Schedule a free consultation with us to learn more about DL Law Group’s legal services. You can contact us by phone at (888) 910-3980 or through our online messaging porta l .
By DL Law Group 23 Jul, 2021
ERISA long-term disability insurance claims are denied for many different reasons . However, this does not mean the insurance company is right. If your ERISA claim has been denied, you have the right to appeal the insurance company’s decision. But, you should move quickly. ERISA plans only allow you 180 days to file a denied claim appeal. Below, our ERISA attorneys explain the ERISA appeals process. ERISA Appeals Process If your ERISA long-term disability claim is denied, you must file an internal appeal with your insurance company before you challenge the decision in court. Generally, you have 180 days to file an appeal. It is critical that you make this deadline. If you miss your deadline, you may lose your chance to recover benefits. Your insurance company must provide you with an electronic or written letter of denial. This letter should provide you with information about why your claim was denied based on your plan and evidence submitted. You may also request any relevant information from your insurance company about your claim. Before you begin the ERISA appeals process, you should consult with an experienced ERISA lawyer . Your attorney can help you: Review and understand your insurance company’s denial of your claim Gather any necessary and/or additional evidence for your appeal Ensure that you do not miss important filing deadlines File a comprehensive appeal on your behalf After you file the appeal, you cannot submit any new evidence if your case goes to federal court. If your case goes to court, there will not be a jury. A judge will review your initial claim and your appeal before making a decision about your benefits. Because of this, it is critical that your appeal is robust and contains as much evidence as possible. Keep in mind that some plans require two appeals with your insurance company before you can file a lawsuit. Once you exhaust the appeals process, and if your claim remains denied, then you may bring an ERISA lawsuit to seek your long-term disability insurance benefits. How Our San Francisco ERISA Lawyers Help Our Clients Our San Francisco ERISA attorneys are dedicated to helping our clients obtain the benefits that they need and deserve. We provide a full range of services surrounding ERISA claims, including: Applying for benefits Appealing claim denials Appealing benefits termination Litigation We handle ERISA cases on a contingency fee basis. This means that you do not pay any legal fees until we are successful on your behalf. Contact Our Experienced Lawyers About Your Denied ERISA Claim If your ERISA long-term disability claim has been denied, we encourage you to reach out to our lawyers. We have extensive experience helping Californians appeal ERISA claim denials. We can answer any ERISA-related legal questions you may have and determine how we may be able to help you. Schedule a free consultation with us to discuss your situation by calling us at (888) 910-3980 or filling out our online contact form .
By DL Law Group 19 May, 2021
Collecting long term disability benefits is never easy. Yet, the recent coronavirus outbreak in San Francisco and across the country has made it even more challenging. Are you wondering what will happen to your benefits during this global pandemic? Are you concerned that you will not meet the insurance company’s deadlines? Are you worried you will not have time to appeal a denial? During this uncertain time, disabled individuals need help now more than ever. The status of your LTD benefits is up in the air at a time when receiving those benefits is more important than ever. That is why you need an experienced disability insurance attorney on your side. Your attorney can look out for your rights during this pandemic and beyond. The Coronavirus and Long Term Disability Benefits The coronavirus, also called COVID-19, is raging across the country. To slow the spread of this virus, businesses and companies have closed. Major disability insurance companies are no exception. Many of their employees now work from home. This has resulted in some disruptions to their efficiency and productivity. As a result, you may not collect the benefits you need. If you have concerns about how the coronavirus will impact your long-term disability benefits, there are things you can do. First, consult with your own LTD insurance carrier. Many insurers recently updated their websites. These sites now contain valuable information on the coronavirus and its impact on their claims process. Receiving Disability Benefits Claim Payments The coronavirus should not impact your insurer’s financial ability to meet benefit claim payments. Most companies rely on automated payments to deliver benefits to recipients. As such, this process should remain unchanged during this time. Many insurers vowed to maintain continuous operations during this pandemic. This starts with continuing automatic payments. Disability Claims Processing New claims might see a delay in processing during this time. Even though insurers and their employees have remote work set-ups in place, you could see longer wait times. Disability claims administrations often rely on active personnel participation. As such, approving or denying claims may take longer than usual. Completing Forms for Insurers If you have forms to complete for your insurer, such as a medical record or follow-up, do not worry. Many physician’s offices are only accepting emergency cases. Dealing with disability paperwork does not qualify as an emergency. If you received forms in recent weeks, it is important to speak to an experienced disability insurance attorney. Your attorney can request the necessary extensions you need to complete the forms. You may need a significant extension of 90 days to get through this pandemic. Contact a Disability Insurance Attorney in California At the DL Law Group, our San Francisco disability insurance lawyers are here for you during this difficult time. We know that the coronavirus pandemic impacts everyone, but especially those with disabilities. You may not receive your long term disability benefits when you need them. If you find your claim denied or have trouble collecting LTD benefits, we can help. Call us at (888) 910-3980 or fill out our confidential contact form for more information. We offer free consultations and can meet with you remotely during this time.
By DL Law Group 29 Mar, 2021
Explained By Our Insurance Bad Faith Lawyers In San Francisco Insurance companies have an essential function in our society. We depend on insurance companies to reimburse us when we are sick or when we suffer property damage. When we pay our monthly premiums to insurance companies, we rightfully expect our policies will be there to offer a helping hand when we need them most. Unfortunately, insurance companies do not always fulfill their contractual obligations. As experienced insurance bad faith lawyers, we know that insurance companies routinely deny valid claims . Insurance bad faith is against California state law. You may be able to hold insurance companies accountable for bad faith. What Is Insurance Bad Faith? There is no universal definition for insurance bad faith . States have varying insurance laws. However, insurance bad faith cases generally involve insurance companies who engage in unfair or unreasonable business practices. Denying valid claims is an example of insurance bad faith. When an insurance company breaches its duty of good faith during the claims process, it is a violation of California state law. There are a few elements to a bad faith claim: The insurance company withheld benefits under the policy. However, you must demonstrate that you had a valid claim and that the insurance company still denied the claim. The insurance company did not have a sufficient reason for denying benefits. If the insurer did not act within reason when denying your claim, then it may be insurance bad faith. Possible examples of insurance bad faith may include: An insurer that engages in deceptive business practices. An insurance company that fails to respond to a valid insurance claim. An insurance company that fails to provide justification for denying a claim. Each case is going to be different. We strongly encourage you to contact our insurance bad faith attorneys for a free consultation. We can help you determine if insurance bad faith occurred under California law. How to Prove Insurance Bad Faith It goes without saying that you should have a good understanding of how your insurance policy works. Consider reading the fine print. Some attorneys will even help you understand your insurance policy as a service. You should make sure that what you are requesting a claim for is covered by your insurance policy. The additional tips below may help with an insurance bad faith claim in California. Keep detailed records. Keep records of all communication with your insurance company. Every phone call, every email, every voicemail. Make sure you have information such as who you spoke with, what was discussed and what time the conversation took place. Be sure to write down this information. Appeal the denial. You can appeal a denial from your insurance company. Your provider must adhere to strict procedural rules during the appeals process. You can also send a demand letter to the insurance provider. File a bad faith complaint. You should also consider hiring a lawyer to file an insurance bad faith claim. An insurance bad faith lawyer can make sure your claim is properly filed and can review the available evidence. Can You Sue an Insurance Company for Bad Faith? It depends. Our San Francisco insurance bad faith attorneys can help you review your possible legal options. We can help you determine which steps you would need to take to file an insurance bad faith lawsuit in California – or if it would even be an option. Contact Our Insurance Bad Faith Attorneys in San Francisco for a Free Consultation DL Law Group can help if you want to learn more about legal options for resolving insurance bad faith. Contact us if you have questions about how to prove insurance bad faith. You can contact our San Francisco insurance bad faith lawyers for a free consultation by dialing (888) 910-3980 or by using the case review form on our site .
By DL Law Group 02 Dec, 2020
The Article Discusses Issues Mental Health Practitioners Have With Health Insurance Companies Mental health problems affect millions of Americans across the country. Major depression, substance abuse disorders, mood disorders and psychosis are an everyday reality for many Americans and their families. Despite living in a country with advanced health care options, many people living with a mental illness struggle to afford care. It would be easier for them to access mental health services if insurance companies stopped creating barriers for patients and providers. The Mighty , a community and publisher for people facing health challenges, featured attorney Katie Spielman of DL Law Group. In the article, which discussed parity issues with mental health coverage , Katie discussed the burden many mental health patients and their providers face due to a broken health care system that favors insurers. Many patients struggle to get insurance claims approved. Mental health practitioners suffer financially and professionally as a result of issues with insurance coverage. Mental Health Parity and Issues Providing Mental Health Services In 2008, federal lawmakers passed a mental health parity law that required insurance companies to provide equal benefits for physical and mental health. Mental health parity expanded when the Patient Protection and Affordable Care Act went into effect. The Patient Protection and Affordable Care Act, signed into law by Barack Obama in 2010, also made mental health and substance abuse treatment essential health benefits. Despite these federal laws, mental health services remain out of reach for many patients. In California, which has the highest rate of unmet mental health needs in the United States, many patients have to pay out of pocket for services. An estimated 42 percent of California mental health practitioners do not accept insurance. This is not the fault of mental health practitioners, but insurance companies who often refuse to allow more providers into their network. There are also numerous problems associated with being an in-network practitioner. Due to high out-of-pocket expenses, patients may be unable to pay practitioners for mental health services. Even in cases where insurance companies cover services, the amount and rate of reimbursement is often not enough to cover overhead expenses for running a private practice. When mental health practitioners accept insurance, many have issues getting claims to go through. It is not uncommon for practitioners to remain unpaid. Despite being required by law to provide equal access to mental and physical health, it is generally difficult to hold insurers legally accountable for the numerous parity issues facing patients and practitioners. We Help Californians Fight Health Insurance Companies Mental health parity issues affect millions of Americans, especially here in California. We strongly encourage you to read The Mighty’s article on this issue to learn more. If you have questions about how to resolve issues with an insurance company who wrongly refuses to provide mental health coverage , then please give us a call at (888) 910-3980 or use the contact form on our site.
By DL Law Group 09 Nov, 2020
Our San Francisco ERISA Attorneys Explain the Differences Life after an illness or injury can be far more difficult. For some people, the prospect of working at a regular job is no longer possible. Some people may purchase disability insurance to cover a portion of their expenses should they become ill or seriously injured. In other cases, employers may offer disability insurance for these purposes. Insurance companies are primarily concerned with making money. Unfortunately, this means an insurance company may unfairly deny a disability claim when you need it most. Your options for appealing a denied claim may vary depending on whether your policy is privately held or offered through an employer. Employer-based insurance policies fall under ERISA’s umbrella. ERISA, also called the Employee Retirement Income Security Act of 1974, is a federal law that covers benefits packages offered by employers. If you have a private plan that you purchased on your own, then ERISA would not come into play during the appeals process. ERISA Disability Appeals and Bad Faith If you have a long-term disability insurance policy through your employer, chances are ERISA will come into play should you have to go through the claims appeals process . You have the right to file an appeal if your policy carrier denies your claim . Depending on the circumstances, you may be able to appeal the carrier’s decision. If your injury occurred due to your job duties, then you have to go through your employer’s workers’ compensation carrier instead. Insurance companies may wrongfully deny your claim through a process called “bad faith.” If your employer’s carrier is guilty of insurance bad faith, then you may be unable to file a bad faith claim. ERISA is a federal law that does not protect policyholders against bad faith. Since it is a federal law that trumps California state laws on bad faith, you may have much more difficulty recovering what you are owed under the policy. Even if you succeed in appealing the denied claim, the insurance carrier only has to pay what they should have paid out originally. You would be unable to recover damages caused by the bad faith denial. You can learn more about ERISA policies and bad faith on our website. Private Disability Insurance and Bad Faith If you have a disability insurance policy that you purchased privately, you have more options during the appeals process. California law governs private insurance policies, so restrictions on insurance bad faith apply. If your carrier denies a claim in bad faith and attempts at appealing the denial are unsuccessful, then you may be able to hold the carrier accountable for a breach of contract. Unlike with an ERISA policy, you could recover what the carrier owes you under the policy and additional damages from the bad faith claim. Our San Francisco bad faith attorneys can help you determine whether it is possible to sue an insurance carrier for a breach of contract. Contact Our San Francisco ERISA Attorneys to Learn More Questions about appealing a disability claim? We encourage you to contact DL Law Group for a free initial consultation. We can explain your potential options for appealing the claim. To schedule a consultation with us, dial (888) 910-3980 or use the contact form on our site .
By DL Law Group 28 Jul, 2020
There are many reasons why an insurance company could deny your disability claim. The most common reason is that you lack sufficient medical evidence proving your disability . Other common reasons for denying a disability claim include: Improperly completed claim forms Failure to comply with an independent medical examination Being uncooperative during the application process Not following your doctor’s prescribed treatment Insurance companies must act in good faith under the law. This includes engaging in fair claims practices. However, insurance companies want to make as much profit as possible. They may choose to deny your valid disability claim. They may also choose to pay a lower amount than what your claim is worth. If this is the case, then you should consult with a San Francisco disability benefits attorney. He or she can help you appeal your disability claim denial. Additionally, you may have the option of filing a California bad faith lawsuit. What Percentage of Disability Appeals Are Approved? Only a small percentage of disability appeals (around 10-15 percent) result in an approval. If the insurance company denied your disability appeal, then you should consult with an experienced attorney immediately. He or she will know the laws in California about bad faith insurance practices . You may discover that you have the option of filing a California bad faith lawsuit. How Do I Sue an Insurance Company for Bad Faith? Are you looking to file a California bad faith insurance lawsuit? If so, then it is important to know which type of insurance policy you have. Most people receive disability insurance through an employee group disability plan . In this case, you will need to exhaust the appeals process before suing your insurer for bad faith. However, you may receive disability insurance through an individual plan. In this case, you may have more options available to you. A San Jose disability benefits lawyer can review your individual policy to determine the best path forward for your case. He or she can help you through each phase of your bad faith insurance claim in California. This includes launching an investigation into your claim. It also includes negotiating with the insurance company and engaging in litigation efforts when necessary. Contact Our San Francisco Disability Benefits Attorneys Was your disability claim appeal denied? Do you believe your insurer acted in bad faith? If so, then you could receive a number of potential remedies. This includes the benefits owed to you under your policy plus interest. However, it could also include a number of other bad faith damages. Our San Francisco disability benefits attorneys can review your situation to determine which remedies are available for your particular case. At DL Law Group , we are committed to helping disabled people get the insurance money they deserve. Contact us today at (888-910-3980) to schedule a free consultation. You can also reach out to us by completing the form on our contact page. We look forward to discussing your situation.
By DL Law Group 21 Jun, 2020
Millions of disability insurance policies were sold to psychiatrists, surgeons, and other medical professionals during the 1980s and 1990s. At that time, interest rates were high, and insurance companies were guaranteed high returns on the billions of premium dollars these contracts generated. Now that interest rates have plummeted, some insurers are looking for what one company’s former medical director characterized as “any pretext or excuse for denying a claim or cutting someone off.” Disabled insureds and their patients need to learn what to expect and how to protect themselves against such practices. Definition of "Total Disability" Most “own-occupation” policies define total disability as the inability to perform the material and substantial duties of the insured’s regular occupation at the time disability began. In most states, this definition is met when an insured becomes unable to perform his or her material and substantial duties “in the usual and customary fashion and with reasonable continuity.” An insured’s ability to perform some of her prior occupational tasks does not necessarily disqualify her from receiving total disability benefits. Insurance Company Tactics Definition of “Occupation” Insurers may try to redefine a claimant’s occupation to deny coverage. A favorite insurer tactic is to assert that an insured had more than one occupation and that while disabled from one, he can still perform the material and substantial duties of another. In one case, Berkshire Life claimed that a professional musician who referred occasional overflow work to colleagues was not a musician but a musician/booking agent. Therefore, reasoned Berkshire, its insured – although disabled from playing her instrument – was not disabled from her occupation because she could still work as a booking agent. In another case, Paul Revere denied total disability benefits to a court reporter with permanent injuries to her hands and wrists. Although the insured could no longer take transcription in Court, the insurer reasoned that she was not totally disabled as a court reporter because she could still perform one of her prior duties, namely proofreading or “scoping.” Similarly, UnumProvident has argued that a chiropractor who could no longer perform the forceful manipulations her job required was not totally disabled because she could still do the bookkeeping for her practice. Contesting The Treating Doctors: Another common insurer tactic is to contest treating physicians’ opinions. Insurers will send an insured’s medical records to one of their in-house consultants or to an outside “independent” medical examiner. These doctors will often create reasons for disagreeing with the treating doctors. They will contest the medical findings, characterize the diagnosis as based on subjective considerations, or otherwise disagree with the conclusions of those treating the claimant. The claim is then denied or terminated and the file closed. Functional Capacity Issues: Another tactic is to send the insured to a functional capacity evaluation, a procedure where the claimant is observed performing tasks claimed to mimic the duties required in the insured’s own occupation. If the claimant can either perform the tasks for an hour or two, or is viewed by the examiner as intentionally under-performing them, the company then uses the results to cut off the claimant’s benefits. These are just some of the tactics one can expect once one files a disability claim. Others include asserting that there was a “material omission or misrepresentation” made by the insured on the application; claiming that a word or phrase in the policy means something other than what it says; sending private investigators to interview former spouses; and videotaping the insured. There are currently thousands of cases pending against Berkshire Life, Paul Revere, UnumProvident, and other disability insurers. These cases – typically filed by court reporters, medical doctors, and other professionals – usually charge that a company is engaging in fraudulent, unfair, deceptive, and bad faith practices in order to boost its bottom line. Confidential industry documents and deposition testimony strongly support these allegations. Nevertheless, the bad conduct continues. Immunity from prosecution under certain federal laws (such as ERISA), lax enforcement by insurance regulators, indemnity agreements between corporate CEOs and their companies, and the absence of significant financial disincentives operate to encourage rather than to deter such conduct. The bottom line is that if you, or a patient, have an own-occupation disability claim, you need to be careful and prepared to protect yourself. If you have additional questions you can go to www.bourhis-wolfson.com for assistance, or call 1-800-264-2082. *Bourhis & Wolfson is a national law firm specializing in disability bad faith insurance matters. Our office has obtained federal court injunctions, unanimous jury verdicts, punitive damage awards, seven figure settlements, and appellate decisions. In additional, our work has been featured on 60 Minutes, Dateline, the Wall Street Journal, and hundreds of newspapers across the Country.
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