Experienced Bad Faith Insurance Attorneys Serving Clients in Los Angeles, CA
Long-term disability insurance should provide peace of mind, and the knowledge that you will be entitled to monthly income replacement benefits should you develop a disabling illness or injury. Sadly, however, the wrongful delays and unreasonable denials that are common in the long-term disability insurance industry mean this isn’t always the case. Suppose you’re based in Los Angeles and you’re concerned that your insurance carrier has mishandled a claim on your individually purchased long-term disability insurance policy. In that case, you should consider working with a specialist Los Angeles insurance bad faith lawyer.
What Does a Los Angeles Insurance Bad Faith Lawyer Do?
At DarrasLaw, our attorneys specialize in cases related to long-term disability insurance claims. Where these claims arise from individually-purchased policies, we challenge unreasonable delays or denials under the legal doctrine of bad faith.
In simple terms, an insurance company has acted in bad faith when it has not fulfilled its contractual obligations to you, the policyholder. A bad faith breach of contract can occur in several ways, including:
- Using misleading or false information to deny a claim.
- Failing to promptly begin paying monthly benefits.
- Denying a valid claim without first undertaking a proper and thorough investigation.
- Using high-pressure tactics to persuade you to accept a less favorable claim settlement.
When you succeed in a Los Angeles insurance bad faith lawsuit or negotiation, you generally become entitled to the monthly benefits your insurer had initially denied, along with any benefits payments you should have received in the period leading up to the settlement. You may also be entitled to general damages for any emotional distress you had to deal with because of your insurer’s wrongful delay or denial of your claim. Additionally, a court may order the defendant to reimburse you for legal fees and any other expenses you incurred because of your legal action, as well as order punishment damages.
Does ERISA Apply to Bad Faith Insurance Litigation?
The Employee Retirement and Income Security Act of 1974 (ERISA) governs many types of employer-sponsored benefits, including long-term disability insurance. The federal legislation sets out a strict set of requirements when it comes to dispute resolution in relation to employer-sponsored long-term disability insurance policies.
So, if your policy is employer-sponsored, you may not be able to file a bad faith insurance lawsuit to challenge an adverse benefit determination unless you work for the government, a public school, or a church. However, our lawyers also deal with Los Angeles ERISA cases, so we can help you either way.
You should note that there are some limited exceptions to the application of ERISA rules to employer-sponsored disability policies. For instance, if you work solely with another partner, the legislation may not apply in your case.
Your Entitlement to Long-Term Disability Insurance Benefits
There’s more to the long-term disability insurance claims process than simply telling your insurance company you’ve developed a disability and waiting for your monthly check.
Firstly, you need to prove you have a disabling condition. This requires you to go to your physician and have them confirm that your illness or injury satisfies the definition of disability set out in your policy.
These definitions vary from policy to policy, as we explain in more detail below.
Additionally, your physician will have to administer the most medically appropriate course of treatment for your condition. Your insurance company may require you to verify that you’re undergoing the prescribed treatments and therapies. It may also seek regular updates about your condition and your response to treatment.
Finally, the elimination period (also known as a waiting period) on your policy must expire before you can file a claim successfully. These periods begin to run on the day you sustain your disabling illness or injury, not the day you file your claim.
What Are the Definitions of Disability?
There are two major disability definitions in long-term disability insurance policies; “own occupation” and “any occupation.”
“Any occupation” policies regard you as disabled once you can no longer do the essential duties associated with any job for which you are suitable in terms of training, education, and previous earnings. These terms are more affordable when it comes to premiums, and are common on employer-sponsored policies.
An “own occupation” definition of disability views you as disabled once you cannot do the essential tasks of the role you had directly before your claim. Certain “own occupation” policies let you work in another job other than the role you had before you became disabled while keeping the full amount of your monthly benefits.
Disability Statistics in Los Angeles
Official statistics from 2021 revealed there were over 992,000 individuals living with a disability in the Los Angeles area, with disabled people accounting for 9.9% of the population of Los Angeles County.
In the entire state of California, there are 6.7 million adult residents living with a disability of some kind, according to data from the Centers for Disease Control and Prevention (CDC). Cognitive and mobility-related conditions are the most prevalent reasons for disability in the state.
Getting the Right Kind of Legal Representation in Your Corner
Whether by negotiating a fair settlement with your long-term disability insurance company or taking your case all the way to court, only a top-rated Los Angeles insurance bad faith lawyer can secure the full compensation you deserve after a wrongful delay or denial of your monthly benefits.
Contact DarrasLaw today to start fighting your case. We’ll provide an initial consultation free of charge, including policy analysis, claim assistance, or appeal analysis.