San Francisco Insurance Law Blog

Can you protect yourself from a faulty insurance policy?

Having an adequate insurance policy is something that can provide you with more confidence and put your mind at ease because you can secure some form of support and protection in case you are involved in certain accidents. However, if you are struggling with getting the full benefits out of your insurance policy in California because they are refusing to honor the terms of your agreement, you could be facing a difficult battle. 

Familiarizing yourself with the terms and conditions of your insurance policy is central to your ability to know under what conditions it will function. If you have holes in your coverage and are unable to find a customized plan that is adequate for your lifestyle and the unique risks you face, you may wish to look into alternative policies that can provide supplemental protection and give you the peace of mind you need. 

Can work incidents result in long-term disability?

California residents who get involved in work-related incidents can end up with injuries that result in short or long-term disability. In these cases, Pillsbury & Coleman, LLP, are here to help you deal with the insurance situation.

“Work-related incidents” is a term that covers a very large scope of possible happenings which often result in injury to you and other employees. It can cover everything from factory explosions to repetitive stress injuries received from typing too much without getting enough of a break.

Private disability or ERISA? The best policy is both policies.

By Terry Coleman

In years past, professionals who wanted a long-term disability policy would go out in the private market. These policies would protect them if they became unable to practice due to injury or illness. And if that doctor or other professional changed jobs, the coverage would follow them.

Why is my insurer demanding an independent medical exam?

One of the most common questions we get is about independent medical examinations. You are limping along (perhaps literally) on disability, and out of the blue the insurance company wants proof that you are still disabled.

This is disheartening and scary. An unfavorable exam could cancel your benefits or force you to go back to work while you are ailing. Why is the insurer asking for an IME? Are you required to go?

What is 'own occupation' and 'any occupation' disability?

There are two main categories of long-term disability insurance (LTD), based on the definition of disability. The first threshold is “own occupation,” meaning that you receive disability benefits if you are unable to perform your regular job. The other threshold is “any occupation,” meaning that you receive disability benefits only if you are unable to perform any gainful employment.

Every LTD policy is different. The fine print matters, particularly the definition of occupation and the definition of totally disabled. Insurance companies are notorious for selling these policies at significant premiums and then denying claims or terminating benefits. Make sure you read the terms of coverage carefully and talk to an attorney if you ever need to invoke the policy.

Why you should talk to a lawyer before your file an LTD claim

You purchased long-term disability insurance as a hedge against a disabling injury, medical condition or mental health issue. It’s the only way to protect your livelihood, because workers’ comp will not pay anywhere near the income you were earning as a practicing professional.

If that dreaded day comes, you will have to file a disability claim against your policy. Despite diligently paying your premiums every month, there is a high chance your claim will be denied. Your best bet may be to talk to an insurance lawyer before you submit that claim. Here’s why.

Mental health is the new battleground in disability claims

At a time when more people are dying by suicide or overdose, those seeking treatment for mental health issues and addiction face major barriers. Namely, insurance companies are deploying many tactics to deny or limit mental health coverage.

This includes professionals and others who have long-term disability insurance. Mental health claims are denied or downplayed by insurers at a greater rate than medical claims, despite federal legislation.

Important element of disability policies

Most people in California do not ever expect to become disabled. Nonetheless, there is no way to ever completely eliminate this from potentially happening. For this reason, many people do look into buying insurance policies that can provide them with some income should they unexpectedly be unable to work for extended periods of time. These are called long-term disability insurance policies and they do differ from short-term disability policies. 

As explained by Magnify Money, when a person is evaluating long-term disability insurance, they should evaluate a few key provisions to make sure they select the right one for their needs. Different policies may define "disability" in different ways. For one policy, a person may be deemed to be disabled if they cannot work in any job or in any capacity. However, another policy may identify a person as disabled only if they cannot work in the exact profession that they previously worked in.

Multi-count lawsuit alleges ERISA violations

When people in California elect to participate in their employer's retirement account program, they should be able to trust that their money and best interests will be properly taken care of. Every fund that falls under the jurisdiction of the Employee Retirement Income Security Act is supposed to be administered in a way that meets the rules of the program. Unfortunately, this does not always happen and innocent people can be at risk of losing valuable retirement savings or paying too much for their plans.

A new lawsuit has been filed in Texas that alleges a specific ERISA retirement plan was not properly managed. As reported by Plan Sponsor recently, there are four specific counts called out in the complaint. One of the counts asserts that there was a gross failure to monitor ERISA compliance among the plan's committees and the members of those committees. Another count alleges a breach of the fiduciary duty. The final two counts assert that prohibited transactions were engaged in. Some of these were with a fiduciary and some with a party-in interest.

Is long-term disability insurance worth the expense?

Like many California residents, you may have experienced an increase in your living costs over the last few years, especially in medical expenses. Even if your employer pays for a portion of your health insurance, chances are you have seen an increase in premiums recently. In many cases, this is because employers are pushing health care and insurance costs back to their employees when possible. This also means fewer employers are offering insurance benefits such as long-term disability. However, even if you do not get long-term disability insurance in your employee benefits package, it may be worth the expense to pay for it yourself.

According to a report from National Public Radio, most long-term disability insurance policies pay a portion of your income if injury or illness precludes you from working for a significant amount of time. Statistics show that about 25% of people become disabled before the standard retirement age of 67. With a long-term disability policy, you may be able to receive about half of your standard income from the policy during the time you are unable to work.

Email Our Attorneys

Our Insurance Lawyers Can Help

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

  • American Board of Trial Advocates
    American Board of Trial Advocates A prestigious national association of experienced trial lawyers and judges. Membership is by exclusive invitation only. All members shall have completed 10 civil jury trials to jury verdict or hung jury as lead counsel.
  • Best Lawyers
    Best Lawyers The oldest and most respected peer-review publication in the legal profession. A listing in Best Lawyers is widely regarded by both clients and legal professionals as a significant honor, conferred on a lawyer by his or her peers.
  • AV | PeerReviewRated | Martindale-Hubbell | For Ethical Standards and Legal Ability
    Martindale-Hubbell Peer Review Ratings An objective peer review rating indicator of a lawyer's high ethical standards and professional ability, generated from evaluations of lawyers by other members of the bar and the judiciary. Pillsbury & Coleman founding partner Philip L. Pillsbury Jr. is rated “AV Preeminent.”
  • Super Lawyers
    Super Lawyers A peer-review rating service of outstanding lawyers from more than 70 practice areas who have attained a high-degree of peer recognition and professional achievement.
  • Best Lawyers | Best Law Firms | U.S.News & World Report | 2019
    Best Lawyers Best Law Firms U.S. News 2019
  • American Association for Justice | Formerly the Association of Trial Lawyers of America (ATLA)
    American Association for Justice (AAJ) Founded in 1946, AAJ is the world’s largest trial bar and supports the work of attorneys to ensure that injured plaintiffs can obtain justice.
  • American College of Coverage Counsel
    American College of Coverage and Extracontractual Counsel Composed of preeminent insurance coverage counsel in the United States and Canada, representing the interests of both insurers and policyholders. The minimum membership requirement is the practice of insurance law for at least fifteen consecutive years.
  • Association of Business Trial Lawyers | abtl
    Association of Business Trial Lawyers Founded in 1972, ABTL is dedicated to connecting litigators and judges to address issues important to trial lawyers.
  • Consumer Attorneys of California
    Consumer Attorneys of California The only California-wide unified trial bar for plaintiffs lawyers who represent consumers harmed by powerful foes such as insurance companies, pharmaceutical companies, automobile manufacturers and banks.
  • SFTLA | San Francisco Trial Lawyers Association
    San Francisco Trial Lawyers Association For over 60 years, this prestigious bar association has educated and trained trial lawyers and supported and passed critical legislation to protect and advance individuals’ rights.
  • United Policyholders | Empowering the Insured
    United Policyholders A non-profit group dedicated to providing trustworthy and useful information and an effective voice for insurance consumers in all 50 states.
  • America's Top 100 High Stakes Litigators | 2018 | Top 100
    ACCEC | American College of Coverage and Extracontractual Counsel | Fellow