Disability Insurance Litigation

Fear. Exhaustion. Anger. Disbelief. Humiliation. Hopelessness. These are some of the reactions – often all at once – our clients have after learning that their disability insurance benefits have been denied or terminated. Our job is to give you back your feelings of safety, certainty, and calm by standing up to the insurance company when it lets you down and putting you back in charge of your life.

Realizing that you have a disability that affects your ability to work is a life-altering moment for most people. So many of us have our identities bound up in our professions – it can be wrenching to realize that you might not be able to continue on the path you had planned. This is on top of the physical pain and challenges you may be experiencing as a result of the disability.

Most people with insurance believe that, if they become disabled, at least they will not have to worry about having some income while trying to recover or learning to manage their new reality. Having your insurance company tell you that you and your doctors are wrong and that you are indeed capable of working can be devastating.

The Real Costs of a Denied Disability Claim

When disability insurance clients call us, some are furious at their insurer or their employer. Some are too sick and exhausted to fully engage in the process of fighting back. Some feel embarrassed, as if their insurer denying their claim calls into question their very real disability. But all of the clients we speak with are scared. They don’t know how they will pay their bills and support themselves or their family. With the claim denied, they may be in danger of losing their job unless they force themselves to return to work and may be terminated for the inability to perform the job as expected. Some people, such as doctors and lawyers, may have ethical obligations to stop working regardless of what the insurer says for the good of their patients and clients.

If their employment disappears, they may lose the employer-provided healthcare insurance they need to treat their disability. Ironically, one of the requirements of most disability insurers is that the insured be under the regular care of a physician, something that can be impossible for people who lose their healthcare insurance. 

At Monahan Tucker Law, we understand how all of these concerns impact your fight for disability benefits. We’ve worked with hundreds of long-term disability insurance claimants for a wide variety of conditions, and we know what it takes to file a successful claim. 

What Does A Disability Lawsuit Look Like?

If the insurance company refuses to reinstate benefits after an appeal, the next step is litigation. As explained in more depth at ERISA vs Non-ERISA Claims,  first the attorney will determine if the litigation is subject to federal law, under ERISA, or the state contract and insurance laws of the state in which the insured lives.

If the insured received the disability benefits through work, and that work was not for the government or a church-related entity, chances are good it is subject to ERISA.  That means that it will be filed in federal court, and subject to federal law.  If the insured bought an individual disability policy or worked for a government entity or a church entity, then the lawsuit will likely be subject to state law and can potentially include a claim for insurance bad faith. This allows the insured to seek punitive damages.

An ERISA lawsuit will usually resolve within a year.  There will very little, if any, discovery in most cases. The insurance company will likely seek to settle the case and could be interested in buying out the policy entirely, paying a discounted amount to include all future benefits under the policy as well.  If the case proceeds to trial, it will be a bench trial without witnesses The judge will decide whether or not the insurance company was wrong in denying or terminating benefits.  If the insurer was wrong, the judge will order it pay any back benefits owed and to reinstate benefits.

An insurance bad faith lawsuit will take longer. There will be discovery as both sides try to obtain documents and testimony.  Many continue for three years or more before they resolve.  These cases are heard by a jury and will have a trial with witnesses and evidence. The insurance company will again potentially be interested in settling the case.  Most cases, but not all, result in an eventual settlement.

What Can I Do to Protect Myself If I Am Considering Litigation?

Be aware that the insurance company is legally able to conduct surveillance of your activities.  It can monitor your social media presence.  It can dispute your claims of symptoms, especially subjective symptoms like pain and fatigue.  The best way to protect yourself and your claim if you are considering litigation is to protect yourself against their tactics.  Take down your social media accounts.  Keep in mind that if you bring litigation, the insurer will likely be sending investigators to follow you and film your activities.  Keep a daily journal of your symptoms and share it with your physician(s) to clearly document what you are experiencing each day and how it affects your ability to work.

Most importantly, find an attorney who makes you feel comfortable with the process.  Talk to several attorneys.  Gather all the information you need to make a good decision.  Remember – filing a lawsuit does not make you a victim.  It makes you someone who is taking back their agency and putting themselves back in charge.  Lawsuits are hard, but winnable.

Together, we’ve got this.