FAQs

Monahan Tucker Law represents clients on a contingency fee basis. That means that the law firm advances all the costs for the litigation. We do not bill you by the hour, so you do not have to worry about how much your fees are adding up over the course of our representation. With a contingency fee arrangement, we do not get paid anything unless we are successful, and we are paid a percentage of what we obtain for you.

Choosing an attorney can feel overwhelming! There are many attorneys available who all say that that they are the one you should hire. First and foremost, you should hire the attorney with whom you feel most comfortable. Talking about disability, loss of a loved one, loss of a home — it can make you feel very vulnerable, and you want someone who helps you feel protected. You want an attorney who does not see you as a victim, but as someone who is reclaiming their agency by hiring an expert. You also want to ensure that your attorney is actually barred in your state and will be representing you themselves. Many “national” plaintiff firms are simply a national advertising conglomerate, who bring in clients around the country and them assign them to local firms you did not select, and instructs them to obtain a quick and inexpensive settlement. That approach benefits them, not you. You also want to confirm that your attorney is not planning to file your lawsuit in the state where they are located regardless of where you are, simply for their convenience. The court district where a lawsuit is filed can tremendously affect the results of a case. If your attorney wants to file your suit in a different state because it is where they can practice, consider it a red flag. Ultimately, you want an attorney who makes you feel secure, who is knowledgeable, who asks questions, and does not make promises they cannot keep.

If your claim for life insurance benefits is denied, contact your insurer immediately to find out why it was denied, what steps can be taken to appeal the decision and any deadlines for that appeal. You may be able to submit additional evidence or other documentation in order to prove the validity of the claim- ask your insurer what evidence they would need to see to reverse their decision. If you’re still not able to receive compensation for a valid claim, an attorney can review your case and ensure that all necessary documents are being provided. Additionally, if you believe that your insurer is acting in bad faith, legal action may be necessary to defend your rights.

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.

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.

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.

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.

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.

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.

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.