Experienced ERISA
& Insurance Attorneys
"WE ARE ATTORNEYS EXPERIENCED IN FIGHTING INSURANCE COMPANIES."
We are insurance claims attorneys and ERISA attorneys who have helped clients with insurance denials whether governed by California Law of Bad Faith or Federal Law of Employee Benefit Plans (ERISA).
“…it is entirely predictable that insurers will go overboard to minimize claims.” – Judge Letts
Accidental Death Policy Claims
Accidental death and disability policies (AD&D policies) provide benefits when an individual dies unexpectedly due to an accident. Thus the focus of an insurance company looking at an accidental death policy is the cause of death. Was the death accidental? Was the death caused by illness or suicide?
Disability Insurance & ERISA Claims
The denial of a disability claim is devastating. People who are totally disabled can’t earn money to support their family or themselves, and desperately need their disability benefits.
Life Insurance Claims
One would expect that when a loved one dies their life insurance company will pay the benefits contracted for. When they don’t it usually comes as quite a shock to the beneficiary. Be aware that a life insurance company’s initial response to an application for benefits is to investigate how to deny the claim.
What Law Applies to Your Case
California Law – Bad Faith
State law applies to all insurance contracts entered into with California residents unless preempted by ERISA. There is implied in every California insurance policy a duty of good faith and fair dealing which precludes the insurer from doing anything to deprive an insured person of the benefits and/or protection provided in the policy. Unreasonable conduct by the insurance carrier is a violation of this implied duty of good faith and fair dealing. These violations are referred to as Bad Faith Conduct.
The primary areas where Bad Faith Conduct occurs is in the failure to fully investigate and failure to objectively evaluate a claim.
When investigating a claim an insurance company has the duty to diligently search for evidence that support its insured’s claim. If it seeks to discover only the evidence that defeats the claim it holds its own interest above that of its insured and hence breaks the implied covenant of good faith and fair dealing.
Federal Law – ERISA
The Employee Retirement Income Security Act of 1974 (ERISA) governs most employee benefit plans including disability insurance, life insurance, medical insurance and pension benefits provided through one’s employer.
ERISA has specific procedural requirements that must be met prior to filing any lawsuit for benefits under the plan. The primary hurdle in filing a lawsuit is to make sure you exhaust all administrative reviews or appeals provided for in the plan.
Though these administrative reviews/appeals are oftentimes a roadblock to filing a lawsuit, they can also be a benefit to perfecting your claim. It is an opportunity to place as much documentation supporting your claim as you can into the claim file. Generally, if information is not contained in the administrative claim file it cannot be relied upon later in a suit against the plan.