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San Francisco Insurance Law Blog

New wildfires likely means new fire loss claim denials

Homeowners in wildfire country are often hit with a double tragedy. First their home is damaged or destroyed, and then in the aftermath the insurance company finds some reason to deny their property insurance claim.

Just as predictable as wildfire season, we tend to see a “fire loss denial season” months later when those property owners invoke their policies. Insurers who deny fire claims in bad faith can be held accountable for monetary damages.

Common reasons ERISA disability claims are denied

Short-term or long-term disability insurance through your employer is not the safety net you think it is. Employees who actually file ERISA disability claims are regularly turned down, often with little explanation and little recourse.

Why was your claim denied? It may have to do with the fine print of the policy or a mistake in filling out the paperwork. Whatever the reason, it is possible to appeal an adverse decision. New rules that are favorable to claimants may help to level the playing field, but you will still likely need an attorney who understands how to fight insurers of ERISA plans.

Cancer disability claims are frequently denied

Cancer is one of the most common causes of disability. But many cancer patients who invoke their long term disability insurance have their claims denied.

The stated reasons for denial vary, but typically the rationale is that the person is "not disabled enough." It is possible to fight back against a claim denial by documenting how the symptoms of the cancer and the side effects of treatment prevent a person from working.

When does insurance bad faith merit punitive damages?

If you successfully sue an insurance company for bad faith, you are entitled to monetary damages.

In addition to compensatory damages (your actual losses), you may be awarded punitive damages, which are meant to punish and deter the wrongdoing. When do punitive damages apply? How are they calculated?

Musculoskeletal disorders the most common long-term disability

The vast majority of disabilities arise from medical disorders rather than from an accident or injury.

Musculoskeletal disorders – such as back problems, arthritis and carpal tunnel syndrome -- are the biggest category of long-term disability claims. These claims are also frequently denied. Unlike cancer or a broken bone, it it not always easy to quantify or document the pain and limitations of these conditions.

Why is it important to have an attorney in LTD cases?

Long-term disability insurance provides a portion of your income as a beneficiary if you become ill or injured and cannot work. This extended period of nonworking usually is more than 90 days. To receive such benefits, you may file a timely proof of loss and disability claim that an insurance company can approve.

If your employer provides and pays for your plan, it is likely that ERISA governs it. The Employee Retirement Income Security Act of 1974 set out to establish minimum standards for employee benefits. ERISA does not cover claims if you purchased a private disability policy.

How to file a claim if your home was damaged in a fire

California is again facing a series of wildfires, with numerous large and small blazes burning throughout the state. Some Californians are being forced to evacuate their homes when fires get too close.

Being forced to flee from your home is difficult, but returning to a seriously damaged or destroyed home can be emotionally devastating. Beyond your big screen TV, you may have lost irreplaceable family heirlooms or treasured photos. The good news is that your homeowners’ insurance should cover the damage to your home and the cost of replacing its contents. Here is how you should move forward with your insurance claim if your home was damaged in a fire.

Fighting a long-term disability claim denial

Suffering from a long-term disability (LTD) means you already have enough to deal with. You do not want to add fighting with an insurance company to the list. All too often, insurance companies try to avoid paying for coverage. That could leave you vulnerable both physically and financially.

There are actions you can take to fight for LTD coverage. Most insurance policies allow for one or two levels of appeals, after their claim denial. These appeals go to different departments than your original claim, so these may prove successful. If you are on an employee plan, you have to go through the appeals process before you can take steps toward filing a lawsuit.

Seeking recovery on a bad faith insurance claim

When you purchased your home about 10 years ago it was the home of your dreams. Like so many other responsible homeowners, the first thing you did was purchase a home insurance policy. However, recently, the home of your dreams was damaged and needs to be repaired. When you call to notify your insurance carrier of the damage, they inform you they are not responsible and will not pay for the damage and that you will have to pay for the repairs. What do they mean they will not pay? What can you do about it?

Is the Insurance Company Acting in Bad Faith?

Provisions to be aware of in long term disability contracts

It is not uncommon for today’s professionals to feel a significant obligation to their clients. While this commitment is admirable and essential to their success, some professionals may carry this burden even in the midst of debilitating illnesses or chronic pain. As much as someone wants to do for their clients, what happens when they cannot work?  

One would think that in these instances, long term disability (LTD) insurance will be the stopgap that was promised when the policy was originally sold. Depending on the stage of their career, an injured professional may even rely on their (LTD) policy to usher them into retirement.

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