How much will all of this cost me?
How do I choose an attorney?
What can I do if my insurance company denies my life insurance claim?
What should I do if my long-term care insurance claim is denied?

Like life insurance claims above, how you respond to a long-term care claim denial will depend on why the claim was denied. You may be able to submit more evidence or other documentation in order to prove the validity of a long-term care claim. It is important to make sure that all necessary information and documents are included with your claim, such as relevant medical records. Consult with an attorney if legal action is required to get the compensation you are entitled to. Additionally, some states provide a complaints process that can help resolve disputes between policyholders and insurers.

How can I appeal a denied insurance claim for catastrophic property loss?

If your catastrophic property loss insurance claim has been denied, you should contact your insurer immediately to find out why it was denied and what steps can be taken to have the decision reversed. It may be necessary to submit additional evidence or other documentation of the damages in order to prove the validity of the claim. Obtain everything in writing. Obtain a copy of your insurance policy if you do not have a complete copy – the declarations alone are not enough, and most insurance companies do not give you the entire policy.

What is the long-term disability claims process, and how can I ensure my claim will be approved?

To make a claim for disability, you will contact your insurer and fill out their provided forms, including authorizations to obtain medical records. Your insurer will reach out to your identified medical providers and obtain records. If you have been insured for less than a year, your insurer will review your records to see if your disability is based on a pre-existing condition. If not, they will look at the symptoms of your diagnosis that interfere with your ability to perform your occupation. A medical professional employed or hired by the insurer will review your records and determine if they agree with your physician that your symptoms are disabling. If they disagree, they may deny the claim, ask for additional information, or ask you to submit to an independent exam or testing. If you decline to participate in the exam or testing or fail to provide the requested information, they can deny the claim.

If your claim was denied or initially approved and then terminated, you can appeal the decision. If you have not already done so, this is the point when you want to consult an attorney. Especially under ERISA, the appeal is your opportunity to give the insurer all the evidence to support your claim. It will also be the primary evidence before a judge or jury if the insurer does not reverse its decision. An attorney will help you identify the information that will support your claim and obtain it and will prepare your appeal package for you. There is never a guarantee of approval, but the steps above are the best way to increase your chances of having your claim approved.

How are ERISA and non-ERISA claims different?

ERISA claims are regulated by a federal law known as the Employee Retirement Income Security Act (ERISA). This law applies to all employee benefits received through most employers. It does not apply to government employers, church employers, or some employers who offer self-funded benefit plans. Under ERISA, insurance benefits disputes are very streamlined. The employer, or Plan Sponsor, and insurer have specific legal requirements under ERISA related to the documents they have to provide you and their timeframes in which to do it.

If your insurer denies your claim for benefits, you must appeal the denial before you bring suit. You have six months to appeal. If the appeal is denied, you can then bring a lawsuit. Where ERISA is a federal law, all lawsuits related to it must be in federal court. ERISA permits minimal discovery in the lawsuit. There are usually no witnesses or depositions. There is also no jury trial. The judge will decide your lawsuit based on written arguments and possibly an oral argument. Under ERISA, there is no ability to seek punitive damages. The most a judge can award is the back benefits owed to you and reinstatement of your benefits. The insurer can still terminate them again at any time if it believes you no longer meet the criteria for disability.

Non-ERISA claims are claims for benefits brought by government employees, church employees, employees of employers with self-funded plans, and people who obtained their insurance policies outside of their employment. There is no required appeal before bringing suit in non-ERISA litigation, it is governed by the laws of your state for insurance, contract, and tort law. There will be discovery and depositions. There will be a jury trial with witnesses. And depending on the laws of your state, you can seek punitive damages if you can show that your insurer acted unreasonably.

What should I do if a disability prevents me from working?

If you are experiencing a disability that prevents you from working, it’s important to document your condition and how it impacts you. Keep a daily journal of your symptoms. Establish regular medical care and keep detailed records of any treatment or diagnosis you receive. If you have long-term disability benefits, you should review your plan and begin gathering the documents needed to file a claim. An attorney can help.

What are some common tactics used by insurers to deny claims, and how can I protect myself?

Insurers are highly motivated to maximize their profits, and they may use tactics such as purposeful misinterpretation of policy language, refusal to accept the opinions of your treating physicians, failure to investigate the actual requirements of an occupation, or low settlement offers to avoid paying claims. An experienced attorney can review the policy language or settlement offer and advise you on how to protect your rights.

Is it possible to sue an insurer for bad faith practices?

When an insurance company deliberately takes actions intended to avoid paying out valid claims, they are said to be acting in “bad faith.” Insurance bad faith is a state law tort and is not available in ERISA litigation. It is available for non-ERISA litigation, including wildfire claims.

If you believe an insurer is acting in bad faith, you may be able to file suit against them. Seeking legal action may be necessary to get the compensation you are entitled to. Consider consulting an attorney to review your options and the likelihood of success.

I lost my home in a wildfire and do not have enough insurance coverage to rebuild. Do I have any options?

Over 60% of homeowners in the United States are underinsured by enough that they could not rebuild in the event of a catastrophe. Especially in California, with decades of wildfires, construction costs have increased enormously. In 2011, the California Department of Insurance passed regulations requiring your insurer, and any insurance agent or broker, to provide you with written replacement cost estimates showing the breakdown of their estimate any time they provide you with an insurance quote or opinion on the amount of coverage you may need. California courts have also held that if you asked your insurance company or agent prior to the fire if you had enough insurance to rebuild, and they assured you that you did, they can be held responsible for that statement.

The California Department of Insurance has been conducting a multi-year investigation into the handling of wildfire claims. It has determined that most insurance companies have been engaging in unfair business practices by systematically underinsuring homes. If you find yourself significantly underinsured, reach out for a free consultation. Depending on the facts of a given situation, it is quite possible that you have a basis to request a reformation of your insurance policy based on your insurer’s errors.


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We are one of the rare firms that can provide first-hand knowledge of how your insurer thinks and reacts, and has consistently prevailed in some of the most complex and high value insurance disputes seen in ERISA and non-ERISA litigation.


Our attorneys trained at some of the most aggressive large law firms in the world. Though we believe there are usually better ways to litigate and resolve disputes, our opposition does not always agree. When necessary, we are masters of unrelenting, tenacious litigation. When you hire us, you turn the insurer’s previous weapon against it.


We do this work because we want to be here, for you. We understand what you have been through, and that everyone has times where they need support. One of the strongest steps for yourself and your family is to ask us for help. Together, we’ve got this.

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