Pillsbury & Coleman, LLP
We can help you, call or email us today
415.655.1549
or toll free 866.460.7279

Over Two Decades Of Holding Insurance Companies Accountable

San Francisco Law Blog

Understanding what happens when long-term disability insurance benefits denied

Many people purchase long-term disability insurance coverage. This insurance provides them with compensation in the event that they suffer a serious injury or illness that requires them to miss extensive time from work.

There are several advantages to having a long-term disability insurance policy, including the peace of mind of knowing that you will have the ability to make ends meet while dealing with your serious condition. Unfortunately, many of the companies that provide this coverage often make it extremely difficult for people to obtain the benefits according to the terms outlined in the policy. 

Changes coming for ERISA disability claims?

New regulations will now govern the ERISA disability claims and their appeals proceedings. These regulations will take effect on all disability claims that will be filed in 2018 - starting from the very first day of January.

The new rule will affect all disability plans under ERISA. These include pension plans and all long-term and short-term plans whose benefits are hinged on whether the claimant is disabled. The following are the major changes that will govern the ERISA disability claims process. 

Know the traps of ERISA

The Employee Retirement Income Security Act (ERISA) has been a headache for many people who have been hurt on the job since it was passed by U.S. Congress in 1974. Before the law was passed, many employees would try to file long-term disability claims from companies who promised them rock solid insurance policies and benefits, only to find out the company that owed them money was bankrupt or out of business. 

Lifetime Disability Benefits

Some insurance companies offer lifetime disability benefits.  They usually come at an additional fee (or premium) and are attached to the policy as an "endorsement" or "rider" to the policy.  But not all lifetime coverage is created equal.  Some policies - usually those that were issued in the 1980's or 1990's - merely continue your benefits for life without any restrictions or limitations.  Benefits under these policies can even increase over time pursuant to a Cost of Living Adjustment (COLA) provision.  These policies offer the broadest possible coverage.  Other policies are not so generous.  Their coverage may be contingent on when you become disabled or the type of disability that you are suffering from.  For instance, some policies provide reduced benefits if you are disabled after age 60.  Others provide for reduced benefits if you are disabled as a result of a sickness rather than an injury.  The point: it pays to read your policy and know your rights.   

Three tips for your ERISA disability claim

Many workers will have their disability insurance policies governed by ERISA. ERISA is extremely complicated and there are several things that must be done in order for the claims to be approved. Frequently, these claims are denied, leaving workers in a terrible position. This posting discusses some of the things that you should do to ensure that you are taking the appropriate steps with your ERISA disability coverage claim.

Understanding ERISA disability claims

When you're a worker for a company who has offered you disability insurance, you may not be aware of ERISA, or the Employee Retirement Income Security Act. Why would a retirement act impact your disability claim? And how could it possibly cause a denial of that claim? You need to know how the insurance system works so that you can recover from an ERISA disability claim denial. 

Punitive Damages Anyone? - Nickerson v. Stonebridge

Earlier this year, the Supreme Court provided additional guidance on punitive damage awards in insurance bad faith actions.  The decision, Thomas Nickerson v. Stonebridge Life Insurance Company (June 9, 2016) 63 Cal.4th 363, held that the ratio of punitive damages must include an award of Brandt attorneys' fees in its calculation.  Nickerson involved a denial of medical benefits under an indemnity policy.  The insured was a paraplegic who broke his leg when he fell from his wheel chair.  He was hospitalized for a total of 109 days, but his insurer only paid benefits for 18 days, and denied coverage for the remainder without speaking with his doctors.  The insured filed suit.  At trial, he was awarded an additional $31,500 in benefits, $35,000 in emotional distress damages, and $19 million in punitive damages.  The parties also stipulated to an award of Brandt attorneys' fees in the amount of $12,500.  The trial court then reduced the punitive damages award from $19 million to $350,000, reflecting a single digit ratio based on the $35,000 emotional distress award only, citing State Farm Mutual Automobile Ins. Co. v. Campbell (2003) 538 U.S. 408.  The Supreme Court disagreed with the calculation.  It held that the Brandt fee award must also be taken into account when calculating punitive damages because it is an item of compensatory damage. 

Tips for Attending an Insurance Company's "Independent" Medical Examination

If you find yourself unable to work due to an injury or illness, the last thought on your mind is submitting to an insurance company's demand to be examined by a doctor you've never met.  Insurers refer to these events as "Independent Medical Examinations," although under the circumstances they are anything but independent.  The "independent" doctor is selected by the insurer, derives income directly from the insurer, and depends on the insurer for future business.

Visit Our Video Center

Email Us For A Response

Contact Us

Bold labels are required.

Contact Information
disclaimer.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

close

Privacy Policy

Phone Number

PILLSBURY & COLEMAN, LLP

600 Montgomery Street
Suite 3100
San Francisco, CA 94111

Phone: 415-655-1549
Phone: 415-433-8000
Phone: 415-655-1549
Fax: 415-433-4816
San Francisco Law Office Map

Review Us