Understanding Your Rights in a Disability Insurance Denial Case
If your disability insurance claim has been denied, you're not alone. Insurance companies often deny valid claims, leaving people without the financial support they need. Whether your denial was due to missing paperwork, a dispute over medical evidence, or bad faith tactics by the insurer, we can make a difference in fighting for your rights.
Insurance companies are required to follow strict regulations when handling disability claims. If they act unfairly, delay your benefits, or deny a legitimate claim without cause, you have legal options.
Working with a skilled disability insurance lawyer can help you challenge the denial and secure the benefits you deserve. Read on to learn what you should know about your rights in a disability insurance denial case.
Common Reasons for Disability Insurance Denials
Disability insurance companies use various tactics to deny claims. Some of the most common reasons include:
Insufficient medical evidence – Insurers often argue that medical records don't support a disability claim.
Pre-existing condition exclusions – Some policies exclude coverage for pre-existing conditions.
Missed deadlines – Failing to meet strict deadlines can result in claim denials.
Lack of objective evidence – Some insurers require specific medical tests that aren't always necessary to prove a disability.
Surveillance or social media evidence – Insurance companies may use surveillance footage or social media posts to argue that you're not disabled.
Failure to follow treatment plans – If the insurer believes you aren't complying with doctor-recommended treatments, they may deny your claim.
An insurance litigation lawyer from our firm at Liggio Law can analyze your claim, identify any bad faith practices, and build a strong case for appeal.
An Introduction to ERISA and Non-ERISA Disability Claims
Disability insurance claims fall into two main categories:
ERISA claims – Most employer-sponsored disability insurance policies are governed by the Employee Retirement Income Security Act (ERISA). ERISA rules favor insurance companies, making the appeals process highly complicated. Under ERISA, you must go through the insurance company’s internal appeal process before filing a lawsuit.
Non-ERISA claims – Private disability insurance policies, often purchased individually, aren’t subject to ERISA. This gives claimants more legal options when appealing a denial.
Because ERISA claims have strict administrative appeal requirements, having an insurance lawyer who understands the process can make a significant impact on your case.
Key Steps to Take After a Disability Insurance Denial
If your disability claim has been denied, taking the right steps can strengthen your appeal:
Review the denial letter – The insurance company must provide a written explanation of why your claim was denied.
Gather strong medical evidence – Additional medical records, doctor statements, and expert opinions can support your case.
File an appeal on time – Disability insurance appeals have strict deadlines, often 180 days for ERISA claims.
Document all communications – Keep records of any interactions with the insurance company.
Consult an insurance lawyer – A skilled lawyer can review your case, strengthen your appeal, and fight against bad faith denials.
Florida Laws Protecting Disability Insurance Claimants
Florida law requires insurance companies to act in good faith when handling claims. If an insurer unfairly denies a claim, delays payments, or misrepresents policy terms, they can be held accountable under Florida’s Unfair Insurance Trade Practices Act.
According to the Florida Department of Financial Services, policyholders have the right to file complaints against insurers engaging in unfair claim practices. If your insurer is acting in bad faith, an insurance lawyer can help you file a legal claim for compensation beyond your policy benefits.
How Florida Law Differs From Other States
Florida has some unique legal protections for policyholders that differ from other states. Florida law allows policyholders to seek damages beyond the denied benefits if the insurer acted unreasonably. Additionally, Florida courts tend to interpret insurance policies in favor of policyholders when there’s ambiguity, giving claimants an advantage in disputes.
Unlike some states where disability insurance disputes are limited to contract law, Florida allows broader legal remedies, including punitive damages in extreme cases of bad faith practices. Working with a Florida-based insurance lawyer who understands these protections can be crucial in securing the justice you deserve.
Appealing a Disability Insurance Denial in West Palm Beach
Disability insurance appeals require careful preparation and attention to detail. The process generally involves:
Submitting a written appeal – This includes medical records, doctor statements, and legal arguments.
Attending an Independent Medical Examination (IME) – Insurers may require an IME by a doctor of their choosing. An insurance lawyer can protect your rights during this process.
Negotiating a settlement – In some cases, insurers may agree to pay benefits after a strong appeal is presented.
Filing a lawsuit – If the insurance company refuses to approve a valid claim, your lawyer can take them to court.
A strong legal strategy is essential to securing your rightful benefits. Contact our firm at Liggio Law for more information on critical steps to take in your claim.
Frequently Asked Questions About Disability Insurance Denials
Facing a disability insurance denial can raise many questions about your rights, the appeals process, and the next steps. It’s important to understand what options you have and how to protect your interests. Below are some of the most common questions we hear from clients dealing with denied disability claims.
How Long Do I Have To Appeal A Disability Insurance Denial?
The deadline to appeal depends on your policy. ERISA policies typically have a 180-day appeal window. Non-ERISA policies may have different deadlines, so reviewing your denial letter with an insurance lawyer is crucial.
What If My Appeal Is Denied?
If your appeal is denied, you may have the option to file a lawsuit against the insurance company. ERISA cases must go through federal court, while private policy claims may be litigated in state or federal court.
Can I Still Work While Receiving Disability Benefits?
It depends on your policy terms. Some policies allow partial disability benefits if you can work in a limited capacity. However, working full-time may disqualify you from receiving benefits.
Do I Need An Insurance Lawyer To Appeal My Denial?
While you can file an appeal on your own, having an insurance lawyer significantly increases your chances of success. Insurers have legal professionals working to deny claims—having a lawyer helps protect your rights.
Can I Sue My Insurance Company For Bad Faith?
Yes, if your insurer is acting unfairly or engaging in bad faith practices, you may be able to file a lawsuit for additional damages beyond your policy benefits.
Bad Faith Tactics Used By Insurance Companies
Insurance companies are required to handle claims fairly, but some engage in bad faith tactics to wrongfully deny or delay disability benefits. Recognizing these deceptive strategies can help claimants take action against unfair treatment.
One common bad faith practice is delaying the claims process without justification. Insurers may request excessive documentation, fail to respond to communications, or repeatedly ask for additional medical evaluations to stall payments. These delays can place financial strain on policyholders who depend on benefits.
Another tactic involves misrepresenting policy terms. Some insurers intentionally interpret policy language in their favor or provide misleading explanations about coverage limitations. If an insurance company denies a claim based on an unreasonable interpretation of the policy, they may be acting in bad faith.
Unjustified surveillance is another tool insurers use to deny claims. Insurance companies may monitor claimants in public or online to find misleading evidence suggesting they aren’t disabled. However, these investigations often take things out of context and ignore the reality of the claimant’s medical condition.
If an insurer is acting in bad faith, policyholders have legal options to challenge their practices. Holding the company accountable can’t only help secure rightful benefits but also prevent similar misconduct against others.
Contact an Insurance Lawyer in West Palm Beach Today
Serving clients throughout Florida, our law firm is dedicated to holding insurance companies accountable. If you’re in West Palm Beach or surrounding areas, contact us at Liggio Law today. Let our experienced insurance lawyer help you take the next steps in securing your financial future.