Disability Insurance

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What Is Disability Insurance and What Does It Typically Cover in San Francisco? 


Disability insurance is a critical safety net for individuals who can no longer work due to illness or injury. It’s meant to replace a portion of your income when your health prevents you from performing the essential duties of your job. But in reality, getting the benefits you’re entitled to is often far more difficult than it should be, especially in complex urban centers like San Francisco, where high costs of living and demanding professional roles can make disability issues even more financially and emotionally stressful. 

   

At DL Law Group, we help clients throughout San Francisco and the Bay Area fight back against delayed, denied, or underpaid disability insurance claims. With a deep understanding of the insurance industry and local employer practices, we are uniquely equipped to advocate for individuals facing disability-related hardships. 

 

What Is Disability Insurance? 

Disability insurance provides income replacement when you become unable to work due to a disabling medical condition. It protects your financial stability while you focus on recovery and treatment. 

 

There are two main types of disability insurance: 

1. Short-Term Disability (STD) 

  • Covers a portion of your income for a few weeks to several months 
  • Typically begins after a short waiting (elimination) period 
  • Often used for recoverable conditions like surgery recovery, injuries, or pregnancy complications 

   

2. Long-Term Disability (LTD) 

  • Covers long-term or permanent disabilities 
  • Kicks in after STD benefits expire or after a 90–180 day elimination period 
  • Meant for serious illnesses, chronic pain, mental health conditions, or progressive diseases 

   

You may receive coverage through your employer's group benefits plan, purchase it individually, or, in some cases, qualify through federal programs like Social Security Disability Insurance (SSDI). 

   

In San Francisco, where many professionals work in high-demand industries such as tech, healthcare, law, finance, and education, the pressure to keep working can be intense, even when health issues arise. That’s why knowing how disability insurance works (and what to do when a claim is denied) is essential. 

 

What Does Disability Insurance Typically Cover? 

Disability insurance is not about covering medical costs; it’s about replacing lost income. To receive benefits, your condition must prevent you from doing your job or, in some policies, any job based on your education, training, and experience. 

 

Conditions commonly covered by disability insurance include: 

  • Musculoskeletal conditions (e.g., back injuries, herniated discs, arthritis) 
  • Neurological disorders (e.g., multiple sclerosis, Parkinson’s, epilepsy) 
  • Chronic fatigue or fibromyalgia 
  • Cancer and side effects of treatment 
  • Cardiovascular disease or complications after surgery 
  • Serious mental health issues (e.g., depression, anxiety, PTSD, bipolar disorder) 
  • Autoimmune diseases (e.g., lupus, Crohn’s, rheumatoid arthritis) 

   

Precise terms govern disability policies, and insurers often interpret those terms narrowly to avoid paying. In particular, mental health conditions and invisible illnesses are more likely to be scrutinized or denied, even in progressive areas like San Francisco. 

 

Policy Limitations and Exclusions 

Many policies include built-in limitations that may reduce or deny benefits under specific conditions, such as: 

  • Mental health conditions (often capped at 24 months of benefits) 
  • Substance abuse-related disabilities 
  • Pre-existing conditions not disclosed on the application 
  • Self-inflicted injuries or injuries resulting from illegal activity 

   

Knowing precisely what your policy says and how insurers use that language to avoid paying is crucial. 

 

The Disability Claim Process 

To file a disability claim, you'll need to: 

  • Notify your insurer of your disability 
  • Submit claim forms describing your condition and job duties 
  • Provide supporting medical records, doctors' statements, and sometimes undergo an independent medical exam (IME) 
  • Wait for the insurer’s decision 

   

Insurers often demand excessive documentation, delay decisions, or reject claims citing lack of "objective evidence", especially for mental or chronic pain-related claims. 

   

In San Francisco, where healthcare providers are often overbooked and medical costs are high, obtaining timely and complete medical documentation can be a challenge in itself and one that insurers may exploit. 

 

Common Reasons Disability Claims Are Denied 

Despite having a legitimate disability, many claims are denied due to: 


  • Alleged lack of medical evidence, even when your doctor confirms your disability 
  • Disagreements over your ability to perform “any occupation” 
  • Surveillance videos or social media used out of context to undermine your claim 
  • Disputes about whether you meet your policy’s definition of “disabled” 
  • Claims that you failed to meet deadlines or follow policy procedures 
  • Assertions that your condition is excluded due to a pre-existing condition clause 


In our work across San Francisco, we've seen tech workers, teachers, healthcare professionals, and small business owners denied benefits unjustly despite years of paying premiums. The system is tilted in favor of insurers, and claimants often don’t know how to fight back. 

 

ERISA and Individual Policies: What’s the Difference? 

Many disability insurance claims in San Francisco are governed by ERISA (Employee Retirement Income Security Act), especially if coverage was provided through an employer. 

   

ERISA claims involve: 

  • Strict deadlines, typically 180 days to appeal 
  • Limited discovery rights 
  • No jury trials 
  • Courts often favor the insurer unless legal errors are proven 

   

If your disability insurance is privately purchased, your claim may fall under California state law, which allows for: 

  • Jury trials 
  • Broader bad faith damages 
  • More favorable policyholder protections 

   

At DL Law Group, we handle both ERISA and individual policy claims, tailoring our legal strategy to the type of policy and applicable law. 

 

How DL Law Group Helps San Francisco Disability Insurance Policyholders 

At DL Law Group, we represent individuals throughout San Francisco and California who are navigating the complexities of short-term and long-term disability insurance claims. Whether you’re filing a claim for the first time or appealing a wrongful denial, our team is here to provide expert guidance and aggressive advocacy every step of the way. 

   

We handle: 

  • Initial claims and paperwork to reduce the risk of denial 
  • Administrative appeals, particularly for ERISA-governed group policies 
  • Bad faith litigation occurs when insurers act dishonestly or unreasonably 
  • Complex claims involving mental health, chronic illness, or invisible disabilities 
  • Cases involving professionals in demanding fields, such as physicians, engineers, executives, teachers, and tech workers 

   

Our deep understanding of San Francisco’s unique employment culture and healthcare network allows us to tailor our strategies specifically for local clients. We recognize that tech professionals, for example, often face policies that limit coverage for stress-related or cognitive impairment conditions increasingly targeted by insurers seeking to deny claims. 

   

With decades of experience handling disability insurance disputes, we offer: 

  •  Aggressive representation at all stages from initial claim through litigation 
  • Clear communication and compassionate, client-focused service 
  • A no recovery, no fee policy, meaning you pay nothing unless we win your case 

   

We know how insurance companies operate and how to hold them accountable, fighting to ensure you receive the benefits you deserve. 

 

Denied or Delayed Disability Benefits in San Francisco? Contact Us Today 

If your disability insurance claim has been denied, delayed, or underpaid, don’t face the insurance company alone. Call us today or fill out our online form for a free consultation. We’ll review your policy, explain your rights, and take immediate action to protect your income, your health, and your future. 

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Consultations are FREE! No fees unless the case is won.

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Why Choose DL Law Group?


At DL Law Group, we understand that when your insurance claim is wrongfully denied, it’s more than just a legal issue, it’s personal. Below are the key benefits we offer our clients because you deserve more than just representation. You deserve a legal team that listens, stands up to powerful insurance companies, and puts your needs first every step of the way. 


Leaders in Insurance Law 

We’ve built a strong reputation as experts in handling complex insurance bad faith cases and serving as trusted ERISA advocates. With a deep understanding of evolving insurance laws and years of focused experience, we deliver results that set us apart in the legal community. 


Powerful Resources 

We are aware of the tactics insurance companies employ to delay or deny valid claims. DL Law Group brings the legal firepower, experienced staff, and financial strength needed to level the playing field. 


Trusted Reputation 

We are well-respected throughout the legal and insurance communities. Judges, opposing counsel, and insurance carriers recognize our name and know we don’t back down. 


Client-Centered Advocacy 

Our clients often tell us we made a lasting difference in their lives. At DL Law Group, we combine legal excellence with genuine compassion. When we take your case, it’s because we believe in it. You can count on us to fight relentlessly for the justice you deserve. 


Leaders in Insurance Law 

We’ve built a strong reputation as experts in handling complex insurance bad faith cases and serving as trusted ERISA advocates. With a deep understanding of evolving insurance laws and years of focused experience, we deliver results that set us apart in the legal community. 


Client-Centered Advocacy 

Our clients often tell us we made a lasting difference in their lives. At DL Law Group, we combine legal excellence with genuine compassion. When we take your case, it’s because we believe in it. You can count on us to fight relentlessly for the justice you deserve. 


Trusted Reputation 

We are well-respected throughout the legal and insurance communities. Judges, opposing counsel, and insurance carriers recognize our name and know we don’t back down. 


Powerful Resources 

We are aware of the tactics insurance companies employ to delay or deny valid claims. DL Law Group brings the legal firepower, experienced staff, and financial strength needed to level the playing field.